Toxicity associated with gadolinium-based contrast-enhanced examinations

Abstract

This article reports known and emerging adverse health effects associated with the administration of gadolinium-based contrast agents. It focuses on the issue of the incomplete excretion of these drugs leading to the deposition of gadolinium in the tissues of the patients. The evidence of deposition is reviewed. The analysis presents gaps in our knowledge but also suggests neglected or still poorly considered parameters to possibly explain discrepancies among studies (e.g. off-label use; rate of administration; gadolinium concentration in the pharmaceutical formulation, cumulative metal toxicity). The article also presents a critical assessment of some aspects reported in the literature as well as future needs. Potential biases in the investigation and evaluation of the health/clinical implications associated with gadolinium deposition are pointed out. The analysis emphasizes that the vast majority of the clinical studies conducted up to date on gadolinium-based contrast agents were designed to assess acute toxicity and diagnostic efficacy of the agents, not to identify long-term health effects.