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Ten Years Later: Gadolinium Toxicity – A Disease of Degrees
Editorial by Sharon Williams
November 12, 2025
In early 2015, I opened a post with the following question: Why does a Gadolinium Toxicity diagnosis have to be full-blown NSF (Nephrogenic Systemic Fibrosis) or nothing at all? I went on to say that we believe Gadolinium Toxicity is a “disease of degrees”, which can manifest itself in many ways depending on how much gadolinium someone retains. And it can occur in patients with normal renal function.
Here we are ten years later, in 2025, and our belief about retained gadolinium causing a disease with varying degrees of severity is stronger than ever. That belief is based on the results of the Patient Survey that Hubbs Grimm and I conducted last year along with patient advocates Sarah Ratnam and Catriona Walsh. We recently released our first paper that focuses on the symptoms reported by 316 survey participants after MRIs with a gadolinium-based contrast agent (GBCA). The patients had normal and near normal renal function at the time of their MRIs. 185 of the participants have one or more test results that confirm they retained gadolinium for more than 30 days and for as long as 22 years after contrast administration, including 14 years in pelvic bone, and 13 years in sigmoid colon tissue.
The similarities between the symptom reporting patterns of the survey participants closely mirror those published about the clinical presentation of early-phase NSF as described by Marckmann & Skov (2009). Based on what Marckmann wrote about NSF, it seems that NSF itself had varying degrees of severity. Marckmann (2009 & 2011) wrote that there were significant individual differences in the clinical course of NSF, even in end-stage renal disease (ESRD) patients, which seems to indicate that retained gadolinium could trigger a range of symptoms, with a varied clinical outcome in all patient populations.
The variability of the symptoms shows that even in severely renally impaired patients, gadolinium-induced NSF did not cause the exact same set of symptoms or level of severity.
Is NSF itself the “disease of degrees”? Do all patients affected by gadolinium manifest NSF to varying extents, but without the “N” or nephrogenic component? The many similarities between the early clinical picture of NSF and the symptoms reported by participants in our Patient Survey suggest that they do.
Rather than a new or separate disease entity for patients with normal renal function, such as Gadolinium Deposition Disease (GDD) as described by Semelka & Ramalho (2023), our survey findings suggest that GDD and NSF may reflect different points along a continuum of gadolinium-induced toxicity. In other words, what we are observing may be one gadolinium-induced disease process manifesting with varying degrees of severity, which is how Marckmann described NSF in his Severity Grading in 2009.
Gadolinium has the Potential to Harm All Patients (more…)
Reports of Gadolinium Retention in brain tissues of patients with normal renal function raise safety concerns
Several recent studies that involve Gadolinium-based Contrast Agents used for enhanced MRIs have gotten the attention of the radiology community. The findings of all the studies indicate that Gadolinium-based Contrast Agents, or GBCAs, might not work exactly as everyone thought they did. The recent Mayo Clinic study by McDonald et al appears to confirm that at least some gadolinium from the intravenously administered GBCA can remain in brain tissues of patients – including in patients with normal renal function. Based on reports of increasing T1 signal intensity on unenhanced magnetic resonance images (MRI) in patients who had multiple MRIs with a GBCA, it appears that once deposited, gadolinium accumulates in the brain tissue. (Recent studies cited at end.)
Prior to the publication of these studies, patients with normal renal function had been told that their unexplained, chronic symptoms could not be from retained gadolinium; however, the findings of the recent studies cast serious doubt on that. The findings seem to support what patients with normal renal function have been saying for years now – they are retaining gadolinium from the GBCA administered for their MRIs and they are experiencing troubling symptoms because of it.
Recently I had the opportunity to provide some information for a story about GBCA safety that John Hocter, managing editor of Health Imaging, was writing. The recent publication of his article brought the plight of patients with normal renal function to a broader and more public audience. Also contributing to the article was Tobias Gilk, a leading MRI Patient-Safety advocate and member of the newly formed American Board of MR Safety. (more…)
Gadolinium Toxicity – A Disease of Degrees
Why does a Gadolinium Toxicity diagnosis have to be full-blown NSF (Nephrogenic Systemic Fibrosis) or nothing at all? Patients with normal kidney function have been trying to get an answer to that question for years now, but for some reason no one is listening.
NSF, which can occur when someone with severe kidney disease retains large amounts of Gadolinium, is probably the worst manifestation of Gadolinium Toxicity. But what happens to people who retain less Gadolinium? Couldn’t those people also be adversely affected, but perhaps to a lesser degree than full-blown NSF?
We believe Gadolinium Toxicity is a “disease of degrees” which can manifest itself in many ways depending on how much Gadolinium someone retains. Since free Gadolinium is toxic, it would seem that the severity of each person’s symptoms will likely depend on the total amount of Gadolinium retained from the administered Gadolinium-based Contrast Agent. (more…)
Gadolinium Toxicity 