Short answer: Manganese-based and gadolinium-based MRI contrast agents are not two equally available options today. The best-documented manganese agent, mangafodipir (Teslascan), had its EU authorization withdrawn in 2012; a 2024 review reports that no manganese-based MRI contrast agent is commercially available for human use. Gadolinium-based contrast agents (GBCAs) remain in clinical use, but their indications and risks differ by product. The available sources do not establish that either metal class is categorically safer.
How manganese and gadolinium contrast differ
These are different medicines, not interchangeable forms of a single contrast agent. Mangafodipir—sold as Teslascan—was the manganese-based agent with the clearest human-use and regulatory record in the reviewed sources. GBCAs are a group of medicines containing gadolinium; their labels and approved uses are product-specific.
The distinction matters for anyone asking whether an MRI contrast injection “contains manganese or gadolinium”: the answer depends on the exact agent selected for that examination. A manganese supplement is not an MRI contrast agent and cannot substitute for one.
| Comparison | Manganese example: mangafodipir (Teslascan) | Gadolinium example: GBCAs, including gadoxetate (Eovist) |
|---|---|---|
| Availability | The European Medicines Agency (EMA) records EU authorization withdrawal on 21 June 2012 for commercial reasons. A 2024 review reports no manganese-based MRI contrast agent commercially available for human use. | Current U.S. product labeling exists for multiple GBCAs. Availability and use depend on the specific product and jurisdiction. |
| Documented liver use | Historically authorized in the EU to detect suspected liver metastases or hepatocellular carcinoma, and as an adjunct in investigating focal pancreatic lesions (EMA). | Eovist is labeled in the United States to detect and characterize focal liver lesions in adults and pediatric patients, including term neonates, with known or suspected focal liver disease (DailyMed). Other GBCAs have different indications. |
| Handling by the body | The EMA assessment describes manganese release or exchange, with manganese mainly excreted through bile and fodipir metabolites through the kidneys. | Gadolinium may be retained in tissues for months or years; retention varies by agent and tissue. Linear agents generally result in more retention than macrocyclic agents, according to Eovist labeling. |
| Main safety context | Historical clinical studies and preclinical findings do not establish a general safety advantage or make it a current routine alternative. | Labels warn about nephrogenic systemic fibrosis (NSF) in people with impaired elimination and describe retention. Decisions consider the particular agent, patient, and diagnostic need. |
| Comparative evidence | Historical studies evaluated mangafodipir under older protocols; they do not provide a contemporary head-to-head comparison with currently used GBCAs. | Current labeling and professional guidance inform present-day use, but they do not establish a class-wide comparison showing one metal class is safer. |
What the agents were used for—and what is available now
Mangafodipir (Teslascan)
The EMA says Teslascan’s active substance was mangafodipir trisodium. Its EU authorization was granted on 22 May 1997 for diagnostic MRI of liver lesions suspected to be metastatic disease or hepatocellular carcinoma, and for use as an adjunct in investigating focal pancreatic lesions. The marketing authorization holder requested voluntary withdrawal for commercial reasons; the authorization ended on 21 June 2012.
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The former product information described Teslascan as an intravenous infusion intended for single use, because repeated dosing had not been studied. It reported near-maximal enhancement of normal liver and pancreas tissue around 15–20 minutes after administration, lasting about four hours. Those are historical product details, not current instructions for patients or clinicians.
Gadolinium products
Eovist (gadoxetate disodium) is a GBCA with a liver-specific U.S. label: MRI to detect and characterize focal liver lesions in adults and pediatric patients, including term neonates, who have known or suspected focal liver disease. It should not be treated as representative of every GBCA; approved indications vary by product.
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What is known about safety
Gadolinium: kidney disease, NSF, and retention
Eovist labeling warns that GBCAs increase the risk of NSF in patients with impaired elimination. The label identifies the greatest risk in chronic severe kidney disease and acute kidney injury. The risk assessment is agent-specific; a kidney diagnosis alone does not determine whether a contrast MRI should proceed.
The label also describes gadolinium retention in several organs for months or years, with amounts varying by tissue and agent. Linear GBCAs generally produce more retention than macrocyclic GBCAs. The clinical consequences of gadolinium retention in the brain have not been established in patients with normal renal function.
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FDA guidance advises minimizing repeat GBCA examinations when possible, but not avoiding or deferring a necessary contrast MRI. ACR–National Kidney Foundation consensus says that, depending on the indication, the harm of delaying or withholding a group II or III intravenous GBCA in someone with acute kidney injury or an eGFR below 30 mL/min/1.73 m² may outweigh the NSF risk. The radiology and referring teams should weigh the diagnostic benefit and the risk of the particular agent for the individual patient.
Manganese: what historical evidence does and does not show
The EMA’s scientific assessment describes mangafodipir undergoing dephosphorylation and transmetallation, with manganese ions released or exchanged. It describes manganese as mainly excreted through the biliary route, while fodipir metabolites are excreted by the kidneys. In repeated-dose animal toxicity studies, the liver and, to a lesser extent, the kidneys were target organs; the assessment also records reproductive toxicity findings in animals. Animal findings are not, by themselves, proof of established human clinical effects.
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In a 1997 phase III multicentre study of 82 patients, more liver lesions were seen on mangafodipir-enhanced T1-weighted images than on unenhanced sequences. Mild-to-moderate adverse events were reported by 17% of participants. This was a historical study of mangafodipir, not a comparison with contemporary GBCAs.
A separate U.S. multicentre phase III safety study published in 2000 included 546 adults. Adverse events were reported by 23%, most mild to moderate; nausea (7%) and headache (4%) were the most commonly reported. Infusion-associated discomfort was reported by 69%, most often heat (49%) and flushing (33%). These figures describe that study population and protocol; they are not universal rates and do not allow a cross-agent safety comparison.
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Is manganese contrast safer than gadolinium?
The sources do not support a head-to-head safety winner. Mangafodipir’s human trial data are historical, and the agent is not a like-for-like commercially available alternative in the reviewed evidence. GBCAs themselves differ in chemical structure, retention profile, labeling, and approved use, so a broad statement that “gadolinium is more dangerous” would also overstate what the evidence shows.
Nor does manganese’s status as an element found in the body make a manganese-based contrast agent automatically safer. Safety depends on the drug’s formulation, dose, how the body handles it, the patient’s health, and the clinical context—not simply the name of the metal.
Questions to ask before a contrast MRI
If you have kidney disease, a prior contrast reaction, or concerns about repeated imaging, ask your care team questions that address the actual examination and agent:
- Which specific contrast agent is planned?
- What diagnostic question will contrast help answer?
- Does acute kidney injury or severe chronic kidney disease affect the plan for this agent?
- Do prior contrast reactions or multiple previous doses matter for this decision?
- Could another scan answer the same question, and what would be lost by using it?
Do not stop, delay, or change a prescribed scan based only on a general comparison of manganese and gadolinium. The decision should be made with the clinicians who know the imaging question and your medical history.
