Is an MRI with contrast media safe? (2023)

As the guidelines illustrate, the decision to use or not to use contrast media is largely subjective and depends on the judgment and experience of the health care provider.

Types of Contrast Agents

Most contrast media used contain a rare metal called gadolinium, which interacts with the magnetic field generated by the MRI machine. Gadolinium-based contrast agents (GBCA) come in several types, distinguished by:

• Chemical composition
• magnetic properties
• How they are distributed throughout the body.
• How they are administered

Some GBCAs are organ-specific, while others have a higher molecular weight, allowing them to remain in the circulatory system and not spread to adjacent tissues. Others still can target specific cells, such as tumors.

A GBCA is not always useful. For example, gadolinium cannot easily pass through them.blood brain barrier(BBB), which protects the brain from pollutants.While useful for diagnosing diseases with an altered BBB, such asMultiple sclerosis, GBCAs are not as useful if the barrier is intact.

MRI contrast agents licensed by the US Food and Drug Administration (FDA) approved for use include:

• Dotarem (Gadoterat-Meglumin)
• Evoist (Gadoxetat-Dinatrium)
• Gadavist (Gadobutrol)
• Magnevista (Gadopentetate-Dimeglumine)
• Multihance (Gadobenato-Dimeglumina)
• Omniscan (Gadodiamida)
• OptiMARK (gadoversetamide)
• Prohance (Gadoteridol)

Before the test

An MRI is performed by an MRI (also known as a radiologist or radiology technologist) and interpreted by a radiologist.

Timed coordination

A contrast-enhanced MRI can take anywhere from 30 to 90 minutes, depending on the region of the body being examined, the agent used, and the route of GBCA administration.

Oral GBCA MRIs can take up to two and a half hours, requiring you to drink several doses and wait for the medication to enter the intestines.

Be sure to arrive 15-30 minutes before your appointment to complete the required paperwork and get settled.

Location

MRIs are performed in outpatient MRI clinics and in hospitals.

The MRI machine will be installed in a dedicated room within the facility. After you are placed in the machine, the radiology technologist operates the machine behind a glass partition. You can communicate through a two-way speaker system inside the device.

The MRI machine itself is a tubular device into which a flatbed is inserted and removed by remote control. Some smaller units only allow you to insert one arm or one leg.

Many newer models are open on the sides, which reduces the claustrophobia some people feel when scanning.

what to wear

Because MRI uses strong magnetic fields, you should not wear anything that contains metal during the procedure, including:

• zippers
• Schnallen
• metallic buttons
• underwire bras

It is best to leave jewelry at home and remove metal accessories such as piercings and hairpieces from your body.

You will be given a change of clothing if your clothing interferes with the MRI readings. Some people come with their own clothing, such as B. Drawstring pants, sweatpants, plain T-shirts, or sportswear. To avoid going barefoot, bring socks or a pair of slippers.

Dentures and hearing aids must be removed before the procedure. The medical staff will provide you with a safe place to store your belongings.

eat and drink

For GBCAs given by injection or intravenously, you can usually eat, drink, and take your medications as usual. The same is not true for oral GBCAs, which may require you to stop eating and drinking four or more hours in advance.

The radiology staff will inform you if there are any dietary or medication restrictions for your procedure.

Expense and health insurance

Contrast-enhanced MRIs can cost anywhere from $300 to $3,000, depending on the part of the body being scanned and its location.

However, many health insurance companies cover at least part of the costs.priority clearancemake sure it is medically necessary.

Coverage levels can vary by plan, so do your research.copayment or coinsuranceCosts before the procedure and confirm that the radiology unitYRadiologists are bothprovider on the web.

What Brig

Be sure to bring your photo ID and insurance card, as well as an approved form of payment for any copay/coinsurance charges. If you plan to wear small jewelry in there, you may want to bring a bag to store it in.

