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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 then would be a great disservice to the sufferer.

However it may be that second reads are important for a number of reasons, which could include some form of piece of mind, even in a GSC individual. When individuals have asked me about second reads/if I do second reads etc, I often times refer them to a third party imaging company, such as DocPanel, which has trained radiologists in their service who can read these studies. It is straight-forward, and essentially any radiologist can do it if they know where the Globus Pallidus and Dentate Nucleus are.

As I have told sufferers who have reached out to me, the most affordable solution is you should be able to have the primary radiologist go back and comment on these findings of Gd, if they had not in their original dictation, and also they should review prior MRIs as part of their report. This ofcourse would be the most economical strategy. If you don't trust them, for whatever reason, or want a second interpretation, a third party company such as DocPanel is a good option.

In full transparency, I do read cases for Docpanel, but not studies of the brain.

Richard Semelka, MD

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