Gadolinium Deposition Disease Current State of Knowledge and Expert Opinion

This review describes the current knowledge of a form of gadolinium toxicity termed gadolinium deposition disease (GDD), supplemented with the opinions of the authors developed during 6 years of clinical experience treating GDD. Gadolinium deposition disease can also be considered a subset under the symptoms associated with gadolinium exposure rubric. Young and middle-aged White women of central European genetic origin are the most affected. The most common symptoms are fatigue, brain fog, skin pain, skin discoloration, bone pain, muscle fasciculations, and pins and needles, but a long list of additional symptoms is reported herein. The time of onset of symptoms ranges from immediate to 1 month after gadolinium-based contrast agent (GBCA) administration. The primary treatment is to avoid further GBCAs and metal removal through chelation. Presently, the most effective chelating agent is DTPA because of its high affinity with gadolinium. Flare development is an expected outcome, amenable to concurrent immune dampening. We emphasize in this review the critical nature of recognizing GDD when it first arises, as the disease becomes progressively more severe with each subsequent GBCA injection. It is generally very treatable after the first symptoms of GDD, often arising after the first GBCA injection. Future directions of disease detection and treatment are discussed.