What is the most commonly used gadolinium-based contrast agent (GBCA) for Magnetic Resonance Imaging (MRI)?

Most Commonly Used Gadolinium-Based Contrast Agent

Macrocyclic gadolinium-based contrast agents (GBCAs) dominate the current market, with over 80% utilization in Europe, and among manufacturers, Bayer holds the largest market share in the United States while Guerbet leads in Europe. 1

Market Distribution and Usage Patterns

The global GBCA market reflects a clear shift toward macrocyclic agents:

• Macrocyclic agents represent more than 80% of the European market, with substantial market dominance worldwide 1
• Bayer holds the largest overall market share among major manufacturers, while GE Healthcare has the smallest 1
• In the United States specifically, Bayer maintains the largest market share, whereas Guerbet dominates the European market 1
• More than 40 million enhanced MRI scans are performed worldwide annually, representing approximately half a billion dollars in gross sales across the United States, Europe, and Japan 1

Specific Agent Usage Trends

Declining Linear Agents

• Gadodiamide (Omniscan, GE Healthcare) has fallen to below 10% market share in the United States, primarily due to concerns about nephrogenic systemic fibrosis and brain gadolinium deposition 1
• Four linear agents (gadodiamide, gadoversetamide, gadopentetate dimeglumine, and gadobenate dimeglumine) had their marketing authorizations suspended by the European Medicines Agency in 2017 due to convincing evidence of gadolinium brain deposition 1

Rising Macrocyclic Agents

• Gadoterate meglumine (Dotarem, Guerbet) is a macrocyclic agent approved for brain, spine, and associated tissue imaging in adults and pediatric patients including term neonates 2
• Gadobenate dimeglumine (MultiHance, Bracco) has risen substantially in U.S. market share in recent years, benefiting from the declining use of gadodiamide 1
• Gadoteridol (ProHance, Bracco) currently holds approximately 5% of the U.S. market with rising utilization 1

Clinical Rationale for Macrocyclic Preference

The shift toward macrocyclic agents is driven by their markedly superior stability compared to linear agents, both in vitro and in vivo, with significantly reduced risk of gadolinium release and tissue deposition 1:

• Macrocyclic agents demonstrate superior thermodynamic and kinetic stability compared to linear agents 1
• Linear nonionic agents (gadodiamide and gadoversetamide) are markedly less stable than even linear ionic agents 1
• Gadolinium retention in brain, bone, and other organs occurs for months or years, particularly with linear agents 2, 3
• Key experts recommend shifting clinical practice from linear to macrocyclic agents except where no suitable alternative exists 1

Hepatobiliary Agents

For liver imaging specifically, extracellular gadolinium agents are most commonly used, though hepatobiliary agents (gadoxetate disodium and gadobenate dimeglumine) are increasingly utilized 1:

• Gadoxetate disodium (Eovist/Primovist) remains available despite being a linear agent because it meets an important diagnostic need for liver imaging at lower doses 1
• Gadoxetate is used more widely for hepatobiliary phase imaging than gadobenate, with hepatobiliary phase occurring at approximately 20 minutes versus 1-2 hours 1

Safety Considerations

The most commonly used agent should be a macrocyclic GBCA due to superior safety profile 1, 4:

• Gadolinium-based agents have significantly lower incidence of allergic reactions compared to iodinated contrast (0.01% severe anaphylactoid reactions) 1, 4
• Macrocyclic agents are considered safer regarding gadolinium retention in tissues 4, 5
• The recommended dose for gadoterate meglumine is 0.1 mmol/kg body weight administered as intravenous bolus 2