Vol. 7, Issue 2, Part A (2025)

Introduction: Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging (MRI) to enhance visualization of vascular structures and pathological lesions, thereby improving diagnostic accuracy. While generally safe, their increasing use has raised concerns regarding adverse effects, particularly nephrogenic systemic fibrosis (NSF) in patients with renal impairment, and tissue retention of gadolinium even in individuals with normal renal function. This review aims to critically examine the current safety profile of GBCAs, including known toxicities, deposition risks, and professional guidelines for clinical use.
Methods: A narrative literature review was conducted, focusing on peer-reviewed studies, clinical trials, and professional society guidelines published between 1988 and 2025. Emphasis was placed on evidence surrounding GBCA classification (linear vs. macrocyclic), toxicological mechanisms, risk of NSF, gadolinium deposition disease (GDD), potential nephrotoxicity, and recent recommendations.
Results: Linear GBCAs demonstrate a higher risk of transmetalation and gadolinium retention compared to macrocyclic agents. NSF, although rare, occurs more frequently in patients with severe renal impairment exposed to linear agents. GDD remains a controversial and poorly understood phenomen on, with no definitive histopathological correlates. Evidence linking GBCAs to nephrotoxicity is limited and largely inconclusive. Current guidelines recommend cautious use of GBCAs in high-risk populations, preference for macrocyclic agents, minimisation of contrast dose, and consideration of post-procedural dialysis in selected cases.
Conclusion: Although GBCAs are indispensable in modern diagnostic imaging, their use is not without risks. Understanding the differential safety profiles of contrast agents, especially in vulnerable populations, is essential. Macrocyclic GBCAs are generally safer and preferred in high-risk patients. Strict adherence to updated clinical guidelines and ongoing pharmacovigilance is critical to balancing diagnostic benefits with patient safety.