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Evaluating the Patient with Reported Gadolinium-Associated Illness

  • Tatyana Lyapustina
  • Charlotte Goldfine
  • Sean Rhyee
  • Kavita M. Babu
  • Matthew K. Griswold
Review
First Online:

Abstract

Introduction

Gadolinium-based contrast agents (GBCAs) have been increasingly used in clinical practice since their introduction in the 1980s. Recently, increased public attention has been given to patients who report new symptoms following GBCA exposure. This review details the current knowledge surrounding GBCAs, with a focus on the known and proposed disease states that may be associated with GBCAs. Recommendations for the appropriate clinical workup of a patient suspected of having symptoms attributable to gadolinium exposure are included.

Discussion

GBCAs are known to precipitate the disease state nephrogenic systemic fibrosis (NSF), a syndrome characterized by skin thickening in patients with preexisting renal disease. An additional syndrome, termed gadolinium deposition disease, has been proposed to describe patients with normal renal function who develop an array of symptoms following GBCA exposure. While there is a potential physiologic basis for the development of this condition, there is no conclusive evidence to support a causal relationship between GBCA administration and the reported symptoms yet. Clinical evaluation revolves around focused history-taking and physical examination, given the absence of a reliable link between patient symptoms and measured gadolinium levels. There are no recommended treatments for suspected gadolinium deposition disease. Chelation therapy, which is not approved for this indication, carries undue risk without documented efficacy.

Conclusions

The extent to which GBCAs contribute to clinically relevant adverse effects remains an important and evolving field of study. NSF remains the only proven disease state associated with GBCA exposure. Additional data are required to evaluate whether other symptoms should be attributed to GBCAs.

Keywords

Gadolinium Gadolinium deposition disease Nephrogenic systemic fibrosis Gadolinium-based contrast Magnetic resonance imaging 
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Notes

Funding Source

The authors received no sources of funding for this research.

Compliance with Ethical Standards

Previous Presentations

This research has not previously been presented in any form.

Conflict of Interest

None

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© American College of Medical Toxicology 2018

Authors and Affiliations

  1. 1.University of Connecticut Medical SchoolHartfordUSA
  2. 2.University of Massachusetts Medical SchoolWorcesterUSA
  3. 3.Department of Emergency MedicineHartford HospitalHartfordUSA

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