Test Catalog

Test ID: GDS    
Gadolinium, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Aiding in documenting past exposure to gadolinium-based contrast agents in serum specimens

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media (gadolinium-based contrast agents: GBCA) for magnetic resonance imaging and computer tomography scanning.


Gadolinium is primarily eliminated via the kidneys, so exposure can be prolonged in patients with renal insufficiency. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes (1.5 hours). Patients with reduced renal function and some patients with normal renal function may exhibit a prolonged gadolinium elimination half-life.


To date, the only known adverse health effect related to gadolinium retention is a rare condition called nephrogenic systemic fibrosis (NSF). NSF is a relatively uncommon condition in which fibrous plaques develop in the dermis and, often, in deeper connective tissues. Reported cases have occurred almost exclusively in patients with severe renal disease, and almost all have been associated with prior use of GBCAs. NSF is a painful skin disease characterized by thickening of the skin, which can involve the joints and cause significant limitation of motion within weeks to months. Over the past decade, changes in clinical practice guidelines have almost completely eliminated the incidence of NSF. However, the association of NSF and observed elevated gadolinium concentrations is still not fully understood.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

<0.5 ng/mL

Interpretation Provides information to assist in interpretation of the test results

Elevated gadolinium observed in serum specimens drawn more than 96 hours after administration of gadolinium-containing contrast media is not typical of most patients with normal renal function, and may indicate prolonged elimination of gadolinium and exposure to anthropogenic sources.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Serum gadolinium concentration may be elevated if the specimen is drawn less than 96 hours after administration of gadolinium-based contrast agents (GBCA). This elevation is due to residual gadolinium present from contrast media infusion. An elevated serum gadolinium in a specimen collected more than 96 hours after contrast media infusion does not definitively indicate risk of nephrogenic systemic fibrosis (NSF) or significant gadolinium toxicity. Ultimately, patients should consult with their healthcare providers to interpret any test results.

Supportive Data

A small number of patients studied at Mayo Clinic have demonstrated measureable (0.6-2.1 ng/mL) gadolinium in serum collected 30 days after gadolinium infusion, so some prolonged elimination is possible.


Serum gadolinium concentrations above the stated reference range may indicate prolonged elimination, residual gadolinium retention, or continuing environmental exposure. However, elevated serum gadolinium concentrations do not necessarily indicate toxicity.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Othersen JB, Maize JC, Woolson RF, Budisavljevic MN: Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007;22:3179-3185

2. Perazella MA: Nephrogenic systemic fibrosis, kidney disease, and gadolinium: is there a link? Clin J Am Soc Nephrol 2007;2:200-202

4. Christensen KN, Lee CU, Hanley MM, et al: Quantification of gadolinium in fresh skin and serum samples from patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2011;64(1):91-96

5. Girardi M, Kay J, Elston DM, et al: Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol 2011;65:1095-1106

6. Telgmann L, Sperling M, Karst U: Determination of gadolinium-based MRI contrast agents in biological and environmental samples: A review. Analytica Chimica Acta 2013;764:1-16

7. Daftari Besheli L, Aran S, Shaqdan K, et al: Current status of nephrogenic systemic fibrosis. Clin Radiol. 2014 Jul;69(7):661-668

8. Aime S, Caravan P: Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J Magn Reson Imaging 2009;30(6):1259-1267

9. McDonald RJ, McDonald JS, Kallmes DF, et al: Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology 2015;275:772-782

Special Instructions Library of PDFs including pertinent information and forms related to the test