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Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update
J Ramalho1, R C Semelka2, M Ramalho3
1From the Departments of Neuroradiology (J.R., R.H.N., M.C.) Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal Joana-Ramalho@netcabo.pt.
AJNR. American Journal of Neuroradiology
|December 15, 2015
Summary
Gadolinium-based contrast agents are linked to brain deposition, particularly less stable formulations. Enhanced screening and stable agents have reduced nephrogenic systemic fibrosis risks.
Area of Science:
- Radiology
- Nephrology
- Neurology
Background:
- Gadolinium-based contrast agents (GBCAs) were considered safe for patients without severe renal insufficiency.
- A link between GBCAs and nephrogenic systemic fibrosis (NSF) in renal patients led to policy changes.
- NSF has been largely eliminated since 2009 due to patient screening and use of stable GBCAs.
Purpose of the Study:
- To review literature on gadolinium-based contrast agents.
- To correlate GBCA stability with gadolinium deposition in tissues.
- To highlight the association between low-stability agents and brain deposition.
Main Methods:
- Literature review of gadolinium-based contrast agents.
- Analysis of agent stability data.
- Examination of animal and human studies on gadolinium deposition.
- Review of clinical policies and outcomes related to GBCAs.
Main Results:
- Gadolinium deposition in bone tissue is established in patients with normal renal function.
- Recent studies indicate gadolinium can deposit in the brain, even with intact blood-brain barriers.
- Low-stability GBCAs are most frequently associated with brain deposition.
Conclusions:
- While NSF risk has been mitigated, GBCA safety requires ongoing evaluation.
- Gadolinium deposition in the brain is a concern, particularly with less stable agents.
- Further research is needed to understand the long-term implications of gadolinium deposition.
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