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Gadolinium-Containing Contrast Agents - not as Safe as We Thought

Ivelina Borisova, Stanislava Stoycheva, Iliyan Kolev


Introduction: Gadolinium-based contrast agents (GBCA) are extensively used as magnetic resonance imaging (MRI) contrast agents owing to their outstanding signal enhancement, low immunogenicity, and easiness of chemical modification. GBCA are most commonly used for enhancement of vessels in MR angiography or for brain tumor enhancement associated with the degradation of the blood-brain barrier. In 2006, however, a negative association between the use of GBCA and the development of nephrogenic systemic fibrosis (NSF) has been reported for the first time in patients with acute and chronic renal failure. An isolated case of gadolinium-induced NSF has also been registered in Bulgaria in November 2009. Nephrogenic systemic fibrosis (NSF) is a rare and serious syndrome, which was recognized in 1997. It consists of fibrosis of skin, joints, eyes, and internal organs. The mechanism of NSF is not fully understood despite extensive research. The most common symptoms include bone/joint pain and head/neck symptoms including headache, vision change, and hearing change manifested within 2 to 8 weeks after the patients had been exposed.

Materials and Methods: We have used public internet databases - PubMed, SCOPUS, MEDLINE, and EMBASE.

Results: Collected data from different sources shows that GBCA can be extremely toxic to patients with impaired kidney functions, in patients around the time of liver transplantation, in newborn babies less than four weeks of age, etc.

Conclusions: In order to preserve the patients` health, physicians should be more aware of GBCA`s side effects and the patient`s history before every MRI, to restrict the dose to the minimum recommended and all patients should be screened for kidney problems before injection with these types of agents.


gadolinium, magnetic resonance imaging, nephrogenic systemic fibrosis



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