Biphasic oral contrast agents may produce either high or low signal intensities depending on the pulse sequence used, for example low signal intensity on T1 weighted MR images and high signal intensity on T2 weighted images. The combination of different oral contrast agents can generate a macroscopic cancellation of negative and positive magnetic susceptibility, thereby eliminating susceptibility artifacts.
Possible combinations are e.g., ferric ammonium citrate and corn oil, or ferrous sulfate emulsified with baby formula. Paramagnetic agents combined with oil emulsion may be used in MRI as positive abdominal contrast agents. The combination of diamagnetic barium sulfate and superparamagnetic iron oxide (SPIO) in one suspension may be a useful negative contrast agent.

See also Gastrointestinal Paramagnetic Contrast Agents, Gastrointestinal Superparamagnetic Contrast Agents, Gastrointestinal Diamagnetic Contrast Agents, Gastrointestinal Imaging.

Intravenous contrast agents used in MRI are distributed in the extracellular spaces of the body before being excreted. In this sense they are similar to iodinated X-ray contrast media. However, contrast agents used for MRI are quite different from conventional radiographic contrast media in structure and function and there is no known cross sensitivity between these types of contrast agents. Common MRI contrast agents use metal ions (e.g., gadolinium or manganese) complexed with organic molecules.
Gd-DTPA, an ionic linear molecule complex (gadopentetate dimeglumine) was the first marketed MRI contrast agent. Although the osmolality of this substances can be relatively high (up to 1940 mOsm/kg H2O) compared with plasma, adverse reactions and side effects are very rare. The used doses are smaller compared with radiographic contrast media.

See also Nonionic Intravenous Contrast Agents, Dotarem®, and Magnevist®.

Small particles of ferrite are used as superparamagnetic contrast medium in MR imaging (appearing predominantly dark on MRI). These agents exhibit strong T1 relaxation properties, and due to susceptibility differences to their surroundings also produce a strongly varying local magnetic field, which enhances T2 relaxation to darken the contrast media containing structures.
Superparamagnetic contrast agents are also known by the abbreviation SPIO's (small particle iron oxide or superparamagnetic iron oxide) and USPIO's (ultrasmall particle iron oxide or ultrasmall superparamagnetic iron oxide).
Two types of USPIO will be available on the market as blood pool agents, while SPIO's have been used as darkening contrast agents for liver imaging. As particulate matter they are taken up by the RES. Very small particles of less than 300 nanometers also remain intravascular for a prolonged period of time and thus can serve as blood pool agents.

See also the related poll result: 'The development of contrast agents in MRI is'

Liver imaging with gadolinium contrast enhanced MRI is sometimes not sufficient for a reliable diagnosis of liver lesions. For this reasons, special liver Contrast agents that are targeted to the reticuloendothelial system (RES), have been developed to improve both detection and characterization of liver and spleen lesions. Reticuloendothelial Contrast Agents, as e.g. superparamagnetic iron oxides (SPIO), are taken up by healthy liver tissue but not tumors.
These RES targeted contrast agents provide a prolonged imaging window and enough time for high spatial resolution or multiple breath hold images. Reticuloendothelial contrast agents have an increased sensitivity for the detection of small liver lesions (e.g., metastases), compared with gadolinium enhanced MRI and spiral CT. At higher field strengths with an increased signal to noise ratio the susceptibility effect with iron oxide particles may be enhanced.
Other new agents (Gadobenate Dimeglumine, Gadoxetic Acid) have both an initial extracellular circulation and a delayed liver-specific uptake. Since a considerable part of these contrast agents is excreted in the bile, functional biliary imaging can diagnose biliary anomalies, postoperative bile leaks, and anastomotic strictures. Other agents, such as liposomes (with encapsulated Gd-DTPA) or DOTA complexes are in different development stages.

See also Hepatobiliary Contrast Agents, Gadolinium Oxide, Superparamagnetic Iron Oxide and Liposomes.

Radiographic low-osmolar nonionic contrast agents have less side effects and fewer nephrotoxicity than ionic, high-osmolar agents. Gadolinium-based MRI contrast agents have a different formulation from iodinated X-ray contrast media, and there is no known cross sensitivity between these two types of contrast agents. Intravenous MRI contrast agents, specifically the gadolinium chelates have a high safety and lack of nephrotoxicity compared with X-ray contrast media.
The used gadolinium chelates differ in following properties: linear (e.g., gadodiamide and gadoversetamide have nonionic linear structures) vs. macrocyclic cores, and ionic vs. nonionic types. The nonionic molecules have lower osmolality and viscosity, which increase digestibility at greater concentrations, and make faster bolus injections conceivable. The macrocyclic molecules (e.g., gadoteridol has a nonionic macrocyclic ring structure) are more stable and show fewer tendencies to dissociate free Gd.

See also ProHance®, Omniscan®, OptiMARK®, Ionic Intravenous Contrast Agents.

See also the related poll result: 'MRI will have replaced 50% of x-ray exams by'