Not for emergencies. For any urgent medical symptom, call 911 or go to the ER. DOD is not an emergency service. Allergic reactions to contrast agents should be reported to the imaging facility and a licensed provider immediately.
MRI With Contrast: What Patients Should Know
Some MRI studies use intravenous contrast agents — gadolinium-based compounds — to enhance visualization of certain tissues or structures. Whether contrast is used depends on the clinical question and is determined by the ordering provider. Patients with kidney disease may need additional evaluation before contrast MRI.
Educational content only. Contrast safety decisions are made by licensed providers and the imaging facility, not by educational resources. DOD does not perform or interpret MRI.
Quick Answer
MRI contrast agents (gadolinium-based) are intravenous compounds that can enhance visibility of certain structures on MRI. Not all MRI studies require contrast — the ordering provider specifies with or without contrast based on the clinical question. Patients with kidney disease should inform both their provider and the imaging facility. An eGFR blood test may be required before gadolinium contrast. DOD can review MRI order requests — with or without contrast as specified by the provider — for eligible patients in supported states.
What Gadolinium Contrast Does
Gadolinium-based contrast agents (GBCAs) are paramagnetic compounds that alter the magnetic relaxation time of nearby hydrogen protons, increasing signal on T1-weighted MRI sequences. When administered intravenously, GBCAs distribute throughout the body and accumulate in areas of increased vascularity or where the blood-brain barrier may be disrupted, causing those areas to appear brighter on the MRI images.
According to the FDA, gadolinium retention in the body has been detected in patients who received multiple GBCA doses, including in the brain, bone, and skin. The FDA has required labeling updates to warn of gadolinium retention. The long-term clinical significance of gadolinium retention in patients with normal kidney function is still being studied.
eGFR and Kidney Function Before Contrast MRI
For patients with kidney disease, gadolinium contrast poses a risk of nephrogenic systemic fibrosis (NSF) — a rare but serious condition affecting connective tissue. The ACR Contrast Manual provides guidelines on gadolinium use in patients with reduced kidney function.
Many imaging facilities require a recent eGFR (estimated glomerular filtration rate) test before administering gadolinium contrast, particularly in patients with diabetes, chronic kidney disease, a single kidney, or other risk factors. DOD can review lab order requests for eGFR/creatinine testing as part of a contrast MRI consultation when appropriate.
Frequently Asked Questions — MRI With Contrast
Sources and Further Reading
- Gadolinium Contrast Agents (GBCAs) — Patient Information — U.S. Food and Drug Administration (FDA)
- ACR Manual on Contrast Media — American College of Radiology (ACR)
- MRI With Contrast — Patient Information — RadiologyInfo.org (ACR / RSNA)
- Nephrogenic Systemic Fibrosis — ISRM — European Society of Urogenital Radiology (ESUR)
Related Education and Order Pages
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Educational content only. DOD does not perform or interpret MRI. Contrast safety decisions are made by licensed providers and imaging facilities. Sources cited are for educational reference only.