Short name: AMI-25, generic name: Ferumoxide (SPIO)
Ferumoxides are superparamagnetic (T2*) MRI contrast agents, so the largest signal change is on T2 and T2* weighted images.
The agent distributes relatively rapidly to organs with reticuloendothelial cells primarily the liver, spleen and bone marrow. The liver shows decreased signal intensity, as does the spleen and marrow. The agent is taken up by the normal liver, resulting in increased CNR between tumor and normal liver. Hepatocellular lesions, such as adenoma or focal nodular hyperplasia, contain reticuloendothelial cells, so they will behave similar to the liver, with decreased signal on T2 weighted images. On T1 images, there is typically some circulating contrast agent, and blood vessels show increased signal intensity.
Current MRI protocols involve T1 weighted breath-hold gradient echo images of the liver, and fast spin echo T2 weighted pictures. This requires about 15 minutes. The patient is then removed from the scanner, and the contrast agent administered. After contrast administration, the same pulse sequences are again repeated.

Short name: Gd-DTPA, generic name: Gadopentetate dimeglumine, chemical compound: Gadolinium-diethylenetriaminepentaacetic acid
Gadopentetate dimeglumine was introduced in 1981, as the first paramagnetic MRI contrast agent (ionic). The Gd-induced dipole dipole interactions lead to shortening of T1, which results in contrast enhancement on T1 weighted images. The used metal ion Gd3+ (gadolinium) is toxic, and therefore bound in the renally excreted DTPA chelate, a very stable complex. The Gd-complex also induce susceptibility effects, as a result of the magnetic field gradient between the contrast agent in the blood vessels and the surrounding tissue, that lead to shortening of T2 or T2*.
Following intravenous administration, the compound is distributed rapidly in the extracellular space and is eliminated unchanged by glomerular filtration via the kidneys. Up to 6 hours, post injection an average of 83% of the dose is eliminated renal.

See also Magnevist®, Gadolinium and Contrast Agents.

Gadovist® is an extracellular, neutral macrocyclic (gadolinium (Gd) complex) MRI contrast agents for central nervous system indications, particularly suited for studies in which high doses are required or advantageous. Gadovist® (also Gadograf) was available in two concentrations, currently only Gadovist® 1.0 is marketed.
The product was approved in Switzerland in 1999 and in Germany in 2000. Gadovist® 1.0 is in USA currently in the drug development and approval process, particularly for magnetic resonance angiography.

WARNING: NEPHROGENIC SYSTEMIC FIBROSIS Gadolinium-based contrast agents increase the risk for nephrogenic systemic fibrosis (NSF) in patients with acute or chronic severe renal insufficiency (glomerular filtration rate less than 30 mL/min/1.73m²), or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period.

See also Paramagnetic Contrast Agents and Gadobutrol.

Rectal staging is necessary for the preoperative assessment of intra- and extramural tumor infiltration or the decision for adjuvant radio-chemotherapy. One indication of MRI with luminal contrast enhancement is small bowel enteroclysis after duodenal intubation for visualization of inflammatory bowel wall thickening and other complications.
"Double contrast" enhancement of the bowel lumen is the administration of plain water or water with methylcellulose along with heavily T2 weighted sequences or contrast enhanced T1 weighted sequences.
Several oral contrast agents have been used for small bowel MRI: Mannitol, metamucil, locust bean gum, and PEG. All provide sufficient bowel distension and homogeneity, but suffer from side effects such as diarrhea. The volume of PEG or mannitol administered must be not too large in order to achieve the best compromise between distension and acceptance by the patient.
MR colonography with positive bowel lumen enhancement requires higher concentrations of paramagnetic agents compared to the available dedicated enteral contrast agents, IV compounds are used to dope water enemas for this purpose.
Some investigators advocate negative bowel enhancement with Contrast Agents to suppress high signal bowel content in MRCP ( Magnetic resonance cholangiopancreaticography ). The use of a mixture of metamucil and 20 ml of gadolinium chelate provides good homogeneity and good tolerance without diarrhea.

Lantheus Medical Imaging is a worldwide leader in medical imaging, with headquarters in North Billerica, Massachusetts, and nearly 700 employees worldwide with offices in Puerto Rico, Canada, and Australia.
The product portfolio includes ABLAVAR™ (gadofosveset trisodium) a blood pool contrast agent for magnetic resonance angiography MRA, Cardiolite® (Kit for the preparation of Technetium Tc99m Sestamibi), a cardiac perfusion imaging agent and DEFINITY® Vial for (Perflutren Lipid Microsphere) injectable suspension, the leading cardiac ultrasound contrast agent in the US.

MRI Contrast Agents: