title: Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update.
abstract: In current practice, gadolinium-based contrast agents have been considered safe when used at clinically recommended doses in patients without severe renal insufficiency. The causal relationship between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with renal insufficiency resulted in new policies regarding the administration of these agents. After an effective screening of patients with renal disease by performing either unenhanced or reduced-dose-enhanced studies in these patients and by using the most stable contrast agents, nephrogenic systemic fibrosis has been largely eliminated since 2009. Evidence of in vivo gadolinium deposition in bone tissue in patients with normal renal function is well-established, but recent literature showing that gadolinium might also deposit in the brain in patients with intact blood-brain barriers caught many individuals in the imaging community by surprise. The purpose of this review was to summarize the literature on gadolinium-based contrast agents, tying together information on agent stability and animal and human studies, and to emphasize that low-stability agents are the ones most often associated with brain deposition.
authors.affiliation: From the Departments of Neuroradiology (J.R., R.H.N., M.C.) Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal Joana-Ramalho@netcabo.pt.
authors.forename: J
authors.identifier: 0000-0003-4067-0589
authors.initials: J
authors.lastname: Ramalho
authors.affiliation: Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina.
authors.forename: R C
authors.identifier: 0000-0001-5773-8071
authors.initials: RC
authors.lastname: Semelka
authors.affiliation: Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina Hospital Garcia de Orta (M.R.), Almada, Portugal.
authors.forename: M
authors.identifier: 0000-0003-2522-1670
authors.initials: M
authors.lastname: Ramalho
authors.affiliation: From the Departments of Neuroradiology (J.R., R.H.N., M.C.) Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil.
authors.forename: R H
authors.identifier: 0000-0002-2483-964X
authors.initials: RH
authors.lastname: Nunes
authors.affiliation: Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia.
authors.forename: M
authors.identifier: 0000-0002-9081-0087
authors.initials: M
authors.lastname: AlObaidy
authors.affiliation: From the Departments of Neuroradiology (J.R., R.H.N., M.C.).
authors.forename: M
authors.identifier: 0000-0003-2960-1064
authors.initials: M
authors.lastname: Castillo
mesh_terms: D000818:Animals; D002529:Cerebellar Nuclei / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000009:adverse effects* / Q000493:pharmacokinetics*; D005682:Gadolinium / Q000009:adverse effects* / Q000493:pharmacokinetics*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D003287:Contrast Media; D005682:Gadolinium