Prostate MRI: Should You Use Contrast? | Off The Cuff with Mark Moyad, MD, MPH

PCRI’s resident moderator Mark Moyad, MD, MPH talks with radiologist Daniel Margolis, MD, about common concerns about the use of contrast agents for an MRI. Dr. Margolis explains that while the use of a contrast agent is not always necessary their potential benefits far outweigh their potential risks.

Daniel Margolis, MD, is an Associate Professor of Radiology at the Weill Cornell Medical College and an Associate Attending Radiologist at New York-Presbyterian Hospital. He received a B.A. from UC Berkeley in 1992 and his medical degree at the Keck School of Medicine of USC in 1998. He went on to serve his community by completing an internship at the Los Angeles Department of Veterans Affairs. He finished his residency at the UCLA Medical Center in 2003 and completed a prestigious fellowship at Stanford University sponsored by the National Cancer Institute. Dr. Margolis specializes in abdominal imaging and has co-authored nearly 100 publications, many of which focus on prostate imaging.

:06 Dr. Moyad asks Dr. Margolis to describe the process of getting an MRI especially in regard to time, the lack of space, and the use of contrast agents. Dr. Margolis explains that when you get an MRI you can expect to be in the office for 90 minutes, but you will only be on the scanner for 30 minutes (25 minutes of scanning and 5 minutes of moving in and out of the scanner). Contrast agents are commonly used right now because they help detect cancers and in some cases can help assess the risk of the cancer. Many institutions are trying to move away from the use of contrasts to save resources, but there are certain situations in which it is important (e.g. if the diffusion component fails).

2:38 Since contrast agents are not always necessary, Dr. Moyad asks if patients should talk to their doctor about the option of not using contrast agents when they get an MRI since radiologists are likely to use it by default. Dr. Margolis says that the use of contrast by default is a good idea because it helps radiologists make a reading about 50% of the time, and there are very few risks with the use of the contrast (most risks are allergy-related). There is a concern about gadolinium deposits in the brain, but studies have shown no differences in neurological performance between people who used gadolinium contrasts and those who did not.

5:18 Dr. Moyad mentions a 2017 FDA report cautioning about the use of some contrasts, and asks if Dr. Margolis if he faced any blowback from that report. Dr. Margolis explains that there are two classes of gadolinium contrast agents: Cyclic and linear. Both compounds make strong bonds, but cyclic contrasts are significantly less likely to collect in the brain. With a few exceptions, radiologists have gotten away from linear contrasts and just use cyclic contrasts now, although as previously mentioned there is no evidence that deposits in the brain have a negative effect on the body. The risk of getting a contrast agent is considered to be worth it because the risks of prostate cancer are predictable and statistically significant while the risks of contrast agents are speculative and to this point statistically negligible.

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