Interpretive Handbook

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 for magnetic resonance imaging and computer tomography scanning.

Gadolinium is eliminated primarily by renal filtration. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes. Patients with reduced renal function exhibit an increased gadolinium excretion half-life.

Gadolinium has been associated with the nephrogenic systemic fibrosis in patients with impaired renal function. In this syndrome, prolonged retention of gadolinium is thought to allow the gadolinium cation to dissociate from its synthetic organic chelator and deposit predominantly in the skin, although other organs may be affected as well. These patients are often severely debilitated by progressive skin thickening and tightening. Fibrosis of skeletal muscle, lungs, liver, testes, and myocardium have all been observed, often with fatal results. Because the ionic radius of gadolinium (3+) is similar to that of calcium (2+), it may also deposit in bone.

Three hemodialysis treatments are required to substantially remove gadolinium from patients with impaired renal function; peritoneal dialysis is not effective.

As an aid in the diagnosis of nephrogenic systemic fibrosis

Elevated gadolinium (>0.5 mcg/L) observed in a random urine specimen collected >48 hours after administration of gadolinium-containing contrast media indicates impaired ability to eliminate gadolinium. These patients have an increased risk of developing nephrogenic systemic fibrosis.

A normal value is <0.5 mcg/L; the lower limit of the assay's reportable range is 0.1 mcg/L.

Urine gadolinium concentration will be elevated if the specimen is collected <96 hours of administration of gadolinium-containing contrast media. This elevation is due to residual gadolinium present from contrast media infusion. Elevated gadolinium in a specimen collected <96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.

0.0-0.4 mcg/L

Reference values apply to all ages.

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2. Swan SK, Lambrecht LJ, Townsend R, et al: Safety and pharmacokinetic profile of gadobenate dimeglumine in subjects with renal impairment. Invest Radiol 1999;34:443-448

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6. Leung N, Pittelkow MR, Lee CU, et al: Chelation of gadolinium with deferoxamine in a patient with nephrogenic systemic fibrosis. NDT Plus 2009;2(4):309-311