Just as a heads up from a rando on the internet this sort of research is trying to understand mechanisms of things that happened 20-30 years ago and people who were exposed back then (sometimes many times with significant accumulation).
Gadolinium is toxic so contrasts trap it with protective molecules that hold the gadolinium until it leaves the body (most leave via the kidneys, but some also leave via liver/gallbladder). Some fraction of gadolinium escapes depending on the structure of the protective molecules. After the problems with the older contrasts were found kidney function became important (impaired kidney function allows more time for gadolinium to escape) and later new contrasts were designed that are much more stable. The gadolinium contrasts we use today are much more stable than the ones we used previously and there haven't been any cases of the sorts of things this article is about in over ten years. But there are a lot of people alive who received the old agents many times and in higher doses than we use today.
I don't want to diminish the concerns (and frankly I think this is important to understand what happens to gadolinium in the body), but the exposure and accumulation are significantly lower today than they have been in the past because reducing exposure has become a major focus of design safety for gadolinium contrast and the worst offenders have been voluntarily withdrawn from the market.
Anyway if my kid needed contrast for accurate diagnosis, I'd do it. I work at a pediatric hospital and generally the way it works is if contrast might be needed its ordered and consented so that it's an option. During the scan radiologists check the images and decide whether contrast is needed to answer the clinical question (although in general that's more a question of time management if the question has already been answered, there's no reason to keep imaging).
Appreciate this comment, thank you. (It's hard to gauge the recency of these concerns, the materials being used, or the prevalence of NSF -- and it can all get a bit overwhelming.)
Gadolinium is toxic so contrasts trap it with protective molecules that hold the gadolinium until it leaves the body (most leave via the kidneys, but some also leave via liver/gallbladder). Some fraction of gadolinium escapes depending on the structure of the protective molecules. After the problems with the older contrasts were found kidney function became important (impaired kidney function allows more time for gadolinium to escape) and later new contrasts were designed that are much more stable. The gadolinium contrasts we use today are much more stable than the ones we used previously and there haven't been any cases of the sorts of things this article is about in over ten years. But there are a lot of people alive who received the old agents many times and in higher doses than we use today.
I don't want to diminish the concerns (and frankly I think this is important to understand what happens to gadolinium in the body), but the exposure and accumulation are significantly lower today than they have been in the past because reducing exposure has become a major focus of design safety for gadolinium contrast and the worst offenders have been voluntarily withdrawn from the market.
Anyway if my kid needed contrast for accurate diagnosis, I'd do it. I work at a pediatric hospital and generally the way it works is if contrast might be needed its ordered and consented so that it's an option. During the scan radiologists check the images and decide whether contrast is needed to answer the clinical question (although in general that's more a question of time management if the question has already been answered, there's no reason to keep imaging).