Gadolinium Deposition Disease: A New Risk Management Threat

Abstract Gadolinium-based contrast agents (GBCA) have enjoyed wide use since their introduction some 30 years ago. Used in as many as 30% of MRIs performed in the United States, GBCAs have generally been associated with low rates of adverse events. However, the safety profile and attendant medicolegal liability associated with GBCAs changed dramatically in 2016 with the description of gadolinium deposition disease (GDD). Despite being unproven scientifically, a groundswell of GDD-related litigation and personal injury advertising targeting potential GDD patients has occurred. In this article, we describe what GDD is, (2) why GDD has created medicolegal risk, and (3) how can this risk can be mitigated. This article advocates using a risk mitigation strategy focused on reducing brain gadolinium retention during the GDD-sensitive period of the first 2 months post-GBCA administration. As such, the authors recommend the use of gadoteridol as the default GBCA and administering other GBCAs, including linear agents, only when clinically necessary.