Gadolinium-Based Contrast Agent Use, Their Safety, and Practice Evolution (June 2020).
Journal: Kidney360
Authors: Catherine Do 1 2 3, Joshua DeAguero 1 4, Adrian Brearley 5, Xochitl Trejo 6, Tamara Howard 4, G Patricia Escobar 1 2 4, Brent Wagner 1 2 3 4
1Kidney Institute of New Mexico, Albuquerque, New Mexico.
2Renal Section, Medicine Service, New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico.
3Department of Medicine, University of New Mexico Health Care System, Albuquerque, New Mexico.
4University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
5Department of Earth and Planetary Science, University of New Mexico, Albuquerque, New Mexico.
6Sandia High School, Albuquerque, New Mexico
Abstract: “Gadolinium-based contrast agents (GBCAs) have provided much needed image enhancement in magnetic resonance imaging (MRI) important in the advancement of disease diagnosis and treatment. The paramagnetic properties of ionized gadolinium have facilitated these advancements, but ionized gadolinium carries toxicity risk. GBCAs were formulated with organic chelates designed to reduce these toxicity risks from unbound gadolinium ions. They were preferred over iodinated contrast used in computed tomography and considered safe for use. As their use expanded, the development of new diseases associated with their use (including nephrogenic systemic fibrosis) has drawn more attention and ultimately caution with their clinical administration in those with impaired renal function. Use of GBCAs in those with preserved renal function was considered to be safe. However, in this new era with emerging clinical and experimental evidence of brain gadolinium deposition in those with repeated exposure, these safety assumptions are once again brought into question. This review article aims to add new perspectives in thinking about the role of GBCA in current clinical use. The new information begs for further discussion and consideration of the risk-benefit ratio of use of GBCAs.”