Gadolinium Deposition and Toxicity: A Global Concern

Abstract

Gadolinium-based contrast agents (GBCAs) have been used since 1988 for magnetic resonance imaging. These agents were considered very safe and, excluding nephrogenic systemic fibrosis in patients with renal failure, no clinical entities were associated with its administration. Our purpose is to summarize gadolinium induced toxicity by reviewing the most recent literature in this subject. It was believed that GBCAs distribute rapidly in the extracellular volume after intravenous administration and eliminate rapidly, almost completely, via renal excretion. Currently, we know that this is not entirely true. Some GBCAs may be retained, undergo dechelation and induce gadolinium deposition in different tissues such as liver, bone or brain in patients with normal renal function. The retained gadolinium, whether dechelated and associated with different compounds or in its original formulation, may trigger gadolinium-related toxic effects. This potential toxicity became a global concern. This review summarizes the most recent published data regarding gadolinium deposition, possible clinical significance of gadolinium tissue retention and accumulation, strategies to limit gadolinium body burden and some future trends in this area.