{"id":7348,"date":"2021-03-20T15:19:02","date_gmt":"2021-03-20T14:19:02","guid":{"rendered":"https:\/\/alara-group.fr\/?p=7348"},"modified":"2023-12-07T14:26:18","modified_gmt":"2023-12-07T13:26:18","slug":"decryptage-mri-pregnancy-risks-associated-with-electromagnetic-fields-and-gadolinium","status":"publish","type":"post","link":"https:\/\/alara-group.fr\/en\/decryptage-mri-pregnancy-risks-associated-with-electromagnetic-fields-and-gadolinium\/","title":{"rendered":"[DECRYPTAGE] MRI &amp; pregnancy: what are the risks associated with electromagnetic fields and Gadolinium?"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"7348\" class=\"elementor elementor-7348 elementor-7346\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c62b14a elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"c62b14a\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3c90580\" data-id=\"3c90580\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3b8a972 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3b8a972\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f7aa4fb\" data-id=\"f7aa4fb\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-69fc6f4 elementor-align-left elementor-widget elementor-widget-post-info\" data-id=\"69fc6f4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"post-info.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-inline-items elementor-icon-list-items elementor-post-info\">\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-repeater-item-5eb95cd elementor-inline-item\" itemprop=\"about\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text elementor-post-info__item elementor-post-info__item--type-terms\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-post-info__terms-list\">\n\t\t\t\t<a href=\"https:\/\/alara-group.fr\/en\/category\/decoding\/\" class=\"elementor-post-info__terms-list-item\">Decoding<\/a>\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3c948f4 elementor-widget elementor-widget-elementskit-heading\" data-id=\"3c948f4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"elementskit-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"ekit-wid-con\" ><div class=\"ekit-heading elementskit-section-title-wraper text_left   ekit_heading_tablet-   ekit_heading_mobile-\"><h2 class=\"ekit-heading--title elementskit-section-title \">[DECRYPTAGE] MRI &amp; pregnancy: what are the risks associated with electromagnetic fields and Gadolinium?<\/h2><div class=\"ekit_heading_separetor_wraper ekit_heading_elementskit-border-divider ekit-dotted\"><div class=\"elementskit-border-divider ekit-dotted\"><\/div><\/div>\t\t\t\t<div class='ekit-heading__description'>\n\t\t\t\t\t<p>Julie Kabil, PhD <br \/>Anou Sewonu, PhD<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e0991b0 elementor-widget elementor-widget-text-editor\" data-id=\"e0991b0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Introduction<\/strong><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5d0b6b8 elementor-widget elementor-widget-text-editor\" data-id=\"5d0b6b8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tMagnetic Resonance Imaging (MRI) is the modality of choice for the study of many pathologies, as it can produce very high quality images without exposure to ionizing radiation. However, this imaging technique is not without its risks.\nnon-ionizing radiation and its effects, the phenomenon of the projectile effect causing\naccidents, and exposure to contrast media.\n<br><br>\n<span style=\"letter-spacing: 0.3px;\">The risks associated with magnetic and electromagnetic <sup>fields1,2<\/sup> and those associated with contrast media3<sup>,4<\/sup> are now mostly well known and documented. We keep a regular watch on these issues as knowledge advances. In this document, we will deal specifically with the risks associated with MRI examinations during pregnancy, with or without injection of contrast media, based on scientific studies and consensus.<\/span>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fa2eac8 elementor-widget elementor-widget-text-editor\" data-id=\"fa2eac8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Risks related to magnetic and electromagnetic fields in MRI<\/strong><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9859380 elementor-widget elementor-widget-text-editor\" data-id=\"9859380\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tA brief reminder of the fields and risks involved in MRI: to generate images, the machine\nMRI emits an intense and permanent static magnetic field, electromagnetic fields of\nand gradient-switched fields (also known as acquisition gradients).\nOn the one hand, the static magnetic field can lead to accidents due to the projectile effect (if an object\nferromagnet is brought into the MRI room), malfunctions of implanted medical devices such as pacemakers, but also benign and transient phenomena such as sensations of <sup>dizziness1<\/sup>.\n<br>\nRadiofrequency fields can induce\noverheating, burns and also disruptions to active medical devices2\n<br>MRI,\nthe Specific Absorption Rate (SAR) is used to characterize\nthe deposition of power carried by these fields in tissues. Finally, acquisition gradients\ncan generate very intense acoustic noise, as well as Peripheral Nerve Stimulation (PNS).\nwhich manifest themselves as involuntary movements, tingling or <sup>cramps2<\/sup>.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d5381de elementor-widget elementor-widget-text-editor\" data-id=\"d5381de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Risks associated with gadolinium-based contrast media<\/strong><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bbf3ebe elementor-widget elementor-widget-text-editor\" data-id=\"bbf3ebe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tGadolinium is a heavy metal chemical element. Thanks to its paramagnetic properties, it can be used to modify the \n proton relaxivity<sup> 1<\/sup>.