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Gadolinium Safety
Gadolinium Safety
Hanieh Attari, MD; Martin R. Prince, MD, PhD
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Terminology

  • Abbreviations

    • Gadolinium-based contrast agent (GBCA)

Introduction

    Injection Issues

    • Hand vs. Power Injection

      • Extravasation

        GBCA Stability

          • Gadolinium Retention

            • Interference With Blood Tests

              • Nephrogenic Systemic Fibrosis

                Acute Gadolinium Reactions

                • Physiologic Reactions

                  • Hypersensitivity Reactions (Allergic-Like)

                    GBCA in Pregnancy

                      GBCA in Lactation

                        Selected References

                        1. Behzadi AH et al: Immediate allergic reactions to gadolinium-based contrast agents: A systematic review and meta-analysis. Radiology. 286(2):471-482, 2018
                        2. Benzon HT et al: Caution in using gadolinium-based contrast agents in interventional pain procedures. Anesth Analg. 127(6):1452-1456, 2018
                        3. Expert Panel on Breast imaging: ACR Appropriateness Criteria Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol. 15(11S):S263-S275, 2018
                        4. Guo BJ et al: Gadolinium deposition in brain: Current scientific evidence and future perspectives. Front Mol Neurosci. 11:335, 2018
                        5. Heshmatzadeh Behzadi A et al: MRI and CT contrast media extravasation: A systematic review. Medicine (Baltimore). 97(9):e0055, 2018
                        6. Levine D et al: Gadolinium retention after contrast-enhanced MRI. JAMA. 320(18):1853-1854, 2018
                        7. McDonald RJ et al: Gadolinium retention: A research roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates. Radiology. 289(2):517-534, 2018
                        8. Pasquini L et al: Gadolinium-based contrast agent-related toxicities. CNS Drugs. 32(3):229-240, 2018
                        9. Rozenfeld MN et al: Gadolinium-based contrast agents in children. Pediatr Radiol. 48(9):1188-1196, 2018
                        10. Runge VM: Dechelation (Transmetalation): Consequences and Safety Concerns With the Linear Gadolinium-Based Contrast Agents, In View of Recent Health Care Rulings by the EMA (Europe), FDA (United States), and PMDA (Japan). Invest Radiol. 53(10):571-578, 2018
                        11. Kang Y et al: Delayed Gadolinium-enhanced MR Imaging of Cartilage: A Comparative Analysis of Different Gadolinium-based Contrast Agents in an ex Vivo Porcine Model. Radiology. 282(3):734-742, 2017
                        12. Yao H et al: FDA-approved drugs that interfere with laboratory tests: A systematic search of US drug labels. Crit Rev Clin Lab Sci. 54(1):1-17, 2017
                        13. Fretellier N et al: Analytical interference in serum iron determination reveals iron versus gadolinium transmetallation with linear gadolinium-based contrast agents. Invest Radiol. 49(12):766-72, 2014
                        14. Guglielmo FF et al: Gadolinium contrast agent selection and optimal use for body MR imaging. Radiol Clin North Am. 52(4):637-56, 2014
                        15. Löwe A et al: Evaluation of the effect of two gadolinium-containing contrast-enhancing agents, gadobutrol and gadoxetate disodium, on colorimetric calcium determinations in serum and plasma. Invest Radiol. 46(6):366-9, 2011
                        16. Ersoy H et al: Biochemical safety profiles of gadolinium-based extracellular contrast agents and nephrogenic systemic fibrosis. J Magn Reson Imaging. 26(5):1190-7, 2007
                        17. Rohrer M et al: Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. Invest Radiol. 40(11):715-24, 2005
                        18. Proctor KA et al: Gadolinium magnetic resonance contrast agents produce analytic interference in multiple serum assays. Am J Clin Pathol. 121(2):282-92, 2004
                        19. ACR Manual on Contrast Media 10.3 2018. https://www.acr.org/Clinical-Resources/Contrast-Manual
                        Related Anatomy
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                        References
                        Tables

