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Test Code GDT Gadolinium, Dermal, Tissue

Reporting Name

Gadolinium, T

Useful For

Evaluation of dermal tissue for gadolinium

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Dermal Tissue


Advisory Information


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.

 

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



Specimen Required


Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metals 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)

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: Paraffin blocks will be returned 3 days after analysis.


Specimen Minimum Volume

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

Specimen Stability Information

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

Reject Due To

Hemolysis

NA

Lipemia

NA

Icterus

NA

Other

NA

 

Reference Values

<0.5 mcg/g

Day(s) and Time(s) Performed

Wednesday; 11 a.m.

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

Interpretation

Elevated gadolinium (>0.5 mcg/g) observed in dermal tissue specimens collected more than 96 hours after administration of gadolinium-based contrast agents indicates some gadolinium deposition. In a small internal study (n=13), patients with histologically confirmed nephrogenic systemic fibrosis (NSF) and a history of renal failure and exposure to gadolinium-based contrast agents (GBCA) had gadolinium concentrations in the range of 6.3 to 348.7 mcg/g in affected tissues. However, unaffected tissues from gadolinium-exposed subjects showed gadolinium concentrations in the range of 0.6 to 68.2 mcg/g.

 

A detectable gadolinium concentration in tissue suggests recent or past exposure to GBCA.

Cautions

This test is only useful for evaluation of dermal tissue. No other tissue types have been validated. The reference range applies only to dermal tissue in patients who were not exposed to gadolinium-based contrast agents (GBCA).

 

Tissue gadolinium concentration will be elevated if the specimen is collected less than 96 hours of administration of gadolinium-based contrast agents. This elevation is due to residual gadolinium present from contrast media infusion. Elevated gadolinium in a specimen collected less than 96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.

Method Description

Gadolinium in tissue is analyzed by inductively coupled plasma-mass spectrometry.(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)

Analytic Time

2 days

Specimen Retention Time

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

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 renal insufficiency. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes (1.5 hours). Patients with reduced renal function and some patients with normal renal 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 renal disease, and almost all have been associated with prior use of GBCAs. 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 completely eliminated the incidence of NSF. However, the association of NSF and observed elevated gadolinium concentrations is still not fully understood.

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.