Gadolinium contrast aftercare

Gadolinium is a chemical element and a type of metal. Although many magnetic resonance imaging (MRI) examinations are performed without gadolinium, it may be given before an MRI scan if it is necessary to answer the clinical question as it provides further detail to structures in the body and can help identify any abnormality. There are several different forms of gadolinium contrast agents and the type you are given depends on your needs. In most cases this will have been given through a plastic cannula inserted into a vein in your arm.

Although contrast media are sometimes called ‘dyes’, they are usually colourless. The contrast is removed from your body when you go to the toilet, usually within 24 hours for those patients with good kidney function.

It is important that you drink plenty of fluids after your examination to flush the gadolinium out in the urine. Although there is not a set recommended amount, most sources recommend people with good kidney function should drink at least an extra litre of water in the 24 hours after your scan; this is equal to two pints or three cups of water in addition to the normal volume of water you would drink in the day, ideally in the first few hours after your scan is finished.

Risks: Although most patients do not notice any sensations when the contrast is administered, up to one in 10 patients report a cold sensation in the arm, a feeling of nausea or a headache. Less than one in every 100 patients report other side effects including:

• cough
• flushing
• nasal congestion (leading to sneezing)
• light-headedness
• hypersensitivity (typically swelling or rash)

Hypersensitivity (allergic type) reactions are uncommon, with a published rate of 1:150 to 1:25,000 treatments administered. It is more common that patients may experience a ‘vasovagal’ reaction which is a widening of the veins (vasodilation) which can result in a slowed heart rate, paleness, weakness, nausea and sweating. This can either be because of stress at the time of your scan (with a surge in adrenaline) or as a direct effect of the gadolinium. A vasovagal reaction is not an allergic reaction. Vasovagal reactions mostly occur at the same time or immediately after the MRI scan and usually settle within an hour. True allergic or hypersensitivity reactions can either be immediate (within one to four hours of administration): including itching, swelling, bronchospasm, gastrointestinal symptoms, or delayed (up to six hours from administration): including skin reactions, rash or swelling, tend to be more delayed, appearing within one to six hours after drug administration.

Anaphylactic shock has been reported following gadolinium administration though only in case reports and it is considered a rare side effect. Early signs include:

• a raised red rash
• swelling of eyes, lips, hands and/or feet
• feeling faint
• wheeze or shortness of breath
• abdominal or chest pain

In the event of experiencing a severe reaction you will need to go to a hospital emergency department, or if mild problems persist contact your general practitioner (GP).

Special patient groups: Although MRI with gadolinium is not usually recommended for patients with severe kidney problems or patients who have recently had, or are waiting for a liver transplant, if gadolinium has been given, you should not have another gadolinium scan for at least seven days.

Breastfeeding: Small amounts of gadolinium are excreted into breast milk. This should have no effect on an infant at doses used clinically, as very little is excreted in milk and gadolinium is very poorly absorbed from the gastrointestinal tract. Continuing or pausing breast feeding for a period of 24 hours is at the discretion of the treating doctor and the lactating mother.

Fertility: Animal studies do not indicate impairment of fertility.

Other possible side effects include extravasation. This occurs sometimes when contrast is injected and leaks into the tissues surrounding the vein. The area around the injection site may feel sore and swollen. In the event of this happening you will be monitored by the MR team and have a cold compress applied to the affected area. The swelling should clear within 24 hours.

If you continue to have any pain, discomfort or swelling around the injection site up to one week following the scan, you should have the site checked by your GP.

Aftercare: You can eat and drink normally after the procedure.

If you have any queries please call the MRI department on 01223 216667 and ask to speak with a senior radiographer.