\n<br>\nH and obtain images in\nT1 weighting with shorter acquisition times. Like all heavy metals, it can be toxic to living organisms. In order to be administered safely, Gadolinium is complexed with\nwith a ligand through the chelation process, forming a <b>Gadolinium-based contrast medium <\/b>(GBCP). The stability of the Gadolinium-Ligand bond is essential to avoid a\nrelease of free Gadolinium into the body. PCBGs are injected intravenously, pass fairly rapidly to the extracellular matrix and should be eliminated relatively quickly by the renal route (\u2248 1.5h). In theory, PCBGs do not cross the healthy blood-brain barrier (BBB).\nWith regard to PCBG-related adverse effects, the most notable risk identified is that of\nnephrogenic systemic fibrosis, a pathology that can affect patients suffering from\nsevere renal failure3,4. Nausea, headache and paresthesia have also been reported.\n<sup>reported4<\/sup>. However, new risks associated with these products have been discovered since the\n2010s. In fact, it has been shown that some linear PCBG molecules have less stable Gadolinium-ligand bonds than macrocyclic molecules. Faced with the risk of Gadolinium release presented by linear products, the European Medicines Agency\n(AME) issued restrictions on their use in <sup>20175<\/sup>.\n\n<br>Furthermore, the presence of Gadolinium has been demonstrated in the brain <sup>6<\/sup>\nliver <sup>7<\/sup>\n<sup>8<\/sup> and bone <sup>9<\/sup> from patients with normal kidney function. This raises questions about the risks of toxicity of this heavy metal deposited in these various organs, particularly because of the very long period of time required for its release.\nnatural elimination. Note that these Gadolinium deposits have been demonstrated for both linear and macrocyclic molecules.\nResearch is in full swing on this subject, which could prove thorny and have unexpected consequences for the use of Gadolinium-based contrast agents.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-24f0676 elementor-widget elementor-widget-text-editor\" data-id=\"24f0676\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Pregnant women undergoing MRI: examinations without injection of contrast agents<\/strong><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9df3f9a elementor-widget elementor-widget-text-editor\" data-id=\"9df3f9a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tWhen pregnant women undergo MRI examinations, they may be affected by the different MRI fields. While the influence of the static magnetic field is very difficult to assess\nThe scientific literature is full of studies on the risks of heating and noise.\nfor the fetus. In 2006, work based on numerical modeling showed that localized SAR levels in the fetus can reach 40-70% of the maximum SAR measured in the mother <sup>10<\/sup>. As for acoustic noise, maternal tissue and amniotic fluid help to attenuate sound levels. High frequencies are much better attenuated than low frequencies, which can even be amplified. The risk of hearing loss is therefore theoretically possible 11. However, various retrospective studies have shown no difference between fetuses whose mothers were exposed to MRI and those whose mothers were not, in terms of auditory risks 12,13 and risks of congenital anomalies and fetal death <sup>13,14<\/sup>.\n\n<br>These comparative population studies have shown that exposure to the fields in action in MRI does not appear to be a risk factor.\ncause particular harm to the fetus. Furthermore, the published results indicate that this\nThis observation applies to all stages of pregnancy <sup>14<\/sup>.\n\n<br>Nevertheless, current clinical practice is to recommend MRI examinations in pregnant women only in situations of absolute necessity, based on a specific risk-benefit analysis. If the examination is necessary during pregnancy, it is still recommended to postpone it beyond the first day of pregnancy.\nquarter. In addition, the use of MRI equipment with a magnetic field of 1.5T is highly recommended.\nrecommended, as RF power levels are likely to be higher at 3T. For image acquisition, the &#8220;Low SAR mode&#8221; should be preferred if the pelvic region is located within the explored volume, or the &#8220;Normal mode&#8221; for any other region.\nanatomical <sup>11<\/sup>.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5d8fa5c elementor-widget elementor-widget-text-editor\" data-id=\"5d8fa5c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Pregnant women undergoing MRI: examinations involving the injection of contrast agents<\/strong><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2aa804f elementor-widget elementor-widget-text-editor\" data-id=\"2aa804f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tThe injection of Gadolinium-based contrast media is strongly discouraged for pregnant patients. Passage of the placental barrier has been demonstrated in primates, with traces of contrast medium remaining in the fetal kidneys for up to 45 hours after injection 15.\n<br>\nOn the other hand, a retrospective study published in 2016 shows that injection of Gadolinium-based contrast media is strongly correlated with the risk of adverse events such as stillbirths and fetal deaths 14. Learned societies such as the American College of Radiology 16 and the French Society of Neuroradiology (SFNR) <sup>17<\/sup> strongly advise against injecting Gadolinium-based contrast media into pregnant women. Moreover, in absolute emergency situations, as defined by a risk-benefit analysis,\nthe use of PCBGs should be limited to products with macrocyclic molecules and low doses.