Pathophysiology of gadolinium-associated systemic fibrosis

Am J Physiol Renal Physiol. 2016 Jul 1;311(1):F1-F11. doi: 10.1152/ajprenal.00166.2016. Epub 2016 May 4.


Systemic fibrosis from gadolinium-based magnetic resonance imaging contrast is a scourge for the afflicted. Although gadolinium-associated systemic fibrosis is a rare condition, the threat of litigation has vastly altered clinical practice. Most theories concerning the etiology of the fibrosis are grounded in case reports rather than experiment. This has led to the widely accepted conjecture that the relative affinity of certain contrast agents for the gadolinium ion inversely correlates with the risk of succumbing to the disease. How gadolinium-containing contrast agents trigger widespread and site-specific systemic fibrosis and how chronicity is maintained are largely unknown. This review highlights experimentally-derived information from our laboratory and others that pertain to our understanding of the pathophysiology of gadolinium-associated systemic fibrosis.

Keywords: NADPH oxidase; fibrosis; gadolinium; nephrogenic fibrosing dermopathy; skin diseases.

Publication types

  • Review
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Contrast Media / adverse effects*
  • Fibrosis / chemically induced*
  • Fibrosis / epidemiology
  • Fibrosis / pathology
  • Gadolinium / adverse effects*
  • Humans
  • Magnetic Resonance Imaging / adverse effects*


  • Contrast Media
  • Gadolinium