Until recently it was believed that extracellular gadolinium based contrast agents (Gd-CA) were safe for both the kidneys and all other organs within the dose range up to 0.3mmol/kg body weight. However, in 2006, it was demonstrated that some Gd-CA may trig the development of nephrogenic systemic fibrosis, a generalized fibrotic disorder, in renal failure patients. This sub-section of European Journal of Radiology covers the current knowledge about NSF from many aspects. The prevention of NSF must be given high priority, but it should not lead to a denial of a well-justified, enhanced MRI examination with a stable agent.