INVESTIGATION OF GADOLINIUM-BASED CONTRAST REACTIONS IN MRI: SAFETY AND RISK FACTORS

Gadolinium-based contrast agents (GBCAs) are critical for enhancing mag- netic resonance imaging (MRI), improving diagnostic accuracy in over 30 mil- lion annual administrations worldwide. Despite their utility, GBCAs are as- sociated with adverse reactions, including allergic-like responses, anaphylaxis, nephrogenic systemic fibrosis (NSF), and gadolinium retention in tissues, even in patients with normal renal function. This systematic review investigates GBCA safety, risk factors, and mitigation strategies by analyzing 32 clini- cal studies (n=1,245,678 administrations) from 2010 to 2025. We quantified reaction incidence (mild, moderate, severe), identified key risk factors (e.g., allergy history, renal impairment, GBCA type), and evaluated management protocols. Descriptive analyses revealed higher reaction rates with linear GB- CAs (1.0–1.2%) compared to macrocyclic agents (0.1–0.3%), with prior con- trast reactions and renal dysfunction as significant predictors. Premedication and rapid-response protocols effectively reduced risks. While severe reactions are rare (<0.01%), concerns about NSF and gadolinium retention necessitate cautious use. This study underscores the importance of pre-administration screening, preferential use of macrocyclic GBCAs, and standardized safety protocols. Recommendations include enhanced patient risk assessment and adoption of safer agents to minimize adverse outcomes. Continued research is critical to elucidate the long-term effects of gadolinium retention and optimize risk management, ensuring patient safety in MRI diagnostics.