Abstract

Introduction: Gadolinium deposition disease (GDD) is a clinical entity representing persistent defined symptoms following GBCA administration. We report an eight-year expert-observer longitudinal case series of intravenous diethylenetriamine pentaacetic acid (DTPA) chelation in selected patients with GDD who achieved sustained near-complete recovery, with particular attention to the evolution of treatment from a largely physiciandirected protocol to a more individualized, patient-engaged regimen. Methods: Thirty-six potentially eligible patients were contacted, and 30 completed an anonymized structured survey. The cohort comprised 21 women and 9 men (mean age, 46.9 ± 12.9 years). All patients had received at least one intravenous DTPA chelation session under the care of the principal investigator and reported sustained recovery to ≥80% of their pre-GDD baseline. Treatment evolved through three sequential phases: an initial fulldose Ca-/Zn-DTPA regimen with oral corticosteroids, a mid-term full-dose regimen with concurrent intravenous corticosteroids, and a current regimen incorporating graduated DTPA dosing, individualized corticosteroid and antihistamine use, and greater patient participation in treatment decisions. Results: The initial, mid-term, and current treatment phases included 8, 5, and 17 patients, respectively. Thirteen of 30 patients reported a single lifetime gadolinium-based contrast agent exposure, 23 initiated chelation within one year of the presumed causative exposure, and 19 underwent at least five DTPA sessions. Both linear and macrocyclic gadoliniumbased contrast agents were reported as presumed causative exposures. Sustained nearcomplete recovery was reported among selected patients treated during all three regimen periods. Conclusion: This eight-year expert-observer longitudinal case series demonstrates that sustained near-complete recovery can occur in selected patients treated with intravenous DTPA, including under a more individualized and patient-engaged regimen. The study therefore answers an important clinical question—whether this degree of recovery from GDD is achievable—while not determining how often it occurs among all patients who begin chelation. Prospective, consecutive studies with complete denominators, standardized outcomes, and independent assessment are warranted to estimate recovery frequency and refine treatment selection.

Keywords

magnetic resonance imaging, gadolinium deposition disease, intravenous DTPA chelation, expert observer, longitudinal case series, patient-engaged care, patientreported outcomes