Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Spring;19(1):17-25.
doi: 10.31486/toj.18.0111.

Gadolinium Deposition in Neurology Clinical Practice

Tyler E Smith  1 , Andrew Steven  2   3 , Bridget A Bagert  1   3
Affiliations
Review

Gadolinium Deposition in Neurology Clinical Practice

Tyler E Smith et al. Ochsner J. 2019 Spring.

Abstract

Background: Magnetic resonance imaging (MRI) enhanced with gadolinium-based contrast agents (GBCAs) is an essential tool in the diagnosis and management of many neurologic diseases, including multiple sclerosis, brain tumors, and infections. The clinical utility of GBCAs is evidenced by their widespread use. GBCAs are produced in macrocyclic and linear forms. Since 2014, evidence has suggested that repeated administration of GBCAs can lead to gadolinium deposition in the brain. Methods: We review the literature on gadolinium deposition, including both animal and human studies, as well as the literature on GBCA-associated health outcomes. Additionally, we summarize and discuss the updated medical society recommendations and perspectives on GBCA use in clinical practice. Results: The first publication reporting gadolinium deposition in the human brain was published in 2014. Since that seminal report, multiple studies have demonstrated that exposure to linear GBCAs is associated with gadolinium deposition in the dentate nucleus and globus pallidus as seen on brain MRI. Macrocyclic GBCA exposure has not convincingly been associated with gadolinium deposition evident on brain MRI. Conclusion: Clear evidence demonstrates that GBCAs lead to gadolinium deposition in the brain in a dose-dependent manner; however, only linear GBCAs have been associated with gadolinium deposition visualized on MRI. To date, no evidence links gadolinium deposition with any adverse health outcome. Updated medical society guidelines emphasize the importance of an individualized risk-benefit analysis with each administration of GBCAs.

Keywords: Contrast media; gadolinium; magnetic resonance imaging.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Chemical structures of example linear and macrocyclic and gadolinium-based contrast agents.,
Figure 2.
Figure 2.
Sequential axial T1-weighted noncontrast mag-netic resonance images through the posterior fossa of a 52-year-old male with history of multiple sclerosis demonstrate a progressive increase in signal within the dentate nuclei following repeated doses of gadolinium-based contrast agents in (A) December 2011, (B) June 2013, (C) September 2016, and (D) June 2018.
See this image and copyright information in PMC

References

    1. Lohrke J, Frenzel T, Endrikat J, et al. . 25 years of contrast-enhanced MRI: developments, current challenges and future perspectives. Adv Ther. 2016. January;33(1):1-28. doi: 10.1007/s12325-015-0275-4. - DOI - PMC - PubMed
    1. Stojanov DA, Aracki-Trenkic A, Vojinovic S, Benedeto-Stojanov D, Ljubisavljevic S. Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol. Eur Radiol. 2016. March;26(3):807-815. doi: 10.1007/s00330-015-3879-9. - DOI - PubMed
    1. Tweedle MF, Wedeking P, Kumar K. Biodistribution of radiolabeled, formulated gadopentetate, gadoteridol, gadoterate, and gadodiamide in mice and rats. Invest Radiol. 1995;30(6):372-380. - PubMed
    1. Kanda T, Osawa M, Oba H, et al. . High signal intensity in dentate nucleus on unenhanced T1-weighted MR images: association with linear versus macrocyclic gadolinium chelate administration. Radiology. 2015. June;275(3):803-809. doi: 10.1148/radiol.14140364. - DOI - PubMed
    1. Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D. High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology. 2014. March;270(3):834-841. doi: 10.1148/radiol.13131669. - DOI - PubMed

LinkOut - more resources