When GBCA use in musculoskeletal imaging is and is not appropriate
Although gadolinium-based contrast agents (GBCAs) are largely considered safe and are routinely used for MRI exams, experts suggest that providers should still utilize GBCAs sparingly for musculoskeletal studies.
GBCA use has been a highly debated topic for several years. Although it's considered beneficial in several imaging scenarios, exposure to the agent is known to result in gadolinium deposits in the brains of some patients, most often those with neurologic disorders or diseases. The long-term impact of GBCA administration is not yet fully understood; as such, most experts recommend limiting GBCA exposures when possible.
The Society of Skeletal Radiology recently sought to clarify their stance on utilizing the contrast agent. They published a new white paper that discusses the appropriateness of GBCA use in musculoskeletal exams, detailing specific instances when the contrast agent would and would not provide additional clinically relevant information.
Their suggestions were published in Skeletal Radiology on June 10.
In musculoskeletal scenarios, the group suggested that contrast is recommended for:
Bone and soft tissue lesions.
Instances of chronic or complex infections.
Early detection of arthritis.
Complex post-operative cases.
They noted that contrast is not appropriate for:
Advanced arthritis.
Sports injuries.
Routine MRI neurography.
Implants and hardware.
Routine spinal imaging.
GBCA use increased during the iodinated contrast shortage that hit in the spring of 2022, when experts turned to the agent as a substitute for patients in need of contrast-enhanced imaging. Since then, the imaging community has made significant strides in improving GBCAs; a collaboration between industry competitors Bracco Diagnostics and Geurbet resulted in an injection that contains half the gadolinium dose of standard GBCA agents.
The product of that collaboration— Gadopiclenol—was approved by the U.S. Food and Drug Administration in September 2022. Gadopiclenol, which is independently commercialized by both Bracco Diagnostics (as VUEWAY) and Guerbet (as Elucirem), became available in the U.S. in early 2023.
Other efforts have focused on tapping into AI's potential to reduce GBCA doses in patients who routinely require repeated exposures.
While these developments are positive, many experts continue to recommend limiting GBCA use when clinically feasible in order to minimize potential risks, authors of the paper suggested.
“Musculoskeletal radiologists should consider the potential risks involved and practice the judicious use of intravenous contrast, restricting administration to cases where there is demonstrable added value,” corresponding author Jonathan D. Samet, MD, of the Ann and Robert H. Lurie Children’s Hospital of Chicago, and colleagues noted.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.