Yes. Although nearly all gadolinium is cleared from the circulation by renal excretion over the first several hours in patients with normal renal function, some free gadolinium always makes its way into tissues. The displacement of gadolinium from its chelation site occurs at least in part via the so-called transmetallation reaction, where it is bumped out by another cation (such as Zn+2 or Ca+2).
The patient shown right underwent 21 contrast-enhanced MR scans between 2002 and 2012 for a fourth ventricular tumor. Progressive high signal was noted on T1-weighted images in the dentate nuclei and globus pallidi over time, presumably due to gadolinium accumulation.
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European Medicines Agency. EMA’s final opinion confirms restrictions on use of linear gadolinium agents in body scans. 23 Nov 2017.
Hatje V, Bruland KW, Flegal AR. Increases in anthropogenic gadolinium anomalies and rare earth element concentrations in San Francisco Bay over a 20 year record. Environ Sci Technol 2016; (6-fold increase in the concentration of Gd in waters of SF Bay noted between 1993 and 2013. Not a toxic or human safety issue, but an interesting environmental side effect of medical gadolinium use)
Kanal E, Tweedle MF. Residual or retained gadolinium: practical implications for radiologists and our patients. Radiology 2015; 275:630-634. (Editorial/review).
Kanda T, Ishii K, Kawaguchi H, et al. High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology 2014; 270:834-841. (Landmark first report of Gd accumulation in brain).
McDonald RJ, McDonald JS, Dai D, et al. Comparison of gadolinium concentrations within multiple rat organs after intravenous administration of linear versus macrocyclic gadolinium chelates. Radiology 2017; 285:536-545.
McDonald JR, McDonald JS, Kallmes DF, et al. Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology 2015; 275:772-782.
McDonald RJ, McDonald JS, Kallmes DF, et al. Gadolinium deposition in human brain tissues after contrast-enhanced MR imaging in adult patients without intracranial abnormalities. Radiology 2017; 285:546-554. (Shows most of Gd is deposited in vascular endothelium although some makes it into brain cytoplasm and nuclei).
Radbruch A, Weberling LD, Kieslich PJ, et al. Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent. Radiology 2015; 275:783-791. (More Gd deposition seen with linear agent gadopentate [Magnevist] than with macrocyclic agent gadoterate [Dotarem])
White GW, Gibby WA, Tweedle MF. Comparison of Gd(DTPA-BMA) (Omniscan) versus Gd(HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Invest Radiol 2006;41:272-278.
Do all MR contrast agents carry the same risk of NSF?