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Review ArticleREVIEW ARTICLE
Open Access

Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update

J. Ramalho, R.C. Semelka, M. Ramalho, R.H. Nunes, M. AlObaidy and M. Castillo
American Journal of Neuroradiology December 2015, DOI: https://doi.org/10.3174/ajnr.A4615
J. Ramalho
From the Departments of Neuroradiology (J.R., R.H.N., M.C.) and Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina; Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal; Hospital Garcia de Orta (M.R.), Almada, Portugal; Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil; and King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia.
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R.C. Semelka
From the Departments of Neuroradiology (J.R., R.H.N., M.C.) and Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina; Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal; Hospital Garcia de Orta (M.R.), Almada, Portugal; Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil; and King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia.
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M. Ramalho
From the Departments of Neuroradiology (J.R., R.H.N., M.C.) and Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina; Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal; Hospital Garcia de Orta (M.R.), Almada, Portugal; Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil; and King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia.
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R.H. Nunes
From the Departments of Neuroradiology (J.R., R.H.N., M.C.) and Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina; Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal; Hospital Garcia de Orta (M.R.), Almada, Portugal; Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil; and King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia.
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M. AlObaidy
From the Departments of Neuroradiology (J.R., R.H.N., M.C.) and Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina; Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal; Hospital Garcia de Orta (M.R.), Almada, Portugal; Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil; and King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia.
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M. Castillo
From the Departments of Neuroradiology (J.R., R.H.N., M.C.) and Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina; Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal; Hospital Garcia de Orta (M.R.), Almada, Portugal; Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil; and King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia.
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Abstract

SUMMARY: In current practice, gadolinium-based contrast agents have been considered safe when used at clinically recommended doses in patients without severe renal insufficiency. The causal relationship between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with renal insufficiency resulted in new policies regarding the administration of these agents. After an effective screening of patients with renal disease by performing either unenhanced or reduced-dose-enhanced studies in these patients and by using the most stable contrast agents, nephrogenic systemic fibrosis has been largely eliminated since 2009. Evidence of in vivo gadolinium deposition in bone tissue in patients with normal renal function is well-established, but recent literature showing that gadolinium might also deposit in the brain in patients with intact blood-brain barriers caught many individuals in the imaging community by surprise. The purpose of this review was to summarize the literature on gadolinium-based contrast agents, tying together information on agent stability and animal and human studies, and to emphasize that low-stability agents are the ones most often associated with brain deposition.

Abbreviations

DN
dentate nuclei
GBCA
gadolinium-based contrast agent
NSF
nephrogenic systemic fibrosis
  • © 2016 American Society of Neuroradiology

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Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update
J. Ramalho, R.C. Semelka, M. Ramalho, R.H. Nunes, M. AlObaidy, M. Castillo
American Journal of Neuroradiology Dec 2015, DOI: 10.3174/ajnr.A4615

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Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update
J. Ramalho, R.C. Semelka, M. Ramalho, R.H. Nunes, M. AlObaidy, M. Castillo
American Journal of Neuroradiology Dec 2015, DOI: 10.3174/ajnr.A4615
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