Abstract
The U.S. Food & Drug Administration (FDA) has acknowledged that after MRIs with a gadolinium-based contrast agent (GBCA), patients retain an unknown amount of gadolinium (Gd) in the brain, bone, skin, and other tissues, where it can remain for months to years. Although Gd is a toxic metal recognized as the primary cause of nephrogenic systemic fibrosis (NSF), harm attributed to long-term Gd retention in patients with normal renal function has not been recognized.
Results: From a list of 60 symptoms, 19 of the 28 most frequently reported symptoms of the NSF Group were also ranked among the top symptoms reported by two groups of Gd-exposed patients without renal impairment, indicating a substantial overlap in clinical presentation between what has been published about early-phase NSF and the post-GBCA symptom complex. Eleven of the 19 most frequently reported symptoms involve the nervous system.
Conclusion: These observations are consistent with the hypothesis that gadolinium exposure is associated with a spectrum of manifestations and underscore the need for standardized recognition, systematic clinical assessment, and further objective study of Gd-associated multisystem symptoms in all patient populations.
Key Findings
Survey Participants
316 patients with normal or near-normal renal function who experienced symptoms after MRI with a GBCA, plus 8 patients with biopsy-confirmed NSF.
Gadolinium Retention Confirmed
185 patients had laboratory tests confirming gadolinium retention 30 days or longer after their last MRI, with some cases showing retention for up to 22 years.
Symptom Overlap with NSF
19 of the 28 most frequently reported symptoms in the NSF Group were also ranked among the top symptoms reported by patients with normal renal function, indicating substantial overlap in clinical presentation.
Nervous System Impact
11 of the 19 most frequently reported symptoms across all patient groups involve the nervous system, consistent with gadolinium's toxic effects on calcium channels.
Unconfounded Cases
75 patients received only one type of GBCA (19 linear & 56 macrocyclic) with confirmed gadolinium retention. The same 14 nervous system symptoms ranked in the top 25 for both linear and macrocyclic agents.
Chronic Effects
43% of patients reported changes in employment status due to health issues, and 41% said altered brain function affects their ability to work as they did prior to MRIs.
Symptoms by Body System
Symptoms reported within the first 3 months after last MRI with GBCA (WITH Group - 185 patients with confirmed gadolinium retention)
Nervous System
Skeletal System
Integumentary System (Skin)
Endocrine System
Cardiovascular & Circulatory System
Digestive System
Respiratory System
Urinary System
Early-Phase NSF Symptoms
According to Marckmann & Skov (2009), "skin changes and neuropathic symptoms predominate the early phase of NSF." The early phase ranged from 14 to 60 days after GBCA exposure, with an intermediate phase of 60 to 180 days.
- •Skin changes - Rash, erythema, skin discoloration, itching, burning sensations, swelling
- •Neuropathic symptoms - 80% of patients complained of pain, dysesthesia (burning, itching, electric-shock sensations), or hyperalgesia (increased sensitivity to pain)
- •Muscle weakness complaints are common
- •Deep bone pain in the hips and ribs
- •Diffuse hair loss in up to 50% of patients
- •Acute gastroenteritis discomfort with pain, vomiting, and diarrhea
- •Red eyes as signs of noninfectious conjunctivitis in 20% or more
- •Acute pneumonia symptoms in 15%, including shortness of breath, hypoxia
- •Signs of systemic inflammation with fever, elevated C-reactive protein, elevated ferritin, anemia
Survey Methodology
Participants
- 316 patients with normal or near-normal renal function who experienced symptoms after an MRI with a GBCA
- 185 patients had a laboratory test confirming gadolinium retention 30 days or longer after their last MRI (WITH Group)
- 131 patients did not have gadolinium testing performed (WITHOUT Group)
- 8 patients with biopsy-confirmed nephrogenic systemic fibrosis (NSF Group)
Survey Design
The online Patient Survey was created using SurveyMonkey and included 60 symptoms compiled from patient reports, published literature on Gadolinium Deposition Disease (GDD), and Symptoms Associated with Gadolinium Exposure (SAGE). Participants completed the survey without knowledge of other participants' responses.
Geographic Distribution
Patients from around the world participated: 220 from the United States, 12 from Australia, 30 from Germany, 19 from the UK, 12 from Canada, and others from 20+ additional countries.
Important Conclusions
The symptoms reported by those with normal renal function closely match the early phase symptoms of NSF as well as the responses of the NSF Group in this survey. This pattern consistency supports the hypothesis of a gadolinium-related symptom spectrum that extends to those with normal renal function.
Evidence of harm can be found in how body systems dysfunction due to gadolinium's interference with various processes, particularly those that require calcium for proper function. The number of survey responses linked to the nervous system is consistent with gadolinium's documented toxic effects on calcium channels, as acknowledged by the FDA in a 2007 Memorandum.
The Patient Survey results warrant a comprehensive investigation into the long-term adverse health effects of gadolinium retained in connective tissues and glandular tissues in all patient populations.
The symptoms data from this Patient Survey combined with the FDA's 2007 Memorandum that stated, "unchelated gadolinium is a very toxic compound, particularly to the liver and to calcium channels," warrant acknowledgement that retained gadolinium can cause harm to patients with normal renal function, just as it did to some renally impaired patients diagnosed with NSF.
Citation
Williams, S., Grimm, H., Ratnam, S., Walsh, C. (2025). Signs & Symptoms after Gadolinium Administration: A Patient Survey. Report 1: Symptoms Paralleling Early-Phase NSF. Published Online: GadoliniumToxicity.com
Gadolinium Deposition and Toxicity: Humanizing a Life-Changing Event by Debbie Heist Lambert shares personal experiences from patients affected by gadolinium toxicity, providing insight into how those affected navigate this life-changing event. Learn more about this book.