"The results from the current study demonstrate that GBCAs or some chemical form of gadolinium crosses the blood-cerebrospinal fluid barrier and transiently accumulates in the cerebrospinal fluid following intravenous administration of gadobutrol," said Dr. Avinash Nehra, a research fellow at the Mayo Clinic in Rochester, MN. "These findings expand upon our knowledge regarding the biodistribution of gadolinium but have also raised new concerns regarding the safety profile of GBCAs."
Nehra and colleagues analyzed 68 pediatric and adult patients who underwent MRI scans with gadobutrol (Gadavist, Bayer HealthCare) and subsequent lumbar puncture within a period of 30 days. The researchers also included 14 control subjects who had a lumbar puncture with no history of undergoing a GBCA-enhanced MRI scan. They then measured gadolinium in cerebrospinal fluid and serum samples.
Gadolinium was detected in the cerebrospinal fluid of all patients in the gadobutrol group, whereas no gadolinium was found in the control group. Pediatric patients and subjects with an intact blood-brain barrier had significantly faster clearance of gadolinium, compared with adult patients and those with a compromised blood-brain barrier.
"Elemental gadolinium is detectable in cerebrospinal fluid for up to 24 days after intravenous administration of gadobutrol," Nehra told AuntMinnie.com. "This accumulation occurred even in the absence of obvious neurologic pathology and/or renal dysfunction and suggests a likely route for intracranial deposition."
The group advocated additional research to determine the mechanism and clinical significance of gadolinium accumulation in cerebrospinal fluid.
