Safety Aspects of Gadolinium Based Contrast Agents: Time to revisit practice?

Abstract

Gadolinium chelates have been in diagnostic imaging arena for last 35 years.  The sentinel reason for using gadolinium ion as an MR agent is because it has seven unpaired electrons and it shortens spin-lattice relaxation time (T1) of voxels in which they are present and this gives brighter signals to T1 weighted images. These linear gadolinium contrast agents include gadodiamide, gadoversetamide, gadopentetate dimeglumine, and gadobenate dimeglumine while the macrocyclic contrast agents include gadoteric acid and gadoteridol. Gadolinium based contrast agents (GBCA) are well tolerated by the patients, however, they are not absolutely hazards frees. Based on accumulated evidence based data, the side effects of GBCA has a wide spectrum from dimple allergic reactions to morbid or fatal nephrogenic systemic fibrosis (NSF).

The overall incidence of all acute adverse reactions ranges from 0.07%-2.4% and majority of these reactions are mild like itching, rash, nausea, headache and paresthesias. However, life-threatening anaphylactoid reactions are exceedingly rare with a reported incidence of 0.001% to 0.01%.