Gadolinium Retention and Toxicity—An Update

  • Miguel Ramalho
    Department of Radiology, Hospital Garcia de Orta, Almada, Portugal; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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  • Joana Ramalho
    Department of Radiology, Hospital Garcia de Orta, Almada, Portugal; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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  • Lauren M. Burke
    Department of Radiology, Hospital Garcia de Orta, Almada, Portugal; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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  • Richard C. Semelka
    Address correspondence to Richard C. Semelka, MD, Department of Radiology, University of North Carolina at Chapel Hill, CB 7510—2001 Old Clinic Building, Chapel Hill, NC 27599-7510.
    Department of Radiology, Hospital Garcia de Orta, Almada, Portugal; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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      Until 2006, the main considerations regarding safety for all gadolinium-based contrast agents (GBCAs) were related to short-term adverse reactions. However, the administration of certain “high-risk” GBCAs to patients with renal failure resulted in multiple reported cases of nephrogenic systemic fibrosis. Findings have been reported regarding gadolinium deposition within the body and various reports of patients who report suffering from acute and chronic symptoms secondary to GBCA's exposure. At the present state of knowledge, it has been proved that gadolinium deposits also occur in the brain, irrespective of renal function and GBCAs stability class. To date, no definitive clinical findings are associated with gadolinium deposition in brain tissue. Gadolinium deposition disease is a newly described and probably infrequent entity. Patients presenting with gadolinium deposition disease may show signs and symptoms that somewhat follows a pattern similar but not identical, and also less severe, to those observed in nephrogenic systemic fibrosis. In this review, we will address gadolinium toxicity focusing on these 2 recently described concerns.

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