Gadolinium Deposition in Brain: Current Scientific Evidence and Future Perspectives

Abstract

In the past 4 years, many publications described a concentration-dependent deposition of gadolinium in the brain both in adults and children, seen as high signal intensities in the globus pallidus and dentate nucleus on unenhanced T1-weighted images. Postmortem human or animal studies have validated gadolinium deposition in these T1-hyperintensity areas, raising new concerns on the safety of gadolinium-based contrast agents (GBCAs). Residual gadolinium is deposited not only in brain, but also in extracranial tissues such as liver, skin, and bone. This review summarizes the current evidence on gadolinium deposition in the human and animal bodies, evaluates the effects of different types of GBCAs on the gadolinium deposition, introduces the possible entrance or clearance mechanism of the gadolinium and potential side effects that may be related to the gadolinium deposition on human or animals, and puts forward some suggestions for further research.

Keywords: T1 hyperintensity; brain; gadolinium deposition; gadolinium-based contrast agents; magnetic resonance imaging.

FIGURE 1

A patient with optical nerve pilocytic astrocytoma who treated with 5400-cGy radiation therapy and underwent 25 times CE-MRI scans show hyperintensity of the DN on unenhanced T1WI. DN initially appears as slightly hyperintense (A). During the follow-up studies performed at 5 (B) and 8 (C) years after the initial hyperintense appearance of the DN, the signal intensity of the DN become more obvious. Image courtesy of Dr. Mehmet Emin Adin, Russell H. Morgan Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Institutions, Baltimore, MD. Images and text reproduced from reference 1 with written permission from AJNR.