National Institutes of Health Perspective on Reports of Gadolinium Deposition in the Brain

Increased signal intensities in the dentate nucleus and globus pallidus on unenhanced T1-weighted images: evidence in children undergoing multiple gadolinium MRI exams

“…Collectively, while these findings, particularly in children, should raise concerns for safety regarding GBCA usage among all health care practitioners, additional studies are needed to determine the significance, the risk-to-benefit ratios, the potential adverse health effects, the potential impact on practice of care, and the long-term effects, if any, of intracranial GBCA deposition [17][18][19]. Nevertheless, our findings are supplemental to the studies presented by Adin et al [6], Roberts et al [15] and Miller et al [16] that have involved children, and support the notion of possibly adopting a subset of GBCAs (e.g., macrocyclic) with higher stability as the standard of care in children [20][21][22].…”

Safety of the Gadolinium-Based Contrast Agents for Magnetic Resonance Imaging, Focusing in Part on Their Accumulation in the Brain and Especially the Dentate Nucleus

“…7,71 A recent opinion piece published from the National Institutes of Health, Radiology and Imaging Sciences, confirms this shift, specifically recommending when GBCAs are required that consideration should be made in terms of use of a macrocyclic rather than a linear agent. 72 …”

Noninvasive aortic imaging

“…The risk of NSF is higher with linear agents as compared to macrocyclic GBCAs. In addition, there are rising concerns for long term tissue retention of GBCAs in the human body, specifically in the brain, even in individuals with normal renal function (48)(49)(50)(51)(52). The structure of the GBCA again impacts the degree of brain accumulation and linear GBCAs have significantly higher accumulation compared to macrocyclic agents (49,53).…”

“…When GBCAs are indicated, the use of a macrocyclic GBCA (e.g., gadobutrol, gadoteridol, or gadoterate meglumine) should be considered rather than a linear agent. For patients with documented allergy to macrocyclic agents, it is appropriate to use linear agents if indicated (51).…”