Gadolinium in Medical Imaging—Usefulness, Toxic Reactions and Possible Countermeasures—A Review

Abstract

Gadolinium (Gd) is one of the rare-earth elements. The properties of its trivalent cation (Gd3+) make it suitable to serve as the central ion in chelates administered intravenously to patients as a contrast agent in magnetic resonance imaging. Such Gd-chelates have been used for more than thirty years. During the past decades, knowledge has increased about potential harmful effects of Gd-chelates in patients with severe renal dysfunction. In such patients, there is a risk for a potentially disabling and lethal disease, nephrogenic systemic fibrosis. Restricting the use of Gd-chelates in persons with severely impaired renal function has decreased the occurrence of this toxic effect in the last decade. There has also been an increasing awareness of Gd-retention in the body, even in patients without renal dysfunction. The cumulative number of doses given, and the chemical structure of the chelate given, are factors of importance for retention in tissues. This review describes the chemical properties of Gd and its medically used chelates, as well as its toxicity and potential side effects related to injection of Gd-chelates.

Comparison of the biological effects of gadodiamide (Omniscan) and gadoteridol (ProHance) by means of multi-organ and plasma metabolomics

“…1 Nevertheless, during the past decades, warnings about potential harmful effects from the use of linear GBCAs ascribable to the release of free gadolinium cations have been raised. 30,31 In particular, there are findings proving that multiple administrations of linear GBCAs, are responsible for a far higher retention of gadolinium in the brain of healthy patients with respect to macrocyclic ones. [32][33][34] Although the risk of adverse effects due to gadolinium deposition was not proven, in 2017 the European Medicines Agency's recommended the removal of linear GBCAs from the market, 35 while, in the same year, the US Food and Drug Administration announced that they would not restrict the use of linear GBCAs and suggested that the type of GBCA used should be carefully selected in highrisk patients (pregnant women, children, and patients with inflammatory conditions).…”

Medical Imaging in Pregnancy: Safety, Appropriate Utilization, and Alternative Modalities for Imaging Pregnant Patients

“…In addition, the medical imaging procedure must be undertaken with strict adherence to the laid down policies and effective equipment to minimize the risk to the patient and the fetus. This defines the principles followed by physicians and radiologists when making decisions regarding imaging procedures [ 27 ]. Educating the patient about the importance of the imaging procedure and obtaining consent is important in communicating with the patient about the risks and benefits of the imaging procedure.…”

Biomedical Application of Porphyrin-Based Amphiphiles and Their Self-Assembled Nanomaterials

“…It is worth noting that the coordinated heavy metallic ions that donate PBAs with advanced imaging functionalities (MRI and PET) probably can bring toxicity for PBAs. For example, studies have demonstrated that Gd 3+ could accumulate inside the brain and cause kidney damage. , As a result, in-depth investigation on the biosafety of PBAs is necessary for in vivo application.…”

“…For example, studies have demonstrated that Gd 3+ could accumulate inside the brain and cause kidney damage. 192,193 As a result, in-depth investigation on the biosafety of PBAs is necessary for in vivo application.…”