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Gadolinium contrast agents are used as contrast media to enhance magnetic resonance imaging as they are paramagnetic. This compound has a low incidence of adverse side effects, although there is a rare association with nephrogenic systemic fibrosis (NSF) when given to people with severe renal impairment (ie, GFR glomerular filtration rate <30mL/min/1·73m2).[1][2] [3] [4] [5] [6] [7] It seems to be related to the liberation of free gadolinium ions, and the least stable of the agents - Omniscan (gadodiamide) and Magnevist were withdrawn in Europe in 2017. In Europe restricted indications apply to two other agents, gadobenic acid (also known as gadobenate dimeglumine; MultiHance) and gadoxetic acid (Primovist) which are limited to delayed phase liver imaging.


  2. Grobner T. Gadolinium - a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006 Apr;21(4):1104-8. Erratum 2006 Jun;21(6):1745.
  3. Marckmann P, Skov L, Rossen K, Dupont A et al. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol. 2006 Sep;17 (9):2359-62.
  4. Idée JM, Port M, Schaefer M, Le Greneur S, Corot C. Clinical and biological consequences of transmetallation induced by contrast agents for magnetic resonance imaging: a review. Fundam Clin Pharmacol. 2006 Dec;20 (6):563-76.
  5. Thomsen HS, Morcos SK, Dawson P. Is there a causal relation between the administration of gadolinium based contrast media and the development of nephrogenic systemic fibrosis (NSF)? Clin Radiol. 2006 Nov;61(11):905-6.
  6. Morcos SK. Nephrogenic systemic fibrosis following the administration of extracellular gadolinium based contrast agents: Is the stability of the contrast agent molecule an important factor in the pathogenesis of this condition? (In press).
  7. Joffe P, Thomsen HS, Meusel M. Pharmacokinetics of gadodiamide injection in patients with severe renal insufficiency and patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis. Acad Radiol 1998;5:491-502.