Gadolinium is a metal that is used as a contrast material for magnetic resonance imaging (MRI) scans. The vast majority of people tolerate gadolinium contrast without any problems. The most concerning problem related to gadolinium contrast is the development of a condition known as Nephrogenic Systemic Fibrosis (NSF) also known as nephrogenic fibrosing dermopathy. NSF is a very rare, but serious condition that generally develops a few months after the patient is given gadolinium for an MRI. Patients develop hardened skin with nodules and plaques. Significant problems occur when these nodules involve the joints or the eyes. In the most severe form of the disease, these nodules involve the internal organs. The underlying cause of this disease is unknown.
People with poor kidney function are at risk of developing this condition with the administration of gadolinium contrast. The kidney is the organ responsible for elimination of gadolinium from the body. Most cases of this disease have been reported in patients with a known history of kidney failure who are already undergoing hemodialysis. There have been a few cases reported in patients who have had a more acute development of poor kidney function.
In general, any patient who has a kidney problem, either chronic or acute, should probably avoid getting an MRI with gadolinium contrast. If you have healthy kidneys you have much less to worry about. There are multiple brands and types of gadolinium contrast on the market, and the higher risk agents are no longer used. If you have any concern, you can discuss with your doctor or the radiologist who is involved in administering the test to you.
Richard Hamilton, MD, FAAEM, FACEP, FACMT