Although several metal-based agents have been explored over the years, gadolinium-based contrast agents (GBCAs) have come to dominate the contrast-enhanced MRI (CE-MRI) market since their introduction in the late 1980s.1,2

Since 2006, an evolving understanding of the potential risk associated with unbound gadolinium (Gd3+) ions, specifically nephrogenic systemic fibrosis (NSF) has highlighted the clinical need for innovation of contrast media.2-4

Imaging and processing technology have continued to advance, opening the possibility of developing new contrast agents that may improve resolution and/or provide a more optimal balance between benefit and risk.2,5

Advances in MRI technology, including the development of new contrast agents, hold the promise of a clearer, brighter future for surgeons, radiologists, and their patients who will benefit from image enhancement.

Innovations currently under investigation include2

  • GBCAs with higher relaxivity
  • Manganese (Mn)-based agents
  • Iron (Fe)-based agents
  • Metal-free agents
  • Advanced image processing imaging technology

Current and future contrast enhancement approaches

Although research efforts to develop alternative contrast agents are ongoing, candidates have yet to demonstrate the broad utility of current Gd-based agents. While technological advancements in software, including image processing and AI, seem to offer vast potential, it may be some time before these advances are ready for clinical practice.2

While the goals of improving efficacy and/or safety are clear, whether new contrast agents or contrast-free approaches will achieve these goals remains to be seen. It seems likely that the near future for MRI enhancement will still include Gd.2,5


  1. de Haën C. Conception of the first magnetic resonance imaging contrast agents: a brief history. Top Magn Reson Imaging. 2001;12(4):221-230.
  2. Minton LE, Pandit R, Willoughby WR, Porter KK. The future of magnetic resonance imaging contrast agents. Appl Radiol. 2022:7-11.
  3. Endrikat J, Dohanish S, Schleyer N, et al. 10 years of nephrogenic systemic fibrosis: a comprehensive analysis of nephrogenic systemic fibrosis reports received by a pharmaceutical company from 2006 to 2016. Invest Radiol. 2018;53:541-550.
  4. Tweedle MF. Next-generation MRI contrast agents: still including gadolinium.
    Radiology. 2020;294:127-128.
  5. Lancelot E, Raynaud JS, Desché P. Current and future MR contrast agents: seeking a better chemical stability and relaxivity for optimal safety and efficacy. Invest Radiol. 2020;55:578-588