Gadolinium Deposition Disease: A New Risk Management Threat

Gadolinium-based contrast agents (GBCAs) have enjoyed wide use since their introduction some 30 years ago. Used in as many as 30% of MRIs performed in the United States, GBCAs have generally been associated with low rates of adverse events. However, the safety profile and attendant medicolegal liability associated with GBCAs changed in 2016 with the description of gadolinium deposition disease (GDD). Despite being unproven scientifically, a groundswell of GDD-related litigation and personal injury advertising targeting potential GDD patients has occurred. In this article, we describe what GDD is, why GDD has created medicolegal risk, and how this risk might be mitigated. This article advocates using a risk mitigation strategy focused on reducing brain gadolinium retention during the period of purported GDD development. As such, based on the currently available data, the authors recommend the preferential use of gadoteridol as the default GBCA for MRI imaging.