Excessive use of gadolinium-based contrast agents : myth or reality ?

Introduction For thirty years now, linear or macrocyclic gadolinium-based contrast agents (GBCAs) have been routinely used in MRI. They were initially assumed to have virtually no side effects, but gadolinium can accumulate in tissue, bone and brain. Moreover, linear GBCAs can cause nephrogenic systemic fibrosis, a debilitating and potentially life-threatening disease, for patients with kidney failure. Thus, the use of some linear GBCAs has been reduced over the last decade, and has even been stopped in Europe. Objectives Assess the evolution of the consumption of GBCAs in France and particularly in Finistere during the period 2011–2017. Provide explanation for this evolution. Material and methods We used the French Health Insurance Agency (CPAM) and the Brest university hospital databases to assess the evolution of GBCAs consumption and MRI examinations performed during the period 2011–2017. Results During this period 2011–2017, the number of GBCAs reimbursed boxes increased of 95 % in Finistere and of 119 % in France. There was a rise of 64 % in the consumption of GBCAs in the university hospital of Brest. The number of MRI examinations also increased during this period. The increase was of 65 % in private clinics in the Finistere. During this period, there was the equivalent of 1.5 MRI that were newly implemented in Finistere. Another point to consider was the increase of examinations realized by teleradiology. Conclusion Increase of GBCAs consumption during the period 2011–2017 in France ( Fig. 1 ) and particularly in Finistere is only partially related to the increase of MRI examinations’ number. Further studies should be performed to assess whether this increase of enhanced MRI examinations improves the patients’ management. As GBCAs are not recovered during wastewater treatment, impact of gadolinium concentrations increase in coastal seawaters should also be raised [1] , [2] .