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Additionally, perfusion-weighted imaging (PWI) utilizing dynamic contrast enhancement (DCE) has been evaluated for its ability to provide insights into microvascular parameters concerning blood flow within tumor tissue. Nevertheless, increasing worries regarding gadolinium accumulation within the central nervous system and its effects on the environment have led to a reconsideration of its application. This narrative review explores the current role of GBCAs in HNC imaging, the primary sequences used after GBCA administration, their interpretation, and potential alternative imaging approaches. Currently, GBCA administration is a cornerstone of multiparametric MRI for the diagnosis, staging, and monitoring of HNCs, commonly involving a 3D T1-weighted sequence with fat saturation during the equilibrium phase. While PWI shows potential for clinical application in HNCs, its broader clinical adoption requires further standardization. Notably, DCE can visually aid in detecting subtle tumors, and its application in the differential diagnosis of solid parotid lesions is yielding promising results. Arterial spin labeling is emerging as a compelling alternative for PWI, eliminating the need for GBCA administration. Other promising strategies for reducing or even avoiding GBCA use include hybrid PET\/MRI examinations, the development of novel contrast agents (including high-relaxivity GBCAs and gadolinium-free contrast agents), and the implementation of artificial intelligence tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>When should GBCAs be administered to patients undergoing MRI for HNCs?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>GBCA injection is a cornerstone of multiparametric MRI for the diagnosis, staging, and monitoring of HNCs.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>GBCAs are recommended for HNC MRIs, with a possible exception for patients with no clinical or radiological evidence of recurrence after 27 months of follow-up. DCE is useful for identifying small carcinomas and characterizing parotid lesions<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12165-0","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T12:42:43Z","timestamp":1765629763000},"page":"3648-3660","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Use of gadolinium-based contrast agents in head and neck cancer diagnosis, staging, and monitoring: current applications and future perspectives"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4067-7118","authenticated-orcid":false,"given":"Marco","family":"Parillo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Vaccarino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Falzone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Salvador","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio M.","family":"Doniselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo C.","family":"Quattrocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c0lex","family":"Rovira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"12165_CR1","doi-asserted-by":"publisher","first-page":"1462","DOI":"10.1016\/j.annonc.2020.07.011","volume":"31","author":"J-P Machiels","year":"2020","unstructured":"Machiels J-P, Leemans CR, Golusinski W et al (2020) Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS\u2013ESMO\u2013ESTRO clinical practice guidelines for diagnosis, treatment and follow-up\u2020. 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Carlo Cosimo Quattrocchi has signed speaker contracts with Bayer Healthcare, Bracco Imaging, and Guerbet. He is co-chair of the ESMRMB-GREC Working Group, whose yearly meetings have received unconditional support from Bayer Healthcare, Bracco Imaging, GE HealthCare, and Guerbet. He is a member of the ESUR-CMSC, whose 2-yearly meetings have received support from Bayer Healthcare, Bracco Imaging, GE HealthCare, and Guerbet. 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