Gadolinium Deposition and Nephrogenic Systemic Fibrosis: A Radiologist’s Primer

Abstract

Gadolinium-based contrast agents (GBCAs) have an excellent safety profile. However, over the last 2 decades, two specific concerns have surfaced. GBCAs are associated with nephrogenic systemic fibrosis (NSF) and tissue retention of gadolinium. NSF is a rare fibrosing disorder with a poor prognosis, which is characterized by skin and subcutaneous thickening as well as systemic manifestations. The disease has been reported exclusively in patients with advanced renal disease, and it is associated with higher doses and specific types of GBCAs. The number of new cases of NSF has fallen over the past decade, presumably because of adherence by health care providers to regulatory guidelines, which continue to evolve. While gadolinium retention has been known to occur in the liver and bones, the relatively recent findings of deposition and retention in the brain have reignited the debate concerning the safety profile of GBCAs. Despite these concerns, there have been no proven health effects related to gadolinium deposition and retention other than NSF. The authors review the different categories of GBCAs available for commercial use, discuss NSF and gadolinium retention in the brain, and provide updates on the latest U.S. and European regulatory guidelines regarding use of these agents. Given the frequency with which GBCAs are used in clinical practice, it is imperative for all radiologists to learn the current guidelines to provide the safest and highest quality of patient care. ©

Comparison of Biparametric and Multiparametric MRI for Clinically Significant Prostate Cancer Detection With PI‐RADS Version 2.1

“…7,8 Additionally, DCE-MRI with gadolinium chelate increases the burdens on the patient in terms of potential for gadolinium retention and nephrogenic systemic fibrosis, examination time, and cost. [9][10][11][12][13][14] Therefore, interest is growing in performing abbreviated prostate MRI protocols without DCE-MRI, as a procedure termed "biparametric MRI" (bpMRI). 8 A number of studies on bpMRI using PI-RADS v2 have reported that the diagnostic accuracy of bpMRI for detecting csPC is comparable to that of mpMRI.…”

Surveillance Imaging following Endovascular Aneurysm Repair: State of the Art

“…Recently, concern has been raised about gadolinium deposition in the brain, which is of unclear clinical significance and has been related to the number of contrast administrations as well as the use of linear GBCAs. 65 Although currently available aortic endografts have been individually classified as either conditional or safe for use in MRI, endograft material can influence study quality. MRA is more effective in the evaluation of nitinol stent grafts, as stainless steel and nickel alloys cause significantly more susceptibility artifact that may preclude optimal assessment.…”

Medios de contraste intravascular en tomografía computada y resonancia magnética: lo que el clínico necesita saber

“…El depósito de gadolinio puede ocurrir en pacientes con función renal conservada y se asocia con mayor frecuencia a moléculas lineales por su menor estabilidad y mayor tasa de disociación en comparación con las moléculas de estructura macrocíclica (Kanda et al, 2015). Gadodiamida presenta una mayor tasa de depósito en el sistema nervioso central, seguido de Gadopentato de dimeglumina y Gadobenato de dimeglumina (Mathur et al, 2019). A pesar de no existir repercusiones clínicas conocidas, regulaciones internacionales como FDA y EMA recomiendan suspender el uso de medios de contraste basados en gadolinio de estructura química lineal.…”