Sign in →

Test Code GDT Gadolinium, Dermal, Tissue

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

Gadolinium, T

Specimen Type

Dermal Tissue


Specimen Required


Container/Tube:

Preferred: Mayo metal-free specimen vial (blue label) (T173)

Acceptable: Paraffin block is also acceptable if not more than 1 or 2 cuts have been made to it for slides.

Specimen Volume: 2 mg

Collection Instructions:

1. 2 mg of tissue from a skin-punch biopsy is required, at least 2 mm in diameter and 2 mm in depth.

2. Any specimen vial other than a Mayo metal-free vial used should be plastic, leached with 10% nitric acid for 2 days, rinsed with redistilled water, and dried in clean air.

3. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information:

1. This test is useful for evaluation of dermal tissue. No other tissue types have been validated. The reference range applies only to dermal tissue. Fresh, refrigerated, or frozen tissue is preferred.

2. If tissue is other than dermal tissue, see MSCM / Miscellaneous Metals Testing.

3. See Cautions for paraffin block information.

4. Paraffin blocks will be returned 3 days after analysis.


Reject Due To

Hemolysis

NA

Lipemia

NA

Icterus

NA

Other

NA

 

Specimen Stability Information

Specimen Type Temperature Time
Dermal Tissue Refrigerated (preferred) 14 days
  Ambient  14 days
  Frozen  14 days

Specimen Minimum Volume

0.5 cm (14-gauge needle), 1 cm (18-gauge needle), or 2 mm x 2 mm (punch)
0.3 mg by dry weight

Day(s) and Time(s) Performed

Wednesday; 11 a.m.

Specimen Retention Time

Fresh tissue: 1 month Block: returned to client after 3 days

Analytic Time

2 days

Reference Values

<0.5 mcg/g

Useful For

Evaluation of dermal tissue for gadolinium

Method Name

Inducively Coupled Plasma-Mass Spectrometry (ICP-MS)

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

83018

LOINC Code Information

Test ID Test Order Name Order LOINC Value
GDT Gadolinium, T 80643-0

 

Result ID Test Result Name Result LOINC Value
29249 Gadolinium, T 80643-0

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

 

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. Patients with reduced renal function exhibit increased gadolinium excretion half-life.

 

Patient with reduced renal function exposed to gadolinium chelates used as MRI or CT contrast media may be affected by nephrogenic systemic fibrosis (NSF). 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.

 

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

Interpretation

Elevated gadolinium (>0.5 mcg/g) observed in affected dermal tissue specimens collected more than 48 hours after administration of gadolinium-containing contrast media indicates gadolinium deposition. These patients may have increased risk of nephrogenic systemic fibrosis (NSF).

 

In individuals with NSF, affected tissues are likely to contain gadolinium at concentrations in the range of 4 to 186 mcg/g. Unaffected tissues from gadolinium-exposed subjects exhibit gadolinium concentration of 0.6 to 28 mcg/g.             

 

A reportable gadolinium concentration in tissue suggests recent administration of gadolinium-containing contrast media. Patients with increased gadolinium in affected dermal tissue have an increased risk to develop NSF.

Cautions

This test is useful for evaluation of dermal tissue. No other tissue types have been validated. The reference range applies only to dermal tissue.

 

Tissue gadolinium concentration will be elevated if the specimen is collected <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 collected <48 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.

Clinical Reference

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

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

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

4. High WA, Ayers RA, Cowper SE: Gadolinium is quantifiable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007;56:710-712

5. High WA, Ayers RA, Chandler J, et al: Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007;56:21-26

6. 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 Dermat 2011;64(1):91-96

7. Girardi M, Kay J, Elston DM, et al: Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol 2011;65:1095-1106

Method Description

Gadolinium in tissue is analyzed by inductively coupled plasma-mass spectrometry. Aqueous acidic calibrating standards, reagent blanks, quality control specimens, and patient sample digests are diluted with aqueous acidic diluent containing internal standards. These diluted samples are aspirated by a pneumatic high-pressure nebulizer driven by argon gas and directed into a high temperature (6800 K) argon gas discharge (plasma). This discharge decomposes, atomizes, and ionizes the nebulized particles. All atoms, molecules, and ions formed in the discharge are extracted into a mass spectrometer through a platinum orifice. Gadolinium ions are separated from the concomitants by the quadrupole-mass spectrometer. Instrument detector signals from the gadolinium ions are directly proportional to the concentration in the digested sample.(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 Dermat 2011;64[1]:91-96)

Supportive Data

Dermal tissue gadolinium concentrations observed in Mayo Clinic patients with nephrogenic systemic fibrosis (NSF) were in the range of 6 to 186 mcg/g. Non-Mayo Clinic studies observed gadolinium concentrations in NSF patient biopsies from involved sites ranging from 4.8 to 106.2 mcg/g.