Radiographic low-osmolar nonionic contrast agents have less side effects and fewer nephrotoxicity than ionic, high-osmolar agents. Gadolinium-based MRI contrast agents have a different formulation from iodinated X-ray contrast media, and there is no known cross sensitivity between these two types of contrast agents. Intravenous MRI contrast agents, specifically the gadolinium chelates have a high safety and lack of nephrotoxicity compared with X-ray contrast media.
The used gadolinium chelates differ in following properties: linear (e.g., gadodiamide and gadoversetamide have nonionic linear structures) vs. macrocyclic cores, and ionic vs. nonionic types. The nonionic molecules have lower osmolality and viscosity, which increase digestibility at greater concentrations, and make faster bolus injections conceivable. The macrocyclic molecules (e.g., gadoteridol has a nonionic macrocyclic ring structure) are more stable and show fewer tendencies to dissociate free Gd.

See also ProHance®, Omniscan®, OptiMARK®, Ionic Intravenous Contrast Agents.

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Short name: Gd-DTPA-BMA, generic name: Gadodiamide, chemical compound: Gd-diethylenetriaminepentaacetate-bis(methylamide), central moiety: Gd
A paramagnetic MRI contrast agent (nonionic) with a small molecular weight linear chelate. Due to the linkage of two DTPA molecules through amide bonds the molecule is uncharged and has a low osmolality. The substance is excreted almost exclusively by the kidneys.

See also Nonionic Intravenous Contrast Agents and Omniscan®.

Intravenous contrast agents used in MRI are distributed in the extracellular spaces of the body before being excreted. In this sense they are similar to iodinated X-ray contrast media. However, contrast agents used for MRI are quite different from conventional radiographic contrast media in structure and function and there is no known cross sensitivity between these types of contrast agents. Common MRI contrast agents use metal ions (e.g., gadolinium or manganese) complexed with organic molecules.
Gd-DTPA, an ionic linear molecule complex (gadopentetate dimeglumine) was the first marketed MRI contrast agent. Although the osmolality of this substances can be relatively high (up to 1940 mOsm/kg H2O) compared with plasma, adverse reactions and side effects are very rare. The used doses are smaller compared with radiographic contrast media.

See also Nonionic Intravenous Contrast Agents, Dotarem®, and Magnevist®.

(NSF) Nephrogenic systemic fibrosis is a rare and highly debilitating disorder that involves extensive thickening and hardening of the skin with fibrotic nodules and plaques.
MRI contrast media have very low side effects, but accumulating data indicate that gadolinium-based contrast agents increase the risk for the development of NSF among patients with severe renal insufficiency or renal dysfunction due to the hepato-renal syndrome or in the perioperative liver transplantation period.
Due to this reason, gadolinium contrast agents are now considered contraindicated in patients with an estimated glomerular filtration rate fewer than 30 mL/min/1.73m². In these patients, avoid use of gadolinium-based contrast agents unless the diagnostic information is essential and not available with non-contrast enhanced magnetic resonance imaging (MRI).

Recognized or possibly associated factors for NSF:
When administering a gadolinium-based contrast agent, do not exceed the recommended dose and allow a sufficient period of time for elimination of the contrast medium from the body prior to any readminstration. Screen all patients for renal dysfunction by obtaining a history and/or laboratory tests.

See also Contrast Medium, Adverse Reaction, MRI Risks, MRI Safety, Ionic Intravenous Contrast Agents, Nonionic Intravenous Contrast Agents, and Contraindications.

Omniscan® is a nonionic chelate complex with low osmolality used as a paramagnetic MRI contrast agent. The efficacy of Omniscan® is similar to that of Gd-DTPA. Omniscan® is given intravenously to enhance images of intracranial and spinal lesions where there is abnormal vascularity or an abnormal blood brain barrier. The complex does not cross an intact blood brain barrier so Omniscan® only accumulates in lesions such as neoplasm's and abscesses.

WARNING: NEPHROGENIC SYSTEMIC FIBROSIS Gadolinium-based contrast agents increase the risk for nephrogenic systemic fibrosis (NSF) in patients with acute or chronic severe renal insufficiency (glomerular filtration rate less than 30 mL/min/1.73m²), or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period.

See also Gadodiamide, and Classifications, Characteristics, etc.