10 ms·

Study: MRI contrast agent causes harmful metal buildup in some patients

255 points by nikolay 1y ago

https://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1664840/abstract https://www.frontiersin.org/journals/toxicology/articles/10....

hereme888 1y ago
You know what other metal stays in the body, permanently bound to bone and other organs? Bismuth, as in bismuth salycilate, aka Peptobismol. A tiny % actually stays in your body.
- ToDougie 1y ago
  Can you please share more?
  - hereme888 1y ago
    From OpenEvidence.com: "After ingestion, bismuth is primarily found in trace amounts within organs such as the kidney, liver, spleen, and, in rare cases, the brain, where it accumulates intracellularly—especially in lysosomes and nuclear membranes—and extracellularly in basement membranes of blood vessels.[1-4] In normal therapeutic use, the amount of tissue-bound bismuth is extremely low and is not associated with adverse effects. Potential consequences of tissue-bound bismuth are generally negligible at standard doses, but chronic or excessive exposure can lead to toxicity, most notably neurotoxicity (bismuth encephalopathy).[1][4-6] In cases of bismuth intoxication, histochemical studies have shown accumulation in neurons and glial cells, particularly in the cerebellum, thalamus, and hippocampus, with clinical manifestations including confusion, myoclonus, and encephalopathy.[1][4-6] However, these effects are reversible upon discontinuation of bismuth exposure, and recovery is typically complete within weeks.[5-6] Animal studies confirm that bismuth binds to proteins such as ferritin and metallothionein, and is retained in lysosomes, nuclear membranes, and myelin-associated proteins.[2][4][7] The kidney is the primary site of accumulation and excretion, and tissue levels decline after cessation of exposure, with little evidence of permanent retention at therapeutic doses.[2-3] In summary, permanent tissue binding of bismuth is minimal and clinically insignificant with standard use, but chronic high-dose exposure can result in neurotoxicity and other organ effects, which are reversible after stopping bismuth.[5-6][8-9]" 1. Autometallographic Tracing of Bismuth in Human Brain Autopsies. Stoltenberg M, Hogenhuis JA, Hauw JJ, Danscher G. Journal of Neuropathology and Experimental Neurology. 2001;60(7):705-10. doi:10.1093/jnen/60.7.705. 2. Metallobiochemistry of Ultratrace Levels of Bismuth in the Rat II. Interaction of Bi With Tissue, Intracellular and Molecular Components. Sabbioni E, Groppi F, Di Gioacchino M, Petrarca C, Manenti S. Journal of Trace Elements in Medicine and Biology : Organ of the Society for Minerals and Trace Elements (GMS). 2021;68:126752. doi:10.1016/j.jtemb.2021.126752. 3. Distribution of Bismuth in the Rat After Oral Dosing With Ranitidine Bismuth Citrate and Bismuth Subcitrate. Canena J, Reis J, Pinto AS, et al. The Journal of Pharmacy and Pharmacology. 1998;50(3):279-83. doi:10.1111/j.2042-7158.1998.tb06861.x. 4. In Vivo Distribution of Bismuth in the Mouse Brain: Influence of Long-Term Survival and Intracranial Placement on the Uptake and Transport of Bismuth in Neuronal Tissue. Larsen A, Stoltenberg M, Søndergaard C, Bruhn M, Danscher G. Basic & Clinical Pharmacology & Toxicology. 2005;97(3):188-96. doi:10.1111/j.1742-7843.2005.pto_973132.x. 5. Bismuth Encephalopathy- A Rare Complication of Long-Standing Use of Bismuth Subsalicylate. Borbinha C, Serrazina F, Salavisa M, Viana-Baptista M. BMC Neurology. 2019;19(1):212. doi:10.1186/s12883-019-1437-9. 6. Bismuth Subgallate Toxicity in the Age of Online Supplement Use. Sampognaro P, Vo KT, Richie M, Blanc PD, Keenan K. The Neurologist. 2017;22(6):237-240. doi:10.1097/NRL.0000000000000144. 7. Bismuth Tracing in Organotypic Cultures of Rat Hippocampus. Locht LJ, Munkøe L, Stoltenberg M. Journal of Neuroscience Methods. 2002;115(1):77-83. doi:10.1016/s0165-0270(02)00004-3. 8. Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use?. Gonçalves Â, Matias M, Salvador JAR, Silvestre S. International Journal of Molecular Sciences. 2024;25(3):1600. doi:10.3390/ijms25031600. 9. Review Article: Safety of Bismuth in the Treatment of Gastrointestinal Diseases. Tillman LA, Drake FM, Dixon JS, Wood JR. Alimentary Pharmacology & Therapeutics. 1996;10(4):459-67. doi:10.1046/j.1365-2036.1996.22163000.x.
- DennisP 1y ago
  Does that cause any symptoms? Because apparently this can, and they tell you how to avoid it. > Lead author Dr Brent Wagner told Newsweek he personally avoids vitamin C when undergoing MRI with contrast, citing its potential to increase gadolinium reactivity. “Metabolic milieu,” including high oxalic acid levels, could explain why some individuals experience severe symptoms while others do not, he said. Avoiding high-oxalic foods for a few days before the MRI also seems like a good idea. Just check the diet for calcium oxalate kidney stones.
  - Hemospectrum 1y ago
    > Does that cause any symptoms? Tinnitus.
    - hereme888 1y ago
      Actually, that's the salicylate portion causing tinnitus, not the bismuth.
gclawes 1y ago
Every time I've gotten an MRI the doctors and techs have sworn up and down it's impossible for this stuff to stick around. Getting tired of not being able to believe what doctors say...
- bamboozled 1y ago
  The other day I had to get a CT scan, I was kind of annoyed I wasn't offered and MRI, and here we are. I hold a different opinion to you though, I'm glad doctors are always learning more while generally operating with good /extremely good intentions.
  - byryan 1y ago
    Really wish more people had that mind set. Practicing medicine isn't easy, especially in the US when you have to battle the insane insurance industry.
    - deleted 1y ago
      [deleted]
  - margalabargala 1y ago
    > I hold a different opinion to you though, I'm glad doctors are always learning more while generally operating with good /extremely good intentions. I agree. Expecting perfection from humans, even experts, is not reasonable and is frankly counterproductive. Willful ignorance is one thing, but people who genuinely attempt to do the right thing at worst just need to be steered slightly differently.
    - bdzr 1y ago
      > I agree. Expecting perfection from humans, even experts, is not reasonable and is frankly counterproductive. There's a big difference between perfection and "Statistical Literacy Among Doctors Now Lower Than Chance"[1]. I don't think their intentions are bad, but they are woefully incompetent at many basic things. [1] https://slatestarcodex.com/2013/12/17/statistical-literacy-among-doctors-now-lower-than-chance/ https://slatestarcodex.com/2013/12/17/statistical-literacy-a...
shakna 1y ago
Or to not click through multiple layers of clickbait: https://doi.org/10.1016/j.mri.2025.110383 https://doi.org/10.1016/j.mri.2025.110383 Unfortunately, the article isn't much better. It has as an underpinning, a corrected paper: https://doi.org/10.1093/ndt/gfl294 https://doi.org/10.1093/ndt/gfl294
- cowsandmilk 1y ago
