Recently, Gd-based magnetic resonance imaging (MRI) contrast agents (GBMCA) have been linked to a new disease, Nephrogenic Systemic Fibrosis (NSF), with skin and systemic toxicity and death in certain patients with renal failure. Due to widespread use of GBMCA in diagnostic MRI, it is essential to study their excretion, metabolism, and target sites in cells and tissues. A CAMECA IMS-3f SIMS ion microscope and scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS) were used for imaging Gd isotopes in relation to calcium distributions in histologic sections of human tissues. SIMS imaging revealed two types of Gd localization in skin biopsies of patients who received GBMCA. The Gd was present in micrometer size deposits in association with calcium, and in detectable amounts in a more diffuse cellular distribution. Only the Gd-containing deposits associated with Ca and P were detectable using SEM/EDS. As only insoluble deposits remain in the biopsy tissues after aqueous and organic solvent processing of the tissue, our observations support release of free Gd from the GBMCA and selective localization of insoluble Gd in the target tissue from patients with NSF. This study opens new novel applications of SIMS for characterization of the safety of GBMCA. (C) 2008 Elsevier B. V. All rights reserved.