Gadolinium-based contrast agents (GBCA) have been standardly intravenously applied to improve visibility of MRI examinations since 1988, when gadopentetate dimeglumine (Magnevist ÂŽ) was approved for clinical practice. Gadolinium itself is a heavy metal, highly toxic in biological systems. Therefore, gadolinium must be bound to ligands for the purpose of contrast agents. GBCA consist of gadolinium ion and a chelating molecule, which could be cyclic or linear. The macrocyclic molecule pre-organizes the rigid ring to cage the gadolinium ion, which offers better protection and binding of gadolinium ion. Linear chelates with a flexible open chain are less stable and provide weaker link of the gadolinium ion. The rate of gadolinium dissociation from the macrocyclic ligands is remarkably slower than their dissociation from the linear chelates (1). Nephrogenic systemic fibrosis (NSF) is a disease associated with GBCA applications and connected to impaired kidney function. NSF was firstly described by Cowper et al. in 2000 (2). It is necessary to mention that Cowper et al. did not link that disease to gadolinium applications (2). This was done several years later (in 2006) by a group of nephrologists led by Grobner and Marckmann (3,4). NSF represents a systemic multiorgan disorder characterized by fibrosis. It is a serious and possibly life-threatening disease, affecting not only skin, but all fibrous tissues in the body including those in internal organs such as heart, liver, lungs and muscles. The failure of these organs may be responsible for patients' death. However, NSF is a highly clinically variable disease, some patients may suffer only from mild cosmetics skin affection, others may be limited in the movement and even in daily self-care and in rare cases the disease is lethal. Absolute majority of NSF cases have been associated with linear GBCA (5). Grobner's and Marckmann's research (3,4) broke down the common unfortunate illusion about the general safeness of GBCA. The reaction of authorities and radiology societies was prompt. Food and Drug Administration, European Medicines Agency, American College of Radiology, European Society of Urogenital Radiology and other societies released warnings, guidelines and recommendations how to correctly use GBCA in daily medical practice and how to manage patients with renal insufficiency (6-9). According to them, using high risk linear GBCA is not recommended in patients with the estimated glomerular filtration rate (eGFR) under 30 mL/min/1.73 m 2 including hemodialysis patients nor in patients suffering from acute kidney insufficiency. In the Tables 1 and 2 you can find more details about characterization of GBCA including their NSF risk and recommended management. In 2011 Zou et al. reviewed 370 biopsy-proven NSF cases (5). According to their findings no NSF case had been reported 3 years before their paper was published, thus since 2008 (5). In the last decade we have been thinking that the number of NSF cases has been limited and we have been living in the world where NS...