  1. The correction doesn’t invalidate that previous study at all 2. I fail to see how the previous study is an “underpinning” of the new paper. The new paper is a chemistry paper about dissociation of GBCAs in the presence of certain chemicals. Maybe people care because it is a potential explanation for toxicity, but the paper is very focused on the chemistry findings.
  - shakna 1y ago
    It is underpinning, as it is the most frequently cited in the entire paper. It is underpinning, as the claims in both introduction and conclusion are precipitate to it. The correction: > After personal communication with the radiologists the administered Gd-contained contrast agent was documented in the MR examination reports of the mentioned nine patients incompletely and inexactly as Gd–DTPA by themselves. There is solely one MR contrast agent used in the described observation period: Gd–DTPA–BMA. Therefore, all mentioned nine patients received Gd–DTPA–BMA and not Gd–DTPA. Means that Gd-DTPA is irrelevant. Guess which is analysed here?
    - bonsai_spool 1y ago
      Neither - the OP paper talks about Gd-DOTA. I’m not a specialist so I can’t comment on how significant that is. We generally don’t use the compounds that cause NSF, which is one reason why the 2006 paper link you provided may not reflect the agents under current study.
anon291 1y ago
The link between NSF and gadolinium-based agents has been known for almost two decades and is common knowledge in the industry.
- Neywiny 1y ago
  Yes. The problem is that it's common in the industry. But it's ultimately up to the patient. Maybe alone. Pretty much guaranteed scared. Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress.
  - bawolff 1y ago
    What are you proposing instead? Should patients just die of their illness instead? Medical procedures have risk, some are small risk some are higher risk. There are none that are 100% safe. Doctors are supposed to evaluate if the risk is worth the value the procedure would supply. What is the alternative to the status quo that you would propose?
    - Neywiny 1y ago
      There's a big difference between not getting the MRI and getting the MRI without gadolinium. My suggestion is to ensure that people know the risks outside of just the people who work in it. I'm not sure how that didn't get across in my original comment. With your comprehension skills, you are at an increased risk of falling victim to this exact scenario
      - bonsai_spool 1y ago
        >>> Yes. The problem is that it's common in the industry. But it's ultimately up to the patient. Maybe alone. Pretty much guaranteed scared. Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress. > There's a big difference between not getting the MRI and getting the MRI without gadolinium. My suggestion is to ensure that people know the risks outside of just the people who work in it. I'm not sure how that didn't get across in my original comment. With your comprehension skills, you are at an increased risk of falling victim to this exact scenario I don't see anything wrong with the GP's comprehension skills. Anyway, every procedure has risk - and no procedure is recommended if there is not an offsetting clinical benefit. There are clear guidelines for when gadolinium is to be used for an MRI and the guidelines factor in risk for 'NSF'.
Neywiny 1y ago
This is very interesting to see on here. My mother was the dissenting vote on an FDA panel on this. There are articles about it. I'll copy her words (as reported by something but seems legit) > She said that the FDA's plan doesn't go far enough. > "It's hard to dismiss an anecdotal report when you are the anecdote. When a patient is finally tested and found to have gadolinium retention, there's no FDA-approved antidote. So what does the patient do?" And I want to reiterate that she was "the" no not "a" no. I don't know if her vote alone is what's caused more research into this. But it's probably the thing I brag about her the most. Even though everybody else said it was fine or abstained, she stood strong. If you look up the articles from the time of the panel (2017) you'll see a lot of articles about this panel and how she was the sole no vote. Included in that was a public post from Chuck Norris praising her. He was going to come out to meet us but I think it was a bad Texas hurricane season so that fell through
- fluidcruft 1y ago
  I mean there have been no reported cases of NSF in the last ten years after certain gadolinium agents were removed from the market.
- AmbroseBierce 1y ago
  In case anyone is wondering what Chuck Norris has to do with all this: > Chuck and Gena Norris filed a lawsuit against several medical companies in 2017, alleging that a gadolinium-based contrast agent used in Gena Norris's MRIs caused her to develop a condition called gadolinium deposition disease and resulted in debilitating symptoms like cognitive issues, pain, and muscle wasting. In January 2020, the Norrises, along with their attorneys, voluntarily dismissed the lawsuit with prejudice, meaning it cannot be refiled. The dismissal was made without a settlement payment, and each party paid their own legal costs. It might give a glimpse into his worldview to mention that during the COVID pandemic Mr Norris shared an article on social media that claimed that the COVID vaccinations killed millions of people. [0] [0] https://m.facebook.com/story.php?story_fbid=870953857718632&id=100044120782094 https://m.facebook.com/story.php?story_fbid=870953857718632&...
  - 1y ago
unsupp0rted 1y ago
Nobody told me gadolinium can be retained before I had it the first couple times. Like somebody else mentioned, they swore up and down it's perfectly safe.
- bonsai_spool 1y ago
  > Nobody told me gadolinium can be retained before I had it the first couple times. The reason these publications exist is that this is new knowledge > Like somebody else mentioned, they swore up and down it's perfectly safe. I am positive that you were not told that '[gadolinium] is perfectly safe' because there is a well-known complication of gadolinium administration. It's rare, but it's mentioned in every consent form.
  - mystraline 1y ago
    > I am positive that you were not told that '[gadolinium] is perfectly safe' because there is a well-known complication of gadolinium administration. It's rare, but it's mentioned in every consent form. Consent is not "Sign this cause its the only course of treatment". And thats what happens almost every time. And yes, I too have gadolinium retention in my joint. 3 MRIs. And no, was not told this was a complication... But I'm sure the papers I signed included weasel words to that effect.
    - bonsai_spool 1y ago
      > And yes, I too have gadolinium retention in my joint. 3 MRIs. And no, was not told this was a complication... But I'm sure the papers I signed included weasel words to that effect. The presence of the gadolinium is not a complication. At best, it is an unintended side effect whose clinical significance is not known. A complication is an unexpected/non-routine, negative outcome. We now have learned that the deposition is something to expect. There is no new information around clinical changes that one can attribute to gadolinium.
