AIM: To discuss the factors related to the adverse reaction (ADR) in the clinical application of four gadolinium contrast agents and the best way to deal with it. METHODS: The characteristics of the contrast agent, the patient's constitution, the diagnosis and treatment, the application of contrast agent, the history of pre-enhanced basic medication and the occurrence of ADR (gadolinium contrast agent osmotic pressure, the form of the blood in the blood after the injection, the way of excretion, the patient's age, sex, dosage, injection, enhancement time, enhanced site; ADR reaction time, severity, treatment after treatment) were compared to comprehensively analyze the contrast agent adverse reaction factors, summary of contrast agent induced acute, late onset and ultra late onset ADR incidence, occurrence characteristics and corresponding clinical treatment methods. RESULTS: Age, injection velocity, pre- enhanced base medication and scanning site were independent risk factors for gadolinium contrast agent ADR; linear ionic specific agent had the highest ADR; the symptoms of various systems and different levels of ADR were strictly symptomatic; all the systems were most common with acute skin symptoms, without special treatment, high recovery rate, late onset or super. Late onset patients need to be treated with antihistamine or glucocorticoid, and no gadolinium deposits of NSF, dentate nucleus, double lung, and pleura were found in patients who had been enhanced with a number of large dose contrast agents within 4 years of follow-up. CONCLUSION: The relative incidence of ring-shaped contrast agents show less ADR, and the history of basic medication (diabetes, allergic rhinitis, tumor History) before the enhancement, and the middle-aged outpatient with large dose of slow weight and light weight when the enhancement is enhanced, have the highest acute mild ADR. The medical workers in the imaging department should master the reasonable ADR treatment, which can effectively reduce the incidence of adverse reactions.