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Test Name:
Gadolinium, Serum

• SBMF No:
  42290
• Performance Lab Name:
  Mayo Medical Laboratories
• Test Mnemonic:
  GD S
• ABN:
  Required – Not FDA-Approved
• CPT Code:
  83018
• Ref Lab Test No:
  89299
• Also Known As:
  Gd
• Spec Type:
  Serum
• Spec Container:
  Dark blue (royal) top tube (trace element-free - serum) provided in SBMF “Trace Metal Collection Kit” (order SBMF stock #7208)
        IMPORTANT: Do not use dark blue (royal) top (EDTA) tube
• Pref Vol:
  1.0 mL
• Min Vol:
  0.5 mL
• Fasting:
  No
• Patient Prep:
  Do not collect sample within 48 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies)
• Spec Collect:
  Routine venipuncture
• Spec Process:
  Allow blood to clot for 30 minutes
  Promptly centrifuge 15 minutes
  Within 60 minutes of collection time, "pour off" serum into the metal-free plastic vial provided in the SBMF "Trace Metal Collection Kit"
  Do not use pipettes or wooden sticks to aid in specimen transfer
• Spec Store Transport:
  Refrigerated
• Methodology:
  Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
• Use:
  Diagnosis of nephrogenic systemic fibrosis (NSF) by documenting gadolinium retention in the body.
• Clinical Significance:
  

  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 for magnetic resonance imaging (MRI) and computer tomography (CT) scanning.(1)

  Gadolinium is eliminated primarily by the renal filtration. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes.(1) Patients with reduced renal function exhibit an increased gadolinium excretion half-life.(2)

  Gadolinium has been associated with the nephrogenic systemic fibrosis (NSF) in patients with impaired renal function.(2,3) In this syndrome, prolonged retention of gadolinium is thought to allow the gadolinium cation to dissociate from its synthetic organic chelator and deposit predominantly in the skin, although other organs may be affected as well. These patients are often severely debilitated by progressive skin thickening and tightening. Fibrosis of skeletal muscle, lungs, liver, testes, and myocardium have also been observed, often with fatal results. Because the ionic radius of gadolinium (3 ) is similar to that of calcium (2 ), it may also deposit in bone.(1)

  Three hemodialysis treatments are required to substantially remove gadolinium from patients with impaired renal function; peritoneal dialysis is not effective.(4)

• Reference Range:
  <0.5 ng/mL

  Interpretation
  Elevated gadolinium (>0.5 ng/mL) observed in a serum specimen draw >48 hours after administration of gadolinium-containing contrast media indicates impaired ability to eliminate gadolinium. These patients have an increased risk of developing NSF.

  A normal value is <0.5 ng/mL; the lower limit of the assay's reportable range is 0.1 ng/mL.

  Cautions
  Serum gadolinium concentration will be elevated if the specimen is drawn <48 hours of administration of gadolinium-containing contrast media. This elevation is due to residual gadolinium present from contrast media infusion. Elevated gadolinium in a specimen drawn <48 hours after contrast media infusion does not indicate risk of NSF.

  Clinical Reference
  1. D'Hease P, De Broe M: Gadolinium. In Handbook on Metals in Clinical and Analytical Chemistry. Edited by HG Seiler, A Sigel, H Sigel. Marcel Dekker, Inc, New York, 1994, pp 365-369.

  2. Swan SK, Lambrecht LJ, Townsend, R, et al: Safety and pharmacokinetic profile of gadobenate dimeglumine in subjects with renal impairment. Invest Radiol 1999;34: 443-448.

  3. Otherson, J.B, Maize JC, Woolson RF, and Budisavljevic MN. Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007;10: 1093-1100.

  4. Perazella, MA: Nephrogenic systemic fibrosis, kidney disease, and gadolinium: is there a link? Clin J AM Soc Nephrol 2007;2:200-202.

  5. Saitoh T, Hayasaka K, Tanaka Y, et al: Dialyzability of gadodiamide in hemodialysis patients. Radiat Med 2006; 24:445-451.

• Additional Test Info:
  This test was developed and its performance characteristics determined by Laboratory Medicine and Pathology, Mayo Clinic. This test has not been cleared or approved by the U.S. Food and Drug Administration.
• Day Run:
  Wed
• Time Run:
  11:00 am
• Time Reported:
  Within 11 days
• Test Type:
  CHEMISTRY