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Gadolinium can be used for cardiovascular MRI

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Gadolinium may be a useful tool to incorporate during a cardiovascular MRI, according to a recent presentation.

Sangeeta B. Shah, MD, director of cardiovascular MRI at Ochsner Medical Center in New Orleans, explained some of the potential benefits of cardiovascular MRI at the 17th Annual Peripheral Angioplasty and All That Jazz meeting in New Orleans.

“Cardiac MRI is fabulous, because it is able to do many things, like assess cardiac anatomy, congenital heart disease, stress testing, shunt calculation, tissue characterization, valvular function and cardiac function,” Shah said. “It offers a tremendous amount of information, good resolution, quantification of pathology, ability to measure serially, and there are no acoustic window limitations or ionization radiation.”

The addition of gadolinium as a contrast agent for cardiac MRI has not been approved by the FDA, although gadolinium has been approved for use in other MRI studies.

“Gadolinium remember, is not needed for all cardiac MRIs, because blood is a natural contrast agent,” Shah said. “It is needed however, when you are going to do an adenosine stress test, an angiogram or when you want to assess viability.”

Shah said that cardiovascular MRI using gadolinium was associated with adverse events in a small number of patients. The primary problem encountered by the use of gadolinium was the occurrence of nephrogenic fibrosing dermopathy.

“Remember that there are less than 400 cases of this worldwide, with more than 20 million gadolinium MRIs performed, so the risk is very small,” Shah said. “The problem is that the condition is not curable.” – by Eric Raible

For more information:

• Shah SB. The role of magnetic resonance imaging in evaluating structural heart disease. Structural Heart Disease and Stroke Symposium, part II. Presented at: 17th Annual Peripheral Angioplasty and All That Jazz; May 4-6, 2008; New Orleans.

We find use of gadolinium essential or highly desirable in most patients referred to us for cardiac MRI, largely because of what Dr. Shah referred to as the “viability” issue. The same technique not only distinguishes heart attack scar from viable heart muscle that will benefit from revascularization, but can detect inflammation due to infection and fibrosis due to many different conditions. The issue of nephrogenic sclerosing fibrosis due to gadolinium is relevant only in patients with severe kidney dysfunction. A recent presentation from Mayo Clinic pointed out that even in that group, the frequency is less than 2% of patients and that 98% of those occurred in patients on dialysis or in a range of renal glomerular filtration rate that usually requires dialysis, and none had glomerular filtration rate >30 mL/1.56 m2/min - the usual cutoff for severe renal dysfunction.

– Nathaniel Reichek, MD
Cardiology Today Editorial Board member