Magnevist® is a paramagnetic ionic contrast agent for use in magnetic resonance imaging. Contrast enhanced MRI with Magnevist® allows additional diagnostic information of tumors, inflammation and vascular lesions and the determination or differentiation of such lesions.
The contrast enhancing effect is produced by the di-N-methylglucamine salt of gadopentetate (Gd-DTPA), the gadolinium complex of diethylenetriamine pentaacetic acid. Magnevist® has the strongest effect on T1 weighted images, by increasing T1 signal intensity in tissues where Magnevist® has accumulated.

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 Ionic Intravenous Contrast Agents and Gadopentetate Dimeglumine.

MR images can be manipulated for evaluation in various ways. Postprocessing includes: Subtraction, addition, rotation, inversion, multiplanar reconstruction (MPR), maximum intensity projection (MIP), etc.
Subtraction is particularly useful in contrast enhanced MRI examinations (for example breast MRI, brain MRI). The pre contrast images are subtracted from the images after an injection of contrast agents (sometimes also called dye) for a better tumor detection.

See also Computer Aided Detection

ProHance® consists of a nonionic gadolinium complex (Gadoteridol) used as a paramagnetic MR contrast agent.
ProHance® provides contrast enhancement of the brain, spine and surrounding tissues resulting in improved visualization (compared with unenhanced MRI) of lesions with abnormal vascularity or those thought to cause a disruption of the normal blood brain barrier. ProHance® can also be used for whole body contrast enhanced MRI including the head, neck, liver, breast, musculoskeletal system and soft tissue pathologies.

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 Gadoteridol.

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.

Magnetic resonance imaging (MRI) of the spine is a noninvasive procedure to evaluate different types of tissue, including the spinal cord, vertebral disks and spaces between the vertebrae through which the nerves travel, as well as distinguish healthy tissue from diseased tissue.
The cervical, thoracic and lumbar spine MRI should be scanned in individual sections. The scan protocol parameter like e.g. the field of view (FOV), slice thickness and matrix are usually different for cervical, thoracic and lumbar spine MRI, but the method is similar. The standard views in the basic spinal MRI scan to create detailed slices (cross sections) are sagittal T1 weighted and T2 weighted images over the whole body part, and transverse (e.g. multi angle oblique) over the region of interest with different pulse sequences according to the result of the sagittal slices. Additional views or different types of pulse sequences like fat suppression, fluid attenuation inversion recovery (FLAIR) or diffusion weighted imaging are created dependent on the indication.

Indications:

Contrast enhanced MRI techniques delineate infections vs. malignancies, show a syrinx cavity and support to differentiate the postoperative conditions. After surgery for disk disease, significant fibrosis can occur in the spine. This scarring can mimic residual disk herniation. Magnetic resonance myelography evaluates spinal stenosis and various intervertebral discs can be imaged with multi angle oblique techniques. Cine series can be used to show true range of motion studies of parts of the spine. Advanced open MRI devices are developed to perform positional scans in the position of pain or symptom (e.g. Uprightâ„¢ MRI formerly Stand-Up MRI).