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Response to: Safety risks with gadolinium‐based contrast agents

We are grateful to Drs. Marzella, Blank, Gelperin, and Johann-Liang of the U.S. Food and Drug Administration for providing a timely update/reminder on the evolving safety concerns related to gadolinium and especially to Gadodiamide’s association with nephrogenic systemic fibrosis (NSF) as well as the potential for nephrotoxicity, allergic reactions, and injection site reactions. These concerns emphasize the importance of good timing technique to maintain high image quality with a minimum dose of gadolinium in azotemic patients. We are also hopeful that further research into the mechanism of NSF and new agents may offer improved safety profiles in azotemic patients. For example, gadofosveset (Vasovist), with its higher relaxivity and a thermodynamic stability comparable to that of Magnevist, offers the equivalent amount of T1 relaxation enhancement with only one-sixth of the gadolinium atoms (1,2).