Q: I am scheduled to get a breast MRI and have heard that gadolinium contrast is not safe. Can they do the MRI without contrast?

A: The direct bottom line answer is “no/” We cannot do a breast MRI without IV contrast.

What you may be referring to is that in May 2017 the FDA issued a drug safety communication indicating that, in some cases, with repeated contrast MRI scans (generally four or more), trace amounts of gadolinium based contrast agents (GBCA) can remain in the brain and other organs for years after administration, and the long-term consequences of this are unknown.

Although the communication further stated that they do not know of any adverse health effects from gadolinium, they recommended that physicians consider this and limit the use of gadolinium when possible.

Over the decades many types of gadolinium agents have been developed and studied. Some binding agents hold on to gadolinium tighter than others and are considered the safest. One such agent, under the trade name Dotarem – and I have no financial interest in this product – has been used for decades in Europe and more recently in the United States because it seems to be one of the safest out there.

So consider asking your MRI center what agent they use and whether it has a similar safety profile.

Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. You can reach him at michael.ulissey@cdirad.com.