Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms

Gadolinium chelates are widely used as contrast media for magnetic resonance imaging. The approved gadolinium-based contrast agents (GBCAs) have historically been considered safe and well tolerated when used at recommended dosing levels. However, for nearly a decade, an association between GBCA admi...

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Bibliographic Details
Published in:Biometals 2016-06, Vol.29 (3), p.365-376
Main Authors: Rogosnitzky, Moshe, Branch, Stacy
Format: Article
Language:English
Subjects:
Accumulation
Biochemistry
Biomedical and Life Sciences
Body burden
Bones
Cell Biology
Chelates
Contrast agents
Contrast Media - adverse effects
Contrast Media - metabolism
Contrast Media - pharmacokinetics
Dosing
Fibrosis
Gadolinium
Gadolinium - adverse effects
Gadolinium - metabolism
Gadolinium - pharmacokinetics
Heavy metals
Humans
Impairment
Life Sciences
Medicine/Public Health
Microbiology
Molecular biology
NMR
Nuclear magnetic resonance
Patients
Pharmacology/Toxicology
Plant Physiology
Renal function
Toxicity
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Summary:Gadolinium chelates are widely used as contrast media for magnetic resonance imaging. The approved gadolinium-based contrast agents (GBCAs) have historically been considered safe and well tolerated when used at recommended dosing levels. However, for nearly a decade, an association between GBCA administration and the development of nephrogenic systemic fibrosis (NSF) has been recognized in patients with severe renal impairment. This has led to modifications in clinical practices aimed at reducing the potential and incidence of NSF development. Newer reports have emerged regarding the accumulation of gadolinium in various tissues of patients who do not have renal impairment, including bone, brain, and kidneys. Despite the observations of gadolinium accumulation in tissues regardless of renal function, very limited clinical data regarding the potential for and mechanisms of toxicity is available. This significant gap in knowledge warrants retrospective cohort study efforts, as well as prospective studies that involve gadolinium ion (Gd 3+ ) testing in patients exposed to GBCA. This review examines the potential biochemical and molecular basis of gadolinium toxicity, possible clinical significance of gadolinium tissue retention and accumulation, and methods that can limit gadolinium body burden.
ISSN:0966-0844
1572-8773
DOI:10.1007/s10534-016-9931-7