      - mystraline 1y ago
bonsai_spool 1y ago
This is a poor explanation of an older publication, when the actual new work has a good description: https://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1664840/abstract https://www.frontiersin.org/journals/toxicology/articles/10....
- dang 1y ago
  Thanks - I've put that link in the toptext above. I'm not sure it makes sense to swap out the submitted URL with it. Hopefully people will take a look at both.
cjensen 1y ago
As someone with CKD and scheduled for an MRI, this was anxiety-inducing. The Cleveland Clinic has a good overview[1]. Since there have been no reports of NSF in 15 years, I don't think it's rational to avoid MRIs based on gadolinium retention concerns. [1] https://www.ormanager.com/briefs/study-mri-contrast-agent-causes-harmful-metal-buildup-in-some-patients/ https://www.ormanager.com/briefs/study-mri-contrast-agent-ca...
- SupaShotty 1y ago
  That’s just the OP url again, I think you miscopied.
  - cjensen 1y ago
    Yep. https://my.clevelandclinic.org/health/diseases/17783-nephrogenic-systemic-fibrosis-nsf https://my.clevelandclinic.org/health/diseases/17783-nephrog...
- RossBencina 1y ago
  [1] https://my.clevelandclinic.org/health/diseases/17783-nephrogenic-systemic-fibrosis-nsf https://my.clevelandclinic.org/health/diseases/17783-nephrog...
  - deleted 1y ago
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deleted 1y ago
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kazishariar 1y ago
EDTA DMSO DMSA Vitamin C
kazishariar 1y ago
EDTA
justinc8687 1y ago
I think the thing to remember with this, as with any kind of medical procedure, is the benefits versus the risks. In many cases, if you're getting this kind of MRI contrast, there's probably a good reason for it. So even if there's some risk, it might be better than say, the cancer or something else they're looking for. I feel like this is something that's often forgot in these discussions.
RagnarD 1y ago
This isn’t newly known, but it’s convenient to stay with the comfortably familiar until the better alternative is forced.
keane 1y ago
There's a subreddit, created August 2024, discussing this: https://www.reddit.com/r/GadoliniumToxicity/ https://www.reddit.com/r/GadoliniumToxicity/
lynx97 1y ago
Great. Only this year, I got roughly 6 doses of gadlinium, and prior to that, I got one every year, going back 20 years. I just recently chatted with a MRI nurse about the fact that I have a bad feeling about getting that stuff so frequently over time, and she dismissed my concerns. They used to remind patients to drink more after the MRI, but even that routine has been ended roughly 5 years ago. Is there anything else I can do except drink more on the day of the injection?
- lostlogin 1y ago
  Some contrasts are more stable than others - however I’d be surprised if anyone was using linear agents anymore. Macrocyclic contrast agents bind the gad more tightly.
kyykky 1y ago
My kid went to brain MRI because of migraines (standard procedure here for kids to check if there is e.g. a tumor causing the headache). I was pretty nervous due to this kind of research and the preparatory material saying that they might need to use a contrast agent. In the end they didn’t use a contrast agent and I stressed unnecessarily.
- fluidcruft 1y ago
  Just as a heads up from a rando on the internet this sort of research is trying to understand mechanisms of things that happened 20-30 years ago and people who were exposed back then (sometimes many times with significant accumulation). Gadolinium is toxic so contrasts trap it with protective molecules that hold the gadolinium until it leaves the body (most leave via the kidneys, but some also leave via liver/gallbladder). Some fraction of gadolinium escapes depending on the structure of the protective molecules. After the problems with the older contrasts were found kidney function became important (impaired kidney function allows more time for gadolinium to escape) and later new contrasts were designed that are much more stable. The gadolinium contrasts we use today are much more stable than the ones we used previously and there haven't been any cases of the sorts of things this article is about in over ten years. But there are a lot of people alive who received the old agents many times and in higher doses than we use today. I don't want to diminish the concerns (and frankly I think this is important to understand what happens to gadolinium in the body), but the exposure and accumulation are significantly lower today than they have been in the past because reducing exposure has become a major focus of design safety for gadolinium contrast and the worst offenders have been voluntarily withdrawn from the market. Anyway if my kid needed contrast for accurate diagnosis, I'd do it. I work at a pediatric hospital and generally the way it works is if contrast might be needed its ordered and consented so that it's an option. During the scan radiologists check the images and decide whether contrast is needed to answer the clinical question (although in general that's more a question of time management if the question has already been answered, there's no reason to keep imaging).
  - nness 1y ago
    Appreciate this comment, thank you. (It's hard to gauge the recency of these concerns, the materials being used, or the prevalence of NSF -- and it can all get a bit overwhelming.)
uecker 1y ago
Note that MRI with contrast has very low risk and I am not aware of any evidence that Gadolinium retention even has adverse health effects. It is a concern though and this is why it is being studied. But I do not think the use of MRI contrast agents is something anybody without kidney disease should be concerned about. In general, risks and benefits must be balanced for any medical procedure. Such risks are continuously monitored and studied and guidelines are formulated based on this. Also consider that there is very clear harm from people being scared away by misinformation from medical procedures they would benefit from.
- bobmcnamara 1y ago
  >I am not aware of any evidence that Gadolinium retention even has adverse health effects I found this related article: https://www.research.va.gov/currents/1024-Metal-in-MRI-contrast-agents-may-cause-serious-health-problems.cfm https://www.research.va.gov/currents/1024-Metal-in-MRI-contr...
  - uecker 1y ago
    I am working in this field, so I am aware of nephrogenic systemic fibrosis as rare condition caused by Gadolinium contrast agents in people with kidney disease. As far as I know, there was no new case in the last 10-15 years after the took certain less-stable contrast agents from the market and assessing kidney function is also standard now. In the aftermath of this, scientists discovered that Gadolinium is retained in the body after MRI scans to a small amount. As far as I know there is no evidence that this causes any harm, but as I said, this is a concern and this is why it studied.
