Gadolinium is a highly paramagnetic heavy metal used as a base for contrast agents in MRI imaging. In its free form the Gd3+ ion is highly toxic. To overcome this problem Gadolinium Based Contrast Agents (GBCAs) consist of gadolinium and a chelating agent that binds to it and so it is safely excreted from the body. Until recent years gadolinium was considered a safe agent. In 2006 an association was described between gadolinium administration and development of nephrogenic systemic fibrosis in patients with impaired renal functions, nevertheless the high safety record for patients with normal renal functions was maintained. Since 2014 numerous reports have appeared, describing gadolinium depositions in human tissues, predominantly in the brain, in healthy people who received prior GBCAs for MRI examinations. Initially it was thought that only linear GBCAs that are less stable chemically deposit, but new reports have appeared describing depositions in patients who received macrocyclic GBCAs, considered more stable chemically, as well.
The purpose of this talk is to increase familiarity and awareness of the radiology community with GBCAs and with the new and emerging information about gadolinium deposition and to suggest guidelines in order to minimize exposure of to gadolinium, with emphasize on pediatric patients. While no definite adverse clinical effects were described so far, it is not clear how gadolinium deposits will affect the brain and other tissues, particularly in infants and young children in whom the brain and other organs still develop and who typically have a longer life spans following the administration/s of gadolinium.
