GBCAs are paramagnetic coordination complexes comprising of a Gadolinium-III (Gd(III)/Gd
3+) ion and a chelator that independently do not emit MR signals but can bring about a significant reduction of the
T1 of nearby water protons
[28][1]. Annually, millions of patients globally undergo MRI scans who receive GBCAs. The lanthanides like Gd are highly coveted CAs due to their intrinsic paramagnetic properties, favorable relaxation time,
[29][2], and stable shelf life. GBCAs permit the imaging of tissues that are less sensitive to motion (hence better quality images) and higher throughput by shortening
T1 of the proton
[28][1]. The contrast enhancement function comes from Gd
3+ that has seven unpaired electrons. After administering the CA, the diagnostic image is procured while the patient is in the scanner. Generally, the diagnostic and prognostic information attained from MRI predominates the information given from other techniques. Several GBCAs have gained regulatory approvals, including Eovist
® (gadoxetate disodium), Omniscan
® (a gadodiamide), Gadavist
® (gadobutrol), Optimark
® (gadoversetamide), etc.
[30,31][3][4]. The free Gd
3+ ion is toxic since its ionic radius is relatively close to zinc, calcium, or iron
[32][5]. Likely interference with calcium ion channels in the living entity is plausible. Gd
3+, therefore, needs to be cocooned within chelator (most often used is organic ligands) to avoid those toxicity issues
[33,34][6][7]. Two classes of chelates developed to complex Gd: linear or macrocyclic organic ligands evade the release of free Gd
3+ and make the resulting complexes kinetically and thermodynamically stable
[35][8].
However, in 2006, GBCAs were associated with a devastating and potentially fatal condition called nephrogenic systemic fibrosis
[36][9], recurrently reported in patients suffering from renal deficiency, and its onset can occur months after the last GBCA administration
[28][1]. Furthermore, it is prevailing that some fraction of the residual Gd
3+ can remain in the body for long periods, although the chemical form or its whole-body distribution is still obscure
[28][1]. Because of the low sensitivity of MRI, formulation stipulates a high concentration of Gd
3+, typically 0.1 mmol kg
−1 body weight (approximately 0.5 M aqueous solution) that is hypertonic relative to body fluids
[37][10]. Notwithstanding this, some macrocyclic GBCAs are still sanctioned and can be administered to the patients but in the lowest possible doses. Together, these conclusions have led to renewed interest in finding alternatives to using Gd
3+ for MR contrast
[38,39][11][12]. Further, in 2017, the European medicines agency (EMA) and FDA confirmed the necessity of restricting the use of some linear GBCAs because they tend to release Gd ions in the biological environment
[40,41][13][14]. For a deeper understanding of GBCAs, the reader is referred to the following reviews
[27,28,34,39][15][1][7][12].