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Radiology. 2018 Nov;289(2):517-534. doi: 10.1148/radiol.2018181151. Epub 2018 Sep 11.

Gadolinium Retention: A Research Roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates.

Author information

1
From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.).

Abstract

Gadolinium-based contrast agents (GBCAs) have revolutionized MRI, enabling physicians to obtain crucial life-saving medical information that often cannot be obtained with other imaging modalities. Since initial approval in 1988, over 450 million intravenous GBCA doses have been administered worldwide, with an extremely favorable pharmacologic safety profile; however, recent information has raised new concerns over the safety of GBCAs. Mounting evidence has shown there is long-term retention of gadolinium in human tissues. Further, a small subset of patients have attributed a constellation of symptoms to GBCA exposure, although the association of these symptoms with GBCA administration or gadolinium retention has not been proven by scientific investigation. Despite evidence that macrocyclic GBCAs show less gadolinium retention than linear GBCAs, the safety implications of gadolinium retention are unknown. The mechanism and chemical forms of gadolinium retention, as well as the biologic activity and clinical importance of these retained gadolinium species, remain poorly understood and underscore the need for additional research. In February 2018, an international meeting was held in Bethesda, Md, at the National Institutes of Health to discuss the current literature and knowledge gaps about gadolinium retention, to prioritize future research initiatives to better understand this phenomenon, and to foster collaborative standardized studies. The greatest priorities are to determine (a) if gadolinium retention adversely affects the function of human tissues, (b) if retention is causally associated with short- or long-term clinical manifestations of disease, and (c) if vulnerable populations, such as children, are at greater risk for experiencing clinical disease. The purpose of the research roadmap is to highlight important information that is not known and to identify and prioritize needed research. ©RSNA, 2018 Online supplemental material is available for this article .

PMID:
30204075
PMCID:
PMC6209069
[Available on 2019-11-01]
DOI:
10.1148/radiol.2018181151

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