Science to Practice: Will Gadolinium Chelates Be Replaced by Iron Chelates in MR Imaging?

Boehm-Sturm et al (1) pose a possible paradigm shift in magnetic resonance (MR) imaging: the substitution of iron chelates for gadolinium chelates as paramagnetic contrast agents. The advent of nephrogenic systemic fibrosis challenges the wide-spread perception that gadolinium is benign, and that all gadolinium-based contrast agents (GBCAs) are identical. Long-term gadolinium retention in patients with normal renal function is now a disturbing fact. Unlike gadolinium, iron is an endogenous metal with a tightly regulated transport and storage mechanism. The question the article raises is therefore a compelling one.