October - 2020

RICHARD SEMELKA, MD. CONSULTING

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Second Read for Gadolinium Deposition in the Brain

Second Read for Gadolinium Deposition in the Brain

I am not a great believer in second reads of Brain MRI studies looking for gadolinium in the brain. It essentially just tells you if you have a certain type of Gadolinium Storage Condition (GSC), basically GSC secondary to having received a number of linear GBCA injections (most often Omniscan). If you have not had 5 Omniscan enhanced studies in the last 4 years, then the MRI would falsely look like there is no Gd deposition. Gd would be present, but not visible on MRI. This

Organ donation with GDD

Organ donation with GDD

I have received a question about organ donation. I would not recommend donating organs for the purpose of helping someone else saving another person's life if you have GDD. My opinion is the fundamental issue is that your immune system has run off the guard-rails and is now attacking itself. This same phenomenon may occur in the transplant recipient. This can occur for example in liver transplant recipient of an individual who has primary sclerosing cholangitis, primary bilia

New MR Contrast Agents. The Devil you know vs the Devil you don't know.

New MR Contrast Agents. The Devil you know vs the Devil you don't know.

This blog deals with my assessment of superparamagnetic iron oxide particulate agents as MR contrast agents. It is highly compacted- but can be extrapolated to the entire field of MR contrast, and perhaps everything else in life. I had not seen this article before (a review on SPIO MR agents), because it is written in an obscure journal that a radiologist would not have ready access. In part I say this because one has to pay attention to the audience and how likely they are t

Chelation with DTPA

Chelation with DTPA

Variations of this blog have been previously written, but it is worth repeating, as it is central to management of GDD. The following is the protocol that we generally use. I will also provide rationale for this protocol and suggest reasonable modifications, and when to use them. This protocol we have published in our article on DTPA chelation published in Investigative Radiology, but often perform in a simplified fashion. We administer Ca-DTPA on day 1, and Zn-DTPA on day 2.

Amount of Retained Gadolinium ???

A well informed sufferer sent me this email some months bacK: Years ago while trying to determine how much gadolinium someone might have in their body if they only retained 1% of the Gd in each dose of contrast they received, I found the following from Dr. Jerrold Abraham (SUNY). Dr. Abraham estimated that everyone might retain between 1-2% of the gadolinium injected in each dose of contrast they received. http://www.upstate.edu/pathenvi/studies/cases/case10.php “However, i

Where Does Subcutaneous Injection of a GBCA Go?

Where Does Subcutaneous Injection of a GBCA Go?

This would be true of all subcutaneous injections and some drugs are deliberately injected subcutaneously, including some of the chelating agents. Reasons for deliberate subcutaneous injection include primarily that there is slow access to the vascular system and therefore prolonged effect of the agent injected. So this would also be true of a subcutaneous injection of a GBCA. In some ways this may emulate the conditions that are created with por renal function, GBCA injectio

GDD and the Microbiome

GDD and the Microbiome

Over recent years the intestinal microbiome has become an important and fascinating subject of research in medicine and health. As I am an abdominal radiologist, I also love the concept of emphasizing the importance of the microbiome in health. Scientific knowledge and learning is still early with the microbiome. Some aspects though are important: 1. the total cell mass of the microbiome is enormous: the number of bacteria that form important functions in our body appear to o