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.
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.
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.
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