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HelpTest Code GDS Gadolinium, Serum
Reporting Name
Gadolinium, SUseful For
Aiding in documenting previous exposure to gadolinium-based contrast agents using serum specimens
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumSpecimen Required
Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Supplies: Metal Free Specimen Vial (T173)
Collection Container/Tube: Plain, royal blue-top Vacutainer plastic trace element blood collection tube
Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, polypropylene vial
Specimen Volume: 0.3 mL
Collection Instructions:
1. Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction.
2. Remove the stopper. Carefully pour specimen into Mayo metal-free, screw-capped vial, avoiding transfer of the cellular components of blood. Do not insert a pipette into the serum to accomplish transfer, and do not ream the specimen with a wooden stick to assist with serum transfer.
3. See Metals Analysis Specimen Collection and Transport for complete instructions.
Specimen Minimum Volume
0.2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | METAL FREE |
| Ambient | 28 days | METAL FREE | |
| Frozen | 28 days | METAL FREE |
Special Instructions
Reference Values
<0.5 ng/mL
Day(s) Performed
Thursday
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83018
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| GDS | Gadolinium, S | 80912-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 29251 | Gadolinium, S | 80912-9 |
Clinical Information
Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media (gadolinium-based contrast agents: GBCA) for magnetic resonance imaging and computer tomography scanning.
Gadolinium is primarily eliminated via the kidneys, so exposure can be prolonged in patients with kidney insufficiency. Patients with reduced kidney function and some patients with normal kidney function may exhibit a prolonged gadolinium elimination half-life.
To date, the only known adverse health effect related to gadolinium retention is a rare condition called nephrogenic systemic fibrosis (NSF). NSF is a relatively uncommon condition in which fibrous plaques develop in the dermis and often in deeper connective tissues. Reported cases have occurred almost exclusively in patients with severe kidney disease, and almost all have been associated with prior use of GBCA. NSF is a painful skin disease characterized by thickening of the skin, which can involve the joints and cause significant limitation of motion within weeks to months. Over the past decade, changes in clinical practice guidelines have almost eliminated completely the incidence of NSF. However, the association of NSF and observed elevated gadolinium concentrations is still not fully understood.
Interpretation
Elevated gadolinium observed in serum specimens drawn more than 96 hours after administration of gadolinium-containing contrast media is not typical of most patients with normal kidney function and may indicate prolonged elimination of gadolinium and exposure to anthropogenic sources.
Cautions
Serum gadolinium concentration may be elevated if the specimen is collected less than 96 hours after administration of gadolinium-based contrast agents. This elevation is due to residual gadolinium present from contrast media infusion. An elevated serum gadolinium in a specimen collected more than 96 hours after contrast media infusion does not definitively indicate risk of nephrogenic systemic fibrosis or significant gadolinium toxicity. Ultimately, individuals should consult with their healthcare providers to interpret any test results.
Supportive Data
A small number of patients studied at Mayo Clinic have demonstrated measurable (0.6-2.1 ng/mL) gadolinium in serum collected 30 days after gadolinium infusion, so some prolonged elimination is possible.
Serum gadolinium concentrations above the stated reference range may indicate prolonged elimination, residual gadolinium retention, or continuing environmental exposure. However, elevated serum gadolinium concentrations do not necessarily indicate toxicity.
Clinical Reference
1. Othersen JB, Maize JC, Woolson RF, Budisavljevic MN. Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant. 2007;22:3179-3185
2. Christensen KN, Lee CU, Hanley MM, et al. Quantification of gadolinium in fresh skin and serum samples from patients with nephrogenic systemic fibrosis. J Am Acad Dermatol. 2011;64(1):91-96
3. Telgmann L, Sperling M, Karst U. Determination of gadolinium-based MRI contrast agents in biological and environmental samples: A review. Analytica Chimica Acta. 2013;764:1-16
4. Daftari Besheli L, Aran S, Shaqdan K, et al. Current status of nephrogenic systemic fibrosis. Clin Radiol. 2014;69(7):661-668
5. Aime S, Caravan P. Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J Magn Reson Imaging 2009;30(6):1259-1267
6. McDonald RJ, McDonald JS, Kallmes DF, et al. Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology. 2015;275(3):772-782
7. Attari H, Cao Y, Elmholdt TR, Zhao Y, Prince MR. A systematic review of 639 patients with biopsy-confirmed nephrogenic systemic fibrosis. Radiology. 2019;292(2):376-386
8. Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS. Risk of nephrogenic systemic fibrosis in patients with stage 4 or 5 chronic kidney disease receiving a group II gadolinium-based contrast agent: A systematic review and meta-analysis. JAMA Intern Med. 2020;180(2):223-230
11. Bornhorst J, Wegwerth P, Day P, et al. Urinary reference intervals for gadolinium in individuals without recent exposure to gadolinium-based contrast agents. Clin Chem Lab Med. 2020;58(3):e87-e90
12. Alwasiyah D, Murphy C, Jannetto P, Hogg M, Beuhler MC. Urinary Gadolinium Levels After Contrast-Enhanced MRI in Individuals with Normal Renal Function: a Pilot Study. J Med Toxicol. 2019;15(2):121-127
Method Description
The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)
Report Available
2 to 8 daysSpecimen Retention Time
14 daysReject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Method Name
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
Forms
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.