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64dc032 elementor-widget elementor-widget-text-editor\" data-id=\"64dc032\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Spin Up advises and supports you<\/strong><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c7f234d elementor-widget elementor-widget-text-editor\" data-id=\"c7f234d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tIn conclusion, if it is necessary for the patient and the examination cannot be postponed, MRI imaging can be carried out in pregnant women on the basis of a risk\/benefit analysis and by maintaining operating levels in &#8220;low SAR&#8221; or normal mode. The use of Gadolinium-based contrast media is strongly discouraged in these patients, except in the following cases\nabsolute emergency. In such situations, the contrast medium must be a macrocyclic molecule and administered in very low doses. SPIN UP puts at your service a\nteam of MRI physicists to advise you, train your teams and support you in the safe management of your pregnant patients.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e75b27e elementor-widget elementor-widget-text-editor\" data-id=\"e75b27e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>References<\/strong><\/p>\n<p>1: ICNIRP Guidelines on limits of exposure to static magnetic fields. Health Physics Society. 2010<br \/>2: ICNIRP Guidelines for limiting exposure to time-varying electric, magnetic and electromagnetic fields<br \/>(up to 300 GHz). Health Physics Society. 2010<br \/>3: Fraum T J et al. Gadolinium-based contrast agents: A comprehensive risk assessment. Journal of<br \/>Magnetic Resonance Imaging. 2017<br \/>4: Fox-Rawlings S, Zuckerman D. The Health risks of Gadolinium-based contrast agents used in MRIs.<br \/>National Center for Health Research. 2019<br \/>5: EMA restrictions on use of linear gadolinium agents in body scans:<br \/>https:\/\/www.ema.europa.eu\/en\/medicines\/human\/referrals\/gadolinium-containing-contrast-agents<br \/>6: Kanda T et al. High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-<br \/>weighted MR images. Radiology. 2014<br \/>7: Maximova N et al. Hepatic Gadolinium deposition and reversibility after contrast agent-enhanced<br \/>MR imaging of pediatric hematopoietic stem cell transplant recipients. Radiology.<br \/>8: Roberts D R et al. High levels of Gadolinium deposition in the skin of a patient with normal renal<br \/>function. Investigative Radiology. 2016<br \/>9: Murata N et al. Macrocyclic and other non-group 1 Gadolinium contrast agents deposit low levels<br \/>of gadolinium in brain and bone tissue. Preliminary results from 9 patients with normal renal function.<br \/>Investigative Radiology. 2016<br \/>10: Hand J W et al. Prediction of Specific Absorption Rate in mother and fetus associated with MRI<br \/>examination during pregnancy. Magnetic Resonance in Medicine. 2006<br \/>11: Lum M and Tsiouris A J. MRI safety considerations during pregnancy. Clinical Imaging. 2020<br \/>12: Chartier A L et al. The safety of Maternal and fetal MRI at 3T. AJR. 2019<br \/>13: Strizek B et al. Safety of MR imaging at 1.5T in fetuses: A retrospective case-control study of birth<br \/>weights and the effects of acoustic noise. Radiology. 2015<br \/>14: Ray J G et al. Association between MRI exposure during pregnancy and fetal and childhood<br \/>outcomes. JAMA. 2016<br \/>15: Oh K Y et al. Gadolinium chelate contrast material in pregnancy: Fetal biodistribution in the<br \/>nonhuman primate. Radiology. 2015<br \/>16: ACR-SPR PRACTICE PARAMETER FOR THE SAFE AND OPTIMAL PERFORMANCE OF FETAL MAGNETIC<br \/>RESONANCE IMAGING (MRI). 2020<br \/>17: Lersy F et al. Consensus Guidelines of the french Society of Neuroradiology (SFNR) on the use of<br \/>Gadolinium-Based Contrast Agents (GBCAs) and related MRI protocols in Neuroradiology. Journal of<br \/>Neuroradiology. 2020<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0956250 elementor-widget elementor-widget-heading\" data-id=\"0956250\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Share this article<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0e637a3 elementor-grid-2 elementor-share-buttons--skin-flat elementor-share-buttons--shape-circle elementor-grid-mobile-1 elementor-share-buttons--view-icon-text elementor-share-buttons--color-official elementor-widget elementor-widget-share-buttons\" data-id=\"0e637a3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"share-buttons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div 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However, this imaging technique is not without its risks.<br \/>\nnon-ionizing radiation and its effects, the phenomenon of the projectile effect causing<br \/>\naccidents, and exposure to contrast media.<\/p>\n","protected":false},"author":1,"featured_media":7353,"comment_status":"closed","ping_status":"open","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"footnotes":""},"categories":[38],"tags":[],"class_list":["post-7348","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-decoding"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Alara group | [DECRYPTAGE] MRI &amp; pregnancy: what are the risks associated with electromagnetic fields and Gadolinium?<\/title>\n<meta name=\"description\" content=\"Our team was in Nancy from June 7 to 9, 2023 for the scientific day organized by the Soci\u00e9t\u00e9 Fran\u00e7aise de Physique M\u00e9dicale!\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alara-group.fr\/en\/decryptage-mri-pregnancy-risks-associated-with-electromagnetic-fields-and-gadolinium\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Alara group | [DECRYPTAGE] MRI &amp; 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