janpmz 1y ago
Sometimes I wonder if metals in the body can pick up cellphone signals.
refurb 1y ago
There are risks with every procedure and medication. A dose of ibuprofen could give you Stevens–Johnson syndrome or TENS and you end up in a burn war for months. Patients should be made aware of all the risks for any treatment, but it would be impossible to avoid they edge cases even with relatively basic medical care.
- MrWB 1y ago
  Most people lack the medical literacy to understand any of this. People don’t read their letters telling them to not eat before surgery, are they going to read the list of potential side effects of a medication? How many people read the information sheets that come with their prescription medication?
  - bobmcnamara 1y ago
    When my wife worked check-in for a surgeon, she used the line, "Good morning ${PATIENT_NAME}! What did you have for breakfast today?" as a shibboleth for sending patients home to reschedule.
hartator 1y ago
What about CT-SCAN contrast?
- fluidcruft 1y ago
  CT contrast typically uses iodine (which absorbs x-rays well).
AdamSanders1988 1y ago
Gadolinium has killed many many people. Many healthy people like me became chronically ill due to Gadolinium based contrast agent. We all had healthy bodies no history of kidney issues. One dosage of gadolinium contrast and the body couldn’t handle the toxic element which is a heavy metal for the body. The body is not designed to remove this on its own. It destroys the tissue it contacts with. FDA has to pull this poison out.
tsoukase 1y ago
It seems only patients with advanced renal disease are effected. So, my suggestion, no Gad in patients with increased Creatine (even Stage I renal disease).
- lostlogin 1y ago
  That’s what is done clinically - though only with severely reduced function. Giving it with an egfr below 25 or 30 is generally avoided. However it is still done when life or limb are at risk.
jhallenworld 1y ago
My son had an MRI with gadolinium- turns out he is allergic to it, he developed a full-body itchy rash. There were like 20 interns in to see him, for the experience I guess. They were ready to send him to the ER in case it interfered with his breathing, luckily it didn't.
- lostlogin 1y ago
  That would have been frightening. Did it require treatment beyond antihistamine? I’ve given MR contrast to patients a lot of times (probably tens of thousands) and have seen hives and rashes a handful of times but vastly more often with iodinated contrast in X-ray procedures (usually CT).
- Madmallard 1y ago
  This happened to me with iodinated CT contrast Every square inch of my body was hives for 2 weeks My kidney function was abnormal for 2 weeks as well and later I was like urinating out goop
olieidel 1y ago
Interesting to see this on HN. I was part of the research group which published this back in 2015 [1], I think we were the second group worldwide to publish this. So, first off, this is not new. The linked publication here mainly seems to be explaining a potential mechanism of how it might happen. Some quick notes to aid in a constructive discussion - bear with me, it's been a while and I've left research and since worked as a software developer, chuckle: - Different gadolinium agents have vastly different "buildup" characteristics - some are better, some are worse. Biochemically, the ones where the gadolinium was trapped in harder "complexes", those were more stable (less accumulation). I suck at biochemistry, so all of those words may be wrong. - If you'd want to over-engineer this, you could indeed select your MRI hospital / practice based on which gadolinium agent they use. - Unless you're getting a ton of MRIs (think multiple sclerosis monitoring etc.), you probably won't be affected. - Most MRIs are without contrast agent anyway, so you probably won't be affected. - The last I heard was that the clinical implications were still being investigated - like, yeah, you do see a buildup of gadolinium in patients who 1) get certain gadolinium agents and 2) have a ton of MRIs, but what does that mean they'll suffer any clinical consequences from this? Not sure. I heard that there was a paper (.. somewhere) which at least showed a correlation with worse MS outcomes of people who had a high buildup, but then again, cause-effect here is not clear as people with worse MS tend to have more MRIs, too (correlation != causation). [1] https://pubs.rsna.org/doi/full/10.1148/radiol.2015150337 https://pubs.rsna.org/doi/full/10.1148/radiol.2015150337
jcalvinowens 1y ago
I had an MRI with contrast once. I remember the gadolinium injection made me extremely nauseous for a few minutes, but otherwise it has had zero effect on me personally. Some sad advice: don't ask doctors about this, my experience is that it will cause them to write you off as a crazy person no matter how you bring it up. Many of them lump this in with what they see as "influencer illnesses", whether fairly or not. And maybe more practically, if you really need an MRI, whatever you might have is much more likely to hurt you.
- radu_floricica 1y ago
  Yeah, happened to me too. Brief but intense. Strangely, only the first time. When I got out I told the technician (I though I had a panic attack, and was puzzled that it happened at the end of the session), and she said "oh, it was probably the contrast, happens rarely". Apparently rarely enough that they don't warn the patients. To be fair it was harmless, and they'd have many more cases of nocebo nausea than actual nausea.
01100011 1y ago
I recently had an MRI with contrast and didn't read up on it until I got home from the MRI. Apparently they used the linear molecule with the higher tendency to disassociate and deposit Gd. Great. The most annoying thing though was the vague instruction to "drink plenty of water" given by the MRI tech on the way out. No, you do not drink "plenty of water". You drink something like 1L above your normal fluid intake in the first hour(?) after the procedure. You should also go in well-hydrated. I swear the quality of medical care in the US just keeps going down, and I'm in a "quality" health system in a rich coastal city.
Madmallard 1y ago
I thought the point was that the double bonded agents stick together and are just excreted and the bonds don't easily get broken at all. I thought the problem was with older agents there were single bonds that could be broken in the chain and that's what can cause the build-up. But I was under the impression those were phased out over a decade ago. So is this saying even the strong double-bonded ones are somehow building up in some way we don't understand? It's also been known forever that these agents are riskier in patients with kidney failure, and that's directly factored into the algorithms doctors use and has been forever. So.... what's the point of this? Is it rage-bait?
victor22 1y ago
If it was healthy hospitals and doctors would call it what it is instead of just saying "its contrast"

