Brain & Nervous System Multiple Sclerosis Diagnosis Contrast Dyes for MRI in Multiple Sclerosis What to Know Before Your Next Scan By Julie Stachowiak, PhD facebook Julie Stachowiak, PhD, is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award, Health Category. Learn about our editorial process Julie Stachowiak, PhD Medically reviewed by Medically reviewed by Diana Apetauerova, MD on June 11, 2020 linkedin Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts School of Medicine. Learn about our Medical Review Board Diana Apetauerova, MD Updated on June 17, 2020 Print Multiple Sclerosis Overview Symptoms Causes Diagnosis Treatment Living With In This Article Table of Contents Expand How GBCDs Work Side Effects of GBCDs Complications and Concerns View All Magnetic resonance imaging (MRI) is the gold standard test for diagnosing and monitoring the progression of multiple sclerosis (MS). Some types of MRI require the use of a substance called gadolinium-based contrast dye (GBCD). This substance, which is administered through a vein during the test, causes active MS lesions to "light up." This can be helpful in evaluating MS, but it's important to know that the dye has certain side effects and risks. Verywell / Cindy Chung How GBCDs Work Gadolinium is a chemical compound that when injected into the bloodstream normally can't get past the blood-brain barrier—a layer of membranes and cell processes that prevents substances in blood from entering the brain or spinal cord. The blood-brain barrier is largely impermeable. However, under certain circumstances, such as active inflammation within the brain or spinal cord that occurs during an MS relapse, the barrier is disrupted. When this happens, gadolinium can enter the brain or spinal cord and leak into an MS lesion, causing it to show up as a highlighted spot on an MRI. Side Effects of Gadolinium-Based Contrast Dyes Most of the side effects of gadolinium-based contrasts (GBCDs) are mild, including: HeadacheNauseaDizzinessA cold sensation when injected Of more concern is the possibility that the contrast material won't be completely eliminated from the body. In 2015, the U.S. Food and Drug Administration (FDA) issued a Safety Communication based on studies that found people with MS who receive multiple MRIs with contrast may wind up with small amounts of the gadolinium-based contrasts agent deposited in certain parts of their brains. The FDA published this warning even though it wasn't clear if the retention of GBCDs would be harmful over time. More recent research suggests that any build-up of gadolinium is dose-dependent—that is, the more times a person receives the dye, the more brain deposits they're likely to have. The same study concluded that there is no link between the brain deposition of gadolinium-based contrast agents and a person's kidney function, age, gender, or the period of time between their contrast exposure (their last MRI) and death. It's also important to note that contrast material is even more likely to be deposited in bone than in brain tissue, although the implications of this aren't yet clear. Understanding MRI for Multiple Sclerosis Complications and Concerns Rarely, certain types of gadolinium contrast cause a serious disease called nephrogenic systemic fibrosis in people with significant kidney dysfunction. This condition, which causes tightening of the skin and damage to internal organs, is most likely to occur in people with MS who also have kidney dysfunction. Although rare, some people have a mild allergic reaction to gadolinium contrast. The main symptom is itchy skin. MRI imaging uses magnets and radio waves. For that reason, pacemakers, artificial bones or joints, and even IUDs can cause problems, as the MRI uses very strong magnets to create images. In addition, MRI machines may be problematic for people with claustrophobia. To minimize this risk, imaging centers increasingly use open MRI equipment. If you are undergoing an MRI, be sure to tell your doctor and the MRI technologist if you have any metal implants, claustrophobia, allergies, or kidney problems. They will be able to tell you what is and what is not safe and how to best proceed. What to Expect From a Brain MRI A Word From Verywell MRI technology makes it possible to view the structures of the central nervous system (the brain, spinal cord, and optic nerve) non-invasively—that is, without the need for surgery. They can be done without contrast dye, but in many cases of MS, gadolinium greatly improves the information a scan provides, making it much easier to identify and quantify lesions. That being said, if your doctor doesn't suspect active inflammation and is simply monitoring the periodic progression of your disease, contrast is generally not be needed and you will not need to undergo the small risks that the dye presents. Was this page helpful? Thanks for your feedback! Get tips and advice on how you can live a full and happy life with MS. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. US Food and Drug Administration. FDA in Brief: FDA Requires New Class Warning and Additional Research on Retention in the Body of Gadolinium From Gadolinium-based Contrast Agents Used in Magnetic Resonance Imaging. Dec 19, 2017. Murata N, Gonzalez-Cuyar LF, Murata K, et al. Macrocyclic and Other Non-group 1 Gadolinium Contrast Agents Deposit Low Levels of Gadolinium in Brain and Bone Tissue: Preliminary Results from 9 Patients with Normal Renal Function. Invest Radiol. 2016 Jul;51(7):447-53. doi:10.1097/RLI.0000000000000252 Bennett CL, Qureshi ZP, Sartor AO, et al. Gadolinium-induced nephrogenic systemic fibrosis: the rise and fall of an iatrogenic disease. Clin Kidney J. 2012;5(1):82-88.doi:10.1093/ckj/sfr172 Additional Reading McDonald RJ et al. Intracranial Gadolinium Deposition After Contrast-enhanced MR Imaging. Radiology. 2015 Jun;275(3):772-82. doi: 10.1148/radiol.15150025 National Multiple Sclerosis Society. FDA to Study Potential Risks Related to a Commonly Used MRI Contrast Agent. Sept 2015. www.nationalmssociety.org/About-the-Society/News/FDA-to-Study-Potential-Risks-Related-to-a-Commonly Ramalho et al. Gadolinium-based Contrast Agent Accumulation and Toxicity: An Update. AJNR Am J Neuroradiol. 2016 Jul;37(7):1192-1198. doi: 10.3174/ajnr.A4615.