Visualizing CSF related disease processes using MRI requires the use of intrathecally administered Gadolinium-based Contrast Agents (GBCAs). MR cisternogram with GBCAs has shown to provide superior image quality compared to CT cisternogram. However, the lack of sufficient safety evidence limits its use to an off-label use. To address this, we performed a systematic review and meta-analysis to explore adverse events after intrathecal GBCA exposure. Based on our analysis, the overall incidence of serious adverse events was 2.24% with lower incidence at lower doses. We conclude that intrathecal use of GBCAs for MR imaging is safe at low doses.