255 points by nikolay 1y ago

https://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1664840/abstract https://www.frontiersin.org/journals/toxicology/articles/10....

hereme888 1y ago

You know what other metal stays in the body, permanently bound to bone and other organs? Bismuth, as in bismuth salycilate, aka Peptobismol. A tiny % actually stays in your body.

ToDougie 1y ago
Can you please share more?
- hereme888 1y ago
  From OpenEvidence.com: "After ingestion, bismuth is primarily found in trace amounts within organs such as the kidney, liver, spleen, and, in rare cases, the brain, where it accumulates intracellularly—especially in lysosomes and nuclear membranes—and extracellularly in basement membranes of blood vessels.[1-4] In normal therapeutic use, the amount of tissue-bound bismuth is extremely low and is not associated with adverse effects. Potential consequences of tissue-bound bismuth are generally negligible at standard doses, but chronic or excessive exposure can lead to toxicity, most notably neurotoxicity (bismuth encephalopathy).[1][4-6] In cases of bismuth intoxication, histochemical studies have shown accumulation in neurons and glial cells, particularly in the cerebellum, thalamus, and hippocampus, with clinical manifestations including confusion, myoclonus, and encephalopathy.[1][4-6] However, these effects are reversible upon discontinuation of bismuth exposure, and recovery is typically complete within weeks.[5-6] Animal studies confirm that bismuth binds to proteins such as ferritin and metallothionein, and is retained in lysosomes, nuclear membranes, and myelin-associated proteins.[2][4][7] The kidney is the primary site of accumulation and excretion, and tissue levels decline after cessation of exposure, with little evidence of permanent retention at therapeutic doses.[2-3] In summary, permanent tissue binding of bismuth is minimal and clinically insignificant with standard use, but chronic high-dose exposure can result in neurotoxicity and other organ effects, which are reversible after stopping bismuth.[5-6][8-9]" 1. Autometallographic Tracing of Bismuth in Human Brain Autopsies. Stoltenberg M, Hogenhuis JA, Hauw JJ, Danscher G. Journal of Neuropathology and Experimental Neurology. 2001;60(7):705-10. doi:10.1093/jnen/60.7.705. 2. Metallobiochemistry of Ultratrace Levels of Bismuth in the Rat II. Interaction of Bi With Tissue, Intracellular and Molecular Components. Sabbioni E, Groppi F, Di Gioacchino M, Petrarca C, Manenti S. Journal of Trace Elements in Medicine and Biology : Organ of the Society for Minerals and Trace Elements (GMS). 2021;68:126752. doi:10.1016/j.jtemb.2021.126752. 3. Distribution of Bismuth in the Rat After Oral Dosing With Ranitidine Bismuth Citrate and Bismuth Subcitrate. Canena J, Reis J, Pinto AS, et al. The Journal of Pharmacy and Pharmacology. 1998;50(3):279-83. doi:10.1111/j.2042-7158.1998.tb06861.x. 4. In Vivo Distribution of Bismuth in the Mouse Brain: Influence of Long-Term Survival and Intracranial Placement on the Uptake and Transport of Bismuth in Neuronal Tissue. Larsen A, Stoltenberg M, Søndergaard C, Bruhn M, Danscher G. Basic & Clinical Pharmacology & Toxicology. 2005;97(3):188-96. doi:10.1111/j.1742-7843.2005.pto_973132.x. 5. Bismuth Encephalopathy- A Rare Complication of Long-Standing Use of Bismuth Subsalicylate. Borbinha C, Serrazina F, Salavisa M, Viana-Baptista M. BMC Neurology. 2019;19(1):212. doi:10.1186/s12883-019-1437-9. 6. Bismuth Subgallate Toxicity in the Age of Online Supplement Use. Sampognaro P, Vo KT, Richie M, Blanc PD, Keenan K. The Neurologist. 2017;22(6):237-240. doi:10.1097/NRL.0000000000000144. 7. Bismuth Tracing in Organotypic Cultures of Rat Hippocampus. Locht LJ, Munkøe L, Stoltenberg M. Journal of Neuroscience Methods. 2002;115(1):77-83. doi:10.1016/s0165-0270(02)00004-3. 8. Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use?. Gonçalves Â, Matias M, Salvador JAR, Silvestre S. International Journal of Molecular Sciences. 2024;25(3):1600. doi:10.3390/ijms25031600. 9. Review Article: Safety of Bismuth in the Treatment of Gastrointestinal Diseases. Tillman LA, Drake FM, Dixon JS, Wood JR. Alimentary Pharmacology & Therapeutics. 1996;10(4):459-67. doi:10.1046/j.1365-2036.1996.22163000.x.
DennisP 1y ago
Does that cause any symptoms? Because apparently this can, and they tell you how to avoid it. > Lead author Dr Brent Wagner told Newsweek he personally avoids vitamin C when undergoing MRI with contrast, citing its potential to increase gadolinium reactivity. “Metabolic milieu,” including high oxalic acid levels, could explain why some individuals experience severe symptoms while others do not, he said. Avoiding high-oxalic foods for a few days before the MRI also seems like a good idea. Just check the diet for calcium oxalate kidney stones.
- Hemospectrum 1y ago
  > Does that cause any symptoms? Tinnitus.
  - hereme888 1y ago
    Actually, that's the salicylate portion causing tinnitus, not the bismuth.

gclawes 1y ago

Every time I've gotten an MRI the doctors and techs have sworn up and down it's impossible for this stuff to stick around. Getting tired of not being able to believe what doctors say...

bamboozled 1y ago
The other day I had to get a CT scan, I was kind of annoyed I wasn't offered and MRI, and here we are. I hold a different opinion to you though, I'm glad doctors are always learning more while generally operating with good /extremely good intentions.
- byryan 1y ago
  Really wish more people had that mind set. Practicing medicine isn't easy, especially in the US when you have to battle the insane insurance industry.
  - deleted 1y ago
    [deleted]
- margalabargala 1y ago
  > I hold a different opinion to you though, I'm glad doctors are always learning more while generally operating with good /extremely good intentions. I agree. Expecting perfection from humans, even experts, is not reasonable and is frankly counterproductive. Willful ignorance is one thing, but people who genuinely attempt to do the right thing at worst just need to be steered slightly differently.
  - bdzr 1y ago
    > I agree. Expecting perfection from humans, even experts, is not reasonable and is frankly counterproductive. There's a big difference between perfection and "Statistical Literacy Among Doctors Now Lower Than Chance"[1]. I don't think their intentions are bad, but they are woefully incompetent at many basic things. [1] https://slatestarcodex.com/2013/12/17/statistical-literacy-among-doctors-now-lower-than-chance/ https://slatestarcodex.com/2013/12/17/statistical-literacy-a...