Other considerations

Tell the radiology staff ahead of time if you:

• a metal implant
• pacemaker
• drug infusion pump
• artificial limbs or joints
• metallic ink tattoos

Although many of these are MRI-safe, they can potentially interfere with the measurement.

Inform the staff if you are pregnant.

if you haveclaustrophobiaPlease inform the staff in time. In some cases, you may be able to take a mild sedative. If one is used, you will need to arrange for someone to drive you home after the procedure.

How an MRI with Contrast is Performed

For a contrast-enhanced MRI, you'll work with a technician certified in the administration of intravenous, oral, and intra-articular GBCAs.

Qualified technicians can also administer sedation, although a nurse may also be available to do so.

Vortest

After completing the required paperwork and signing a consent form, you will be taken to a locker room where you can change into a hospital gown (if necessary).

Before the MRI, the technician or nurse will check your weight, height, heart rate, temperature, and blood pressure. The technician will then prepare you for the scan in several ways.

Intravenous

If the GBCA is intravenous, an IV catheter will be placed in a vein (usually in the arm).

You may feel a sharp sting and a temporary chill while GBCA is being administered, but otherwise you should feel little pain. If it hurts, tell the technician.

Atranquilizersit can also be administered through a portal in the catheter if needed.

Oral

If GBCA is given orally, you will be given one or more doses of the medication to drink. Some have a berry flavor, while others have a sweet and syrupy taste.

Some people develop a metallic taste in their mouth or feel like using the bathroom after drinking the solution. That is normal. However, if you feel nauseated or have a stomach ache, tell the technician right away.

Intra-articular

If the GBCA is administered intra-articularly, the radiologist may use a topical anesthetic before giving the injection. In some cases, excess synovial fluid must be removed througharthrocentesis.

During the injection, you may feel pressure or pain around the injection site along with a temporary sensation of coldness. The injection usually takes 30 seconds to a minute.

throughout the test

After the GBCA is delivered, you will be guided to the MRI flatbed and strapped in to prevent movement.

A cage-type headrest can be used for MRIs of the head. Depending on the level of sedation used, breathing, heart rate, blood oxygen, and blood pressure may be monitored during the procedure, especially in children.

You may also be provided with noise-canceling headphones to communicate with the technician.

It is not uncommon to feel a little warm during the scan. You should also be prepared to hear a loud noise with each recording, described by some as a locomotive. However, newer machines are much quieter.

If you are unable to hold a position, have cramps, or suddenly feel nauseated, tell the technician. It's no problem to stop and rest until you're ready to continue.

Once the technician has completed the requested scans, the images are reviewed to ensure that they are all clear and in the correct position. In some cases, it may be necessary to repeat part of the scan.

post test

If a sedative was not used, you can usually get dressed and leave right away. The technician or nurse may want to check that you are not experiencing any adverse effects before allowing you to leave.

If a sedative was used, you will be taken to a recovery room and monitored until you can sit up safely. As soon as you can stand up, someone has to take you home. Ideally, this person will stay with you for 24 hours in case of an unexpected side effect.

after test

In most cases, an MRI with contrast media has no immediate or lasting effects. Still, it's important to call your doctor right away if you have unusual or severe symptoms, including:

• abnormal heartbeat
• difficulty breathing
• Severe pain, redness, swelling, or discharge at the injection site

interpret results

MRIs with contrast scans are interpreted by a radiologist who reviews findings related to previous scans and your available medical history. He will then issue a radiology report within a few days, which your doctor will discuss with you.

A typical radiology report includes a copy of each individual scan along with notes on any abnormalities noted. Typically, each image is categorized roughly as follows:

• Normal
• Not normal
• Inconclusive

Specific details are given in theimpressionsSection of the report that your health care provider can explain to you.

Based on an evaluation of the scans and a review of your medical history, the radiologist can offer a specific diagnosis or a list of possible causes all at once.differential diagnosis.

Follow up

If the findings are abnormal or potentially abnormal, you may be referred for additional imaging tests or procedures to confirm the diagnosis or determine the severity of the condition.

