Test Catalog

Test ID: GDT    
Gadolinium, Dermal, Tissue

Useful For Suggests clinical disorders or settings where the test may be helpful

Evaluation of dermal tissue for gadolinium

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media (gadolinium-based contrast agents: GBCA) for magnetic resonance imaging and computer tomography scanning.

 

Gadolinium is primarily eliminated via the kidneys, so exposure can be prolonged in patients with renal insufficiency. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes (1.5 hours). Patients with reduced renal function and some patients with normal renal function may exhibit a prolonged gadolinium elimination half-life.

 

To date, the only known adverse health effect related to gadolinium retention is a rare condition called nephrogenic systemic fibrosis (NSF). NSF is a relatively uncommon condition in which fibrous plaques develop in the dermis and, often, in deeper connective tissues. Reported cases have occurred almost exclusively in patients with severe renal disease, and almost all have been associated with prior use of GBCAs. NSF is a painful skin disease characterized by thickening of the skin, which can involve the joints and cause significant limitation of motion within weeks to months. Over the past decade, changes in clinical practice guidelines have almost completely eliminated the incidence of NSF. However, the association of NSF and observed elevated gadolinium concentrations is still not fully understood.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

<0.5 mcg/g

Interpretation Provides information to assist in interpretation of the test results

Elevated gadolinium (>0.5 mcg/g) observed in dermal tissue specimens collected more than 96 hours after administration of gadolinium-based contrast agents indicates some gadolinium deposition. In a small internal study (n=13), patients with histologically confirmed nephrogenic systemic fibrosis (NSF) and a history of renal failure and exposure to gadolinium-based contrast agents (GBCA) had gadolinium concentrations in the range of 6.3 to 348.7 mcg/g in affected tissues. However, unaffected tissues from gadolinium-exposed subjects showed gadolinium concentrations in the range of 0.6 to 68.2 mcg/g.

 

A detectable gadolinium concentration in tissue suggests recent or past exposure to GBCA.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

This test is only useful for evaluation of dermal tissue. No other tissue types have been validated. The reference range applies only to dermal tissue in patients who were not exposed to gadolinium-based contrast agents (GBCA).

 

Tissue gadolinium concentration will be elevated if the specimen is collected less than 96 hours of administration of gadolinium-based contrast agents. This elevation is due to residual gadolinium present from contrast media infusion. Elevated gadolinium in a specimen collected less than 96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.

Supportive Data

 

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Otherson JB, Maize JC, Woolson RF, Budisavljevic MN: Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007;10:1093-1100

2. Perazella MA: Nephrogenic systemic fibrosis, kidney disease, and gadolinium: is there a link? Clin J AM Soc Nephrol 2007;2:200-202

3. Saitoh T, Hayasaka K, Tanaka Y, et al: Dialyzability of gadodiamide in hemodialysis patients. Radiat Med 2006;24:445-451

4. High WA, Ayers RA, Cowper SE: Gadolinium is quantifiable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007;56:710-712

5. High WA, Ayers RA, Chandler J, et al: Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007;56:21-26

6. Girardi M, Kay J, Elston DM, et al: Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol 2011;65:1095-1106

7. Aime S, Caravan P: Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J Magn Reson Imaging 2009;30(6):1259-1267

Special Instructions Library of PDFs including pertinent information and forms related to the test