shakna 1y ago

Or to not click through multiple layers of clickbait: https://doi.org/10.1016/j.mri.2025.110383 https://doi.org/10.1016/j.mri.2025.110383 Unfortunately, the article isn't much better. It has as an underpinning, a corrected paper: https://doi.org/10.1093/ndt/gfl294 https://doi.org/10.1093/ndt/gfl294

cowsandmilk 1y ago
1. The correction doesn’t invalidate that previous study at all 2. I fail to see how the previous study is an “underpinning” of the new paper. The new paper is a chemistry paper about dissociation of GBCAs in the presence of certain chemicals. Maybe people care because it is a potential explanation for toxicity, but the paper is very focused on the chemistry findings.
- shakna 1y ago
  It is underpinning, as it is the most frequently cited in the entire paper. It is underpinning, as the claims in both introduction and conclusion are precipitate to it. The correction: > After personal communication with the radiologists the administered Gd-contained contrast agent was documented in the MR examination reports of the mentioned nine patients incompletely and inexactly as Gd–DTPA by themselves. There is solely one MR contrast agent used in the described observation period: Gd–DTPA–BMA. Therefore, all mentioned nine patients received Gd–DTPA–BMA and not Gd–DTPA. Means that Gd-DTPA is irrelevant. Guess which is analysed here?
  - bonsai_spool 1y ago
    Neither - the OP paper talks about Gd-DOTA. I’m not a specialist so I can’t comment on how significant that is. We generally don’t use the compounds that cause NSF, which is one reason why the 2006 paper link you provided may not reflect the agents under current study.

anon291 1y ago

The link between NSF and gadolinium-based agents has been known for almost two decades and is common knowledge in the industry.

Neywiny 1y ago
Yes. The problem is that it's common in the industry. But it's ultimately up to the patient. Maybe alone. Pretty much guaranteed scared. Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress.
- bawolff 1y ago
  What are you proposing instead? Should patients just die of their illness instead? Medical procedures have risk, some are small risk some are higher risk. There are none that are 100% safe. Doctors are supposed to evaluate if the risk is worth the value the procedure would supply. What is the alternative to the status quo that you would propose?
  - Neywiny 1y ago
    There's a big difference between not getting the MRI and getting the MRI without gadolinium. My suggestion is to ensure that people know the risks outside of just the people who work in it. I'm not sure how that didn't get across in my original comment. With your comprehension skills, you are at an increased risk of falling victim to this exact scenario
    - bonsai_spool 1y ago
      >>> Yes. The problem is that it's common in the industry. But it's ultimately up to the patient. Maybe alone. Pretty much guaranteed scared. Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress. > There's a big difference between not getting the MRI and getting the MRI without gadolinium. My suggestion is to ensure that people know the risks outside of just the people who work in it. I'm not sure how that didn't get across in my original comment. With your comprehension skills, you are at an increased risk of falling victim to this exact scenario I don't see anything wrong with the GP's comprehension skills. Anyway, every procedure has risk - and no procedure is recommended if there is not an offsetting clinical benefit. There are clear guidelines for when gadolinium is to be used for an MRI and the guidelines factor in risk for 'NSF'.

Neywiny 1y ago

This is very interesting to see on here. My mother was the dissenting vote on an FDA panel on this. There are articles about it. I'll copy her words (as reported by something but seems legit) > She said that the FDA's plan doesn't go far enough. > "It's hard to dismiss an anecdotal report when you are the anecdote. When a patient is finally tested and found to have gadolinium retention, there's no FDA-approved antidote. So what does the patient do?" And I want to reiterate that she was "the" no not "a" no. I don't know if her vote alone is what's caused more research into this. But it's probably the thing I brag about her the most. Even though everybody else said it was fine or abstained, she stood strong. If you look up the articles from the time of the panel (2017) you'll see a lot of articles about this panel and how she was the sole no vote. Included in that was a public post from Chuck Norris praising her. He was going to come out to meet us but I think it was a bad Texas hurricane season so that fell through

fluidcruft 1y ago
I mean there have been no reported cases of NSF in the last ten years after certain gadolinium agents were removed from the market.
AmbroseBierce 1y ago
In case anyone is wondering what Chuck Norris has to do with all this: > Chuck and Gena Norris filed a lawsuit against several medical companies in 2017, alleging that a gadolinium-based contrast agent used in Gena Norris's MRIs caused her to develop a condition called gadolinium deposition disease and resulted in debilitating symptoms like cognitive issues, pain, and muscle wasting. In January 2020, the Norrises, along with their attorneys, voluntarily dismissed the lawsuit with prejudice, meaning it cannot be refiled. The dismissal was made without a settlement payment, and each party paid their own legal costs. It might give a glimpse into his worldview to mention that during the COVID pandemic Mr Norris shared an article on social media that claimed that the COVID vaccinations killed millions of people. [0] [0] https://m.facebook.com/story.php?story_fbid=870953857718632&id=100044120782094 https://m.facebook.com/story.php?story_fbid=870953857718632&...
- 1y ago

unsupp0rted 1y ago

Nobody told me gadolinium can be retained before I had it the first couple times. Like somebody else mentioned, they swore up and down it's perfectly safe.

