Table 1.

Classification of gadolinium‐based media according to their risk for nephrogenic systemic fibrosis by three organizations

Classification per NSF riskChemical NameChelate StructureNotes
ACREMAESUR
Group IHighHighestGadodiamideLinear nonionicContraindicated in those with CKD stages 4–5D and AKI
Intravenous use suspended by EMA
No longer marketed in the United States
Group IHighHighestGadopentetate dimeglumineLinear ionicContraindicated in those with CKD stages 4–5D and AKI
Intravenous use suspended by EMA
No longer marketed in the United States
Group IHighHighestGadoversetamideLinear nonionicContraindicated in those with CKD stages 4–5D and AKI
Intravenous use suspended by EMA
Withdrawn by marketing authorization holder in Europe in 2017
No longer marketed in the United States
Group IILowLowestGadoterate meglumineMacrocyclic ionic
Group IILowLowestGadoteridolMacrocyclic nonionic
Group IILowLowestGadobutrolMacrocyclic nonionic
Group IIMediumIntermediateGadobenate dimeglumineLinear ionicLimited to hepatobiliary imaging by EMA
Group IIIMediumIntermediateGadoxetate disodiumLinear ionicLimited to hepatobiliary imaging by EMA
  • Reprinted from ref. 7, with permission. Based on information provided in the ACR manual (1). NSF, nephrogenic systemic fibrosis; ACR, American College of Radiology; EMA, European Medicines Agency; ESUR, European Society of Urogenital Radiology.