                        Tables

                        Terminology

                        • Abbreviations

                          • Gadolinium-based contrast agent (GBCA)

                        Introduction

                          Injection Issues

                          • Hand vs. Power Injection

                            • Extravasation

                              GBCA Stability

                                • Gadolinium Retention

                                  • Interference With Blood Tests

                                    • Nephrogenic Systemic Fibrosis

                                      Acute Gadolinium Reactions

                                      • Physiologic Reactions

                                        • Hypersensitivity Reactions (Allergic-Like)

                                          GBCA in Pregnancy

                                            GBCA in Lactation

                                              Selected References

                                              1. Behzadi AH et al: Immediate allergic reactions to gadolinium-based contrast agents: A systematic review and meta-analysis. Radiology. 286(2):471-482, 2018
                                              2. Benzon HT et al: Caution in using gadolinium-based contrast agents in interventional pain procedures. Anesth Analg. 127(6):1452-1456, 2018
                                              3. Expert Panel on Breast imaging: ACR Appropriateness Criteria Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol. 15(11S):S263-S275, 2018
                                              4. Guo BJ et al: Gadolinium deposition in brain: Current scientific evidence and future perspectives. Front Mol Neurosci. 11:335, 2018
                                              5. Heshmatzadeh Behzadi A et al: MRI and CT contrast media extravasation: A systematic review. Medicine (Baltimore). 97(9):e0055, 2018
                                              6. Levine D et al: Gadolinium retention after contrast-enhanced MRI. JAMA. 320(18):1853-1854, 2018
                                              7. McDonald RJ et al: Gadolinium retention: A research roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates. Radiology. 289(2):517-534, 2018
                                              8. Pasquini L et al: Gadolinium-based contrast agent-related toxicities. CNS Drugs. 32(3):229-240, 2018
                                              9. Rozenfeld MN et al: Gadolinium-based contrast agents in children. Pediatr Radiol. 48(9):1188-1196, 2018
                                              10. Runge VM: Dechelation (Transmetalation): Consequences and Safety Concerns With the Linear Gadolinium-Based Contrast Agents, In View of Recent Health Care Rulings by the EMA (Europe), FDA (United States), and PMDA (Japan). Invest Radiol. 53(10):571-578, 2018
                                              11. Kang Y et al: Delayed Gadolinium-enhanced MR Imaging of Cartilage: A Comparative Analysis of Different Gadolinium-based Contrast Agents in an ex Vivo Porcine Model. Radiology. 282(3):734-742, 2017
                                              12. Yao H et al: FDA-approved drugs that interfere with laboratory tests: A systematic search of US drug labels. Crit Rev Clin Lab Sci. 54(1):1-17, 2017
                                              13. Fretellier N et al: Analytical interference in serum iron determination reveals iron versus gadolinium transmetallation with linear gadolinium-based contrast agents. Invest Radiol. 49(12):766-72, 2014
                                              14. Guglielmo FF et al: Gadolinium contrast agent selection and optimal use for body MR imaging. Radiol Clin North Am. 52(4):637-56, 2014
                                              15. Löwe A et al: Evaluation of the effect of two gadolinium-containing contrast-enhancing agents, gadobutrol and gadoxetate disodium, on colorimetric calcium determinations in serum and plasma. Invest Radiol. 46(6):366-9, 2011
                                              16. Ersoy H et al: Biochemical safety profiles of gadolinium-based extracellular contrast agents and nephrogenic systemic fibrosis. J Magn Reson Imaging. 26(5):1190-7, 2007
                                              17. Rohrer M et al: Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. Invest Radiol. 40(11):715-24, 2005
                                              18. Proctor KA et al: Gadolinium magnetic resonance contrast agents produce analytic interference in multiple serum assays. Am J Clin Pathol. 121(2):282-92, 2004
                                              19. ACR Manual on Contrast Media 10.3 2018. https://www.acr.org/Clinical-Resources/Contrast-Manual