bonsai_spool 1y ago
> Nobody told me gadolinium can be retained before I had it the first couple times. The reason these publications exist is that this is new knowledge > Like somebody else mentioned, they swore up and down it's perfectly safe. I am positive that you were not told that '[gadolinium] is perfectly safe' because there is a well-known complication of gadolinium administration. It's rare, but it's mentioned in every consent form.
- mystraline 1y ago
  > I am positive that you were not told that '[gadolinium] is perfectly safe' because there is a well-known complication of gadolinium administration. It's rare, but it's mentioned in every consent form. Consent is not "Sign this cause its the only course of treatment". And thats what happens almost every time. And yes, I too have gadolinium retention in my joint. 3 MRIs. And no, was not told this was a complication... But I'm sure the papers I signed included weasel words to that effect.
  - bonsai_spool 1y ago
    > And yes, I too have gadolinium retention in my joint. 3 MRIs. And no, was not told this was a complication... But I'm sure the papers I signed included weasel words to that effect. The presence of the gadolinium is not a complication. At best, it is an unintended side effect whose clinical significance is not known. A complication is an unexpected/non-routine, negative outcome. We now have learned that the deposition is something to expect. There is no new information around clinical changes that one can attribute to gadolinium.
    - mystraline 1y ago

bonsai_spool 1y ago

This is a poor explanation of an older publication, when the actual new work has a good description: https://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1664840/abstract https://www.frontiersin.org/journals/toxicology/articles/10....

dang 1y ago
Thanks - I've put that link in the toptext above. I'm not sure it makes sense to swap out the submitted URL with it. Hopefully people will take a look at both.

cjensen 1y ago

As someone with CKD and scheduled for an MRI, this was anxiety-inducing. The Cleveland Clinic has a good overview[1]. Since there have been no reports of NSF in 15 years, I don't think it's rational to avoid MRIs based on gadolinium retention concerns. [1] https://www.ormanager.com/briefs/study-mri-contrast-agent-causes-harmful-metal-buildup-in-some-patients/ https://www.ormanager.com/briefs/study-mri-contrast-agent-ca...

SupaShotty 1y ago
That’s just the OP url again, I think you miscopied.
- cjensen 1y ago
  Yep. https://my.clevelandclinic.org/health/diseases/17783-nephrogenic-systemic-fibrosis-nsf https://my.clevelandclinic.org/health/diseases/17783-nephrog...
RossBencina 1y ago
[1] https://my.clevelandclinic.org/health/diseases/17783-nephrogenic-systemic-fibrosis-nsf https://my.clevelandclinic.org/health/diseases/17783-nephrog...
- deleted 1y ago
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deleted 1y ago

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kazishariar 1y ago

EDTA DMSO DMSA Vitamin C

kazishariar 1y ago

EDTA

justinc8687 1y ago

I think the thing to remember with this, as with any kind of medical procedure, is the benefits versus the risks. In many cases, if you're getting this kind of MRI contrast, there's probably a good reason for it. So even if there's some risk, it might be better than say, the cancer or something else they're looking for. I feel like this is something that's often forgot in these discussions.

RagnarD 1y ago

This isn’t newly known, but it’s convenient to stay with the comfortably familiar until the better alternative is forced.

keane 1y ago

There's a subreddit, created August 2024, discussing this: https://www.reddit.com/r/GadoliniumToxicity/ https://www.reddit.com/r/GadoliniumToxicity/

lynx97 1y ago

Great. Only this year, I got roughly 6 doses of gadlinium, and prior to that, I got one every year, going back 20 years. I just recently chatted with a MRI nurse about the fact that I have a bad feeling about getting that stuff so frequently over time, and she dismissed my concerns. They used to remind patients to drink more after the MRI, but even that routine has been ended roughly 5 years ago. Is there anything else I can do except drink more on the day of the injection?

lostlogin 1y ago
Some contrasts are more stable than others - however I’d be surprised if anyone was using linear agents anymore. Macrocyclic contrast agents bind the gad more tightly.

kyykky 1y ago

My kid went to brain MRI because of migraines (standard procedure here for kids to check if there is e.g. a tumor causing the headache). I was pretty nervous due to this kind of research and the preparatory material saying that they might need to use a contrast agent. In the end they didn’t use a contrast agent and I stressed unnecessarily.

fluidcruft 1y ago
Just as a heads up from a rando on the internet this sort of research is trying to understand mechanisms of things that happened 20-30 years ago and people who were exposed back then (sometimes many times with significant accumulation). Gadolinium is toxic so contrasts trap it with protective molecules that hold the gadolinium until it leaves the body (most leave via the kidneys, but some also leave via liver/gallbladder). Some fraction of gadolinium escapes depending on the structure of the protective molecules. After the problems with the older contrasts were found kidney function became important (impaired kidney function allows more time for gadolinium to escape) and later new contrasts were designed that are much more stable. The gadolinium contrasts we use today are much more stable than the ones we used previously and there haven't been any cases of the sorts of things this article is about in over ten years. But there are a lot of people alive who received the old agents many times and in higher doses than we use today. I don't want to diminish the concerns (and frankly I think this is important to understand what happens to gadolinium in the body), but the exposure and accumulation are significantly lower today than they have been in the past because reducing exposure has become a major focus of design safety for gadolinium contrast and the worst offenders have been voluntarily withdrawn from the market. Anyway if my kid needed contrast for accurate diagnosis, I'd do it. I work at a pediatric hospital and generally the way it works is if contrast might be needed its ordered and consented so that it's an option. During the scan radiologists check the images and decide whether contrast is needed to answer the clinical question (although in general that's more a question of time management if the question has already been answered, there's no reason to keep imaging).
- nness 1y ago
  Appreciate this comment, thank you. (It's hard to gauge the recency of these concerns, the materials being used, or the prevalence of NSF -- and it can all get a bit overwhelming.)

uecker 1y ago

Note that MRI with contrast has very low risk and I am not aware of any evidence that Gadolinium retention even has adverse health effects. It is a concern though and this is why it is being studied. But I do not think the use of MRI contrast agents is something anybody without kidney disease should be concerned about. In general, risks and benefits must be balanced for any medical procedure. Such risks are continuously monitored and studied and guidelines are formulated based on this. Also consider that there is very clear harm from people being scared away by misinformation from medical procedures they would benefit from.

bobmcnamara 1y ago
>I am not aware of any evidence that Gadolinium retention even has adverse health effects I found this related article: https://www.research.va.gov/currents/1024-Metal-in-MRI-contrast-agents-may-cause-serious-health-problems.cfm https://www.research.va.gov/currents/1024-Metal-in-MRI-contr...
- uecker 1y ago
  I am working in this field, so I am aware of nephrogenic systemic fibrosis as rare condition caused by Gadolinium contrast agents in people with kidney disease. As far as I know, there was no new case in the last 10-15 years after the took certain less-stable contrast agents from the market and assessing kidney function is also standard now. In the aftermath of this, scientists discovered that Gadolinium is retained in the body after MRI scans to a small amount. As far as I know there is no evidence that this causes any harm, but as I said, this is a concern and this is why it studied.

janpmz 1y ago

Sometimes I wonder if metals in the body can pick up cellphone signals.

refurb 1y ago

There are risks with every procedure and medication. A dose of ibuprofen could give you Stevens–Johnson syndrome or TENS and you end up in a burn war for months. Patients should be made aware of all the risks for any treatment, but it would be impossible to avoid they edge cases even with relatively basic medical care.

