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Gadolinium-based contrast agents (GBCAs) are essential for improving the diagnostic accuracy of magnetic resonance imaging (MRI) studies. Although traditionally regarded as highly safe, in recent years the marketing authorisation for certain linear GBCAs has been withdrawn, and the use of macrocyclic GBCAs has become subject to regulatory oversight. Current recommendations advocate the use of the lowest effective dose at all times. Central nervous system (CNS) pathology is the most common indication for MRI with GBCAs. However, clinical recommendations and best practices in this setting often lack a comprehensive approach. This document presents recommendations for the use of GBCAs in the main categories of CNS disease-namely neuro-oncological, inflammatory, infectious and vascular conditions-as well as in CNS angiographic studies. These recommendations have been developed by a nationally convened expert committee. It also highlights the importance of ensuring clinical and environmental safety in the use of these contrast media.