For example, a growth suspected of being cancerous may require aPositron emission tomography (PET)Scan that can identify malignancies based on changes in metabolism, or aBiopsy, in which a sample of tissue is taken for examination by apathologist.

If a finding is inconclusive, the MRI may be repeated or an alternate imaging modality may be used. For example, CT scans are often better for imaging bone diseases than MRIs, which are better for imaging soft tissue.

Risks and contraindications

GBCAs are generally considered safe with relatively few side effects. When side effects do occur, they are usually temporary and go away on their own without treatment. In rare cases, complications or serious side effects can occur in certain groups of people, including people with kidney problems.

The long-term cumulative effects of GBCAs are unknown. For this reason, your health care provider may limit the number of MRIs you receive with contrast media or MRIs with other imaging tests, such as x-rays or interspersed tests.Computed Tomography (CT)scans

IV Side Effects

GBCAs are most often given through an intravenous (IV) infusion into a vein. The most common side effects of GBCA infusions are:

• Cold sensation during injection.
• Headache
• nausea
• dizziness
• Tos
• To vomit
• fast heartbeat
• difficulty breathing

Although rare, some people may experience a mild allergic reaction to gadolinium. The main symptom isskin itch, and the allergy itself is rarely serious.

oral side effects

Oral GBCAs are sometimes used for MRIs of the GI tract. You swallow them in liquid form before the scan. The contrast agent typically includes a form of gadolinium (known as gadolinium-DPTA) mixed with mannitol (a type ofsugar alcoholpoorly absorbed by the intestine).

Mannitol is known to cause nausea, vomiting, and diarrhea in some people. Although gadolinium can be used on its own with few or no gastrointestinal side effects, it requires mannitol to remain stable in the acidic environment of the stomach and intestines.

Intra-articular side effects

Arthrography is an MRI technique used to visualize joints when a standard MRI does not provide enough detail.Arthrography requires an intra-articular injection of GBCA into the joint space.

The injection itself can cause localized pressure and pain. There may also be slight swelling after the procedure, which can usually be treated.ice application. Redness and bruising may also occur at the injection site.

rare side effects

In rare cases, certain GBCAs are known to cause a serious condition called nephrogenic systemic fibrosis (NSF) in people with severe kidney disease.

NSF can cause similar stretching and hardening of the skin.scleroderma, as well as the contraction of tendons and muscles that affect the movement and mobility of the joints. The function of certain organs such as the heart, lungs, diaphragm, stomach, intestines, or liver may also be affected.

NSF has no cure, and no known treatment provides consistent results. For this reason, GBCAs should be used with extreme caution in people with impaired kidney function and should be avoided in people with severe kidney function.chronic kidney disease,acute kidney injury, the enDialysis.

long term security

Debate continues about the long-term safety of GBCAs, particularly when used extensively or regularly (eg,Multiple sclerosis monitoring).

In 2015, the FDA issued a safety advisory citing studies in which long-term use of gadolinium in people with MS resulted in deposits of the material in brain tissue.

Recent research indicates that the risk of accumulation is dose dependent, i. h The longer gadolinium is used, the greater the risk.For people who have been exposed to GBCA only one or more times, the risk appears to be negligible.

What the FDA recommendation did not say is whether the deposits posed any health risks. Although some scientists have suggested that the accumulations could cause neurotoxicity (poisoning of the brain), the evidence for this is scant.

Despite the conclusions, the researchers would not go so far as to say that accumulating gadoliniumNeverCause trouble. Rather, they suggested that more research is needed before gadolinium can be considered empirically safe.

A word from Verywell

When a healthcare provider recommends an MRI with contrast, it's not unreasonable to wonder if the contrast agent is really necessary. There may be reasons why contrast is needed, but it's fair to ask if there are other options.

This is especially true if you have known kidney disease or have had multiple MRIs with contrast media. If you have doubts, do not hesitate to look for one.second opinion.