MrWB 1y ago
Most people lack the medical literacy to understand any of this. People don’t read their letters telling them to not eat before surgery, are they going to read the list of potential side effects of a medication? How many people read the information sheets that come with their prescription medication?
- bobmcnamara 1y ago
  When my wife worked check-in for a surgeon, she used the line, "Good morning ${PATIENT_NAME}! What did you have for breakfast today?" as a shibboleth for sending patients home to reschedule.

hartator 1y ago

What about CT-SCAN contrast?

fluidcruft 1y ago
CT contrast typically uses iodine (which absorbs x-rays well).

AdamSanders1988 1y ago

Gadolinium has killed many many people. Many healthy people like me became chronically ill due to Gadolinium based contrast agent. We all had healthy bodies no history of kidney issues. One dosage of gadolinium contrast and the body couldn’t handle the toxic element which is a heavy metal for the body. The body is not designed to remove this on its own. It destroys the tissue it contacts with. FDA has to pull this poison out.

tsoukase 1y ago

It seems only patients with advanced renal disease are effected. So, my suggestion, no Gad in patients with increased Creatine (even Stage I renal disease).

lostlogin 1y ago
That’s what is done clinically - though only with severely reduced function. Giving it with an egfr below 25 or 30 is generally avoided. However it is still done when life or limb are at risk.

jhallenworld 1y ago

My son had an MRI with gadolinium- turns out he is allergic to it, he developed a full-body itchy rash. There were like 20 interns in to see him, for the experience I guess. They were ready to send him to the ER in case it interfered with his breathing, luckily it didn't.

lostlogin 1y ago
That would have been frightening. Did it require treatment beyond antihistamine? I’ve given MR contrast to patients a lot of times (probably tens of thousands) and have seen hives and rashes a handful of times but vastly more often with iodinated contrast in X-ray procedures (usually CT).
Madmallard 1y ago
This happened to me with iodinated CT contrast Every square inch of my body was hives for 2 weeks My kidney function was abnormal for 2 weeks as well and later I was like urinating out goop

olieidel 1y ago

Interesting to see this on HN. I was part of the research group which published this back in 2015 [1], I think we were the second group worldwide to publish this. So, first off, this is not new. The linked publication here mainly seems to be explaining a potential mechanism of how it might happen. Some quick notes to aid in a constructive discussion - bear with me, it's been a while and I've left research and since worked as a software developer, chuckle: - Different gadolinium agents have vastly different "buildup" characteristics - some are better, some are worse. Biochemically, the ones where the gadolinium was trapped in harder "complexes", those were more stable (less accumulation). I suck at biochemistry, so all of those words may be wrong. - If you'd want to over-engineer this, you could indeed select your MRI hospital / practice based on which gadolinium agent they use. - Unless you're getting a ton of MRIs (think multiple sclerosis monitoring etc.), you probably won't be affected. - Most MRIs are without contrast agent anyway, so you probably won't be affected. - The last I heard was that the clinical implications were still being investigated - like, yeah, you do see a buildup of gadolinium in patients who 1) get certain gadolinium agents and 2) have a ton of MRIs, but what does that mean they'll suffer any clinical consequences from this? Not sure. I heard that there was a paper (.. somewhere) which at least showed a correlation with worse MS outcomes of people who had a high buildup, but then again, cause-effect here is not clear as people with worse MS tend to have more MRIs, too (correlation != causation). [1] https://pubs.rsna.org/doi/full/10.1148/radiol.2015150337 https://pubs.rsna.org/doi/full/10.1148/radiol.2015150337

jcalvinowens 1y ago

I had an MRI with contrast once. I remember the gadolinium injection made me extremely nauseous for a few minutes, but otherwise it has had zero effect on me personally. Some sad advice: don't ask doctors about this, my experience is that it will cause them to write you off as a crazy person no matter how you bring it up. Many of them lump this in with what they see as "influencer illnesses", whether fairly or not. And maybe more practically, if you really need an MRI, whatever you might have is much more likely to hurt you.

radu_floricica 1y ago
Yeah, happened to me too. Brief but intense. Strangely, only the first time. When I got out I told the technician (I though I had a panic attack, and was puzzled that it happened at the end of the session), and she said "oh, it was probably the contrast, happens rarely". Apparently rarely enough that they don't warn the patients. To be fair it was harmless, and they'd have many more cases of nocebo nausea than actual nausea.

01100011 1y ago

I recently had an MRI with contrast and didn't read up on it until I got home from the MRI. Apparently they used the linear molecule with the higher tendency to disassociate and deposit Gd. Great. The most annoying thing though was the vague instruction to "drink plenty of water" given by the MRI tech on the way out. No, you do not drink "plenty of water". You drink something like 1L above your normal fluid intake in the first hour(?) after the procedure. You should also go in well-hydrated. I swear the quality of medical care in the US just keeps going down, and I'm in a "quality" health system in a rich coastal city.

Madmallard 1y ago

I thought the point was that the double bonded agents stick together and are just excreted and the bonds don't easily get broken at all. I thought the problem was with older agents there were single bonds that could be broken in the chain and that's what can cause the build-up. But I was under the impression those were phased out over a decade ago. So is this saying even the strong double-bonded ones are somehow building up in some way we don't understand? It's also been known forever that these agents are riskier in patients with kidney failure, and that's directly factored into the algorithms doctors use and has been forever. So.... what's the point of this? Is it rage-bait?

victor22 1y ago

If it was healthy hospitals and doctors would call it what it is instead of just saying "its contrast"