MultiHance® is a paramagnetic contrast agent for use in diagnostic magnetic resonance imaging (MRI) of the liver and central nervous system. MultiHance® is a small molecular weight chelate, which tightly binds the Gd atom. The substance is excreted partly by the kidneys, partly by the biliary system, which is especially unique.
MultiHance® is indicated, for the detection of focal liver lesions in patients with known or suspected primary liver cancer (e.g. hepatocellular carcinoma) or metastatic disease.
MultiHance® is also indicated in brain MRI and spine MRI where it improves the detection of lesions and provides diagnostic information additional to that obtained with unenhanced MRI.
Gd-BOPTA-enhanced MRA can provide superior vascular signal intensity and SNR, as compared with Gd-DTPA, due to its higher relaxivity, even at lower doses.
1 ml of solution MultiHance® contains: (0.5M) gadobenate dimeglumine 529 mg = gadobenic acid 334 mg + meglumine 195 mg. Viscosity at 37°C: 5.3 mPa

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.

(LE) Myocardial late enhancement in contrast enhanced cardiac MRI has the ability to precisely delineate myocardial scar associated with coronary artery disease. Viability imaging implies evaluating infarcted myocardium to see whether there is enough viable tissue available for revascularization. The reversal of myocardial dysfunction is particularly relevant in patients with depressed ventricular function because revascularization improves long-term survival. In comparison to SPECT and PET imaging, myocardial late enhancement MRI demonstrates areas of delayed enhancement exactly in correlation with the infarcted region.
Viability on cardiac MRI (CMR) is based on the fact that all infarcts enhance vividly 10-15 minutes after the administration of intravenous paramagnetic contrast agents. This enhancement represents the accumulation of gadolinium in the extracellular space, due to the loss of membrane integrity in the infarcted tissue. This phenomenon of delayed hyperenhancement has been proven to correlate with the actual extent of the infarct.
MRI myocardial late enhancement can quantify the size, location and transmural extent of the infarct. If the transmural extent of the infarct (region of enhancement on MRI) is less than 50% of the wall thickness, there will be improved contractility in that segment following revascularization. In areas of hypokinesia, if there is a rim of "black" or non-infarcted myocardium that is not contracting well, it indicates the presence of hibernating myocardium, which is likely to improve after revascularization of the artery supplying that particular territory.
The total duration of a myocardial late enhancement MR imaging protocol for viability is approximately 30 minutes, including scout images, first-pass images, cine images in two planes, and delayed myocardial enhancement images. In order to assess viable myocardium, the gadolinium contrast agent is injected at a dose of 0.15 to 0.2 mmol/kg. After about 10 minutes, short axis and long axis views (see cardiac axes) of the heart are obtained using an inversion prepared ECG gated gradient echo sequence. The inversion pulse is adjusted to suppress normal myocardium. Areas of nonviable myocardium retain extremely high signal intensity, black areas show normal tissue.

For Ultrasound Imaging (USI) see Myocardial Contrast Echocardiography at Medical-Ultrasound-Imaging.com.

Categories of negative oral contrast agents:
Negative oral contrast media are usually based on superparamagnetic particles and act by inducing local field inhomogeneities, which results in shortening of both T1 and T2 relaxation times. Superparamagnetic contrast agents have predominant T2 weighted effects. Biphasic contrast media are agents that have different signal intensities on different sequences, depending on the concentration at which they are used.
Suitable materials for oral contrast agents should have little or no absorption by the stomach or intestines, complete excretion, no motion or susceptibility artifacts, affordability, and uniform marking of the gastrointestinal tract. Benefits of negative oral contrast agents are the reduction of ghosting artifacts caused by the lack of signal. Superparamagnetic iron oxides produce also in low concentrations a noticeable signal loss; but can generate susceptibility artifacts especially in gradient echo sequences. Perfluorochemicals do not dilute in the bowel because they are not miscible with water.
High cost, poor availability, and limited evaluations of side effects are possible disadvantages.
Negative oral contrast agents are used e.g., in MRCP, where the ingestion of 600-900 ml of SPIO cancels out the signal intensity of the lumen (in addition after the injection of a gadolinium-based contrast medium, the enhancement of the inflammatory tissues is clearer seen), and in MR abdominal imaging of Crohn's disease in combination with mannitol.

Blueberry or pineapple juices are useable for examinations of the pancreas (MRCP, upper abdominal imaging) as cheep contrast agents, because of the content of magnetic substances (e.g. manganese).

See also Ferristene, Ferumoxsil, Oral Magnetic Particles, Gastrointestinal Imaging.

An undesirable background interference or disturbance that affects image quality.
The Noise is commonly characterized by the standard deviation of signal intensity in the image of a uniform object (phantom) in the absence of artifacts. The measured noise may depend on the particular phantom used due to variable effects on the Q of the receiver coil.
Noisy images appear when the SNR-Rate is too low - this is induced by the operator. Image artifacts and RF noise can often be caused by the presence and/or operation of a medical device in the MR environment. There are various noise sources in any electronic system, including Johnson noise, shot noise, thermal noise. Materials produce their own characteristic static magnetic field that can perturb the relationship between position and frequency essential to accurate image reconstruction.
RF noise, which often appears as static on the image, can be caused by a medical device located anywhere in the MR procedure room. RF noise is a result of excessive electromagnetic emissions from the medical device that interfere with the proper operation of the MR scanner. Since the MR procedure room is shielded from extraneous RF fields entering the room (Faraday cage), operation of electromagnetically noisy equipment outside the room does not typically affect the MR scanner.

See Signal to Noise Ratio and Radio Frequency Noise Artifact.

The activation of the brain is mirrored in the local changes in metabolism and hemodynamics (brit. haemodynamics). By using heavily T2 weighted scans activated brain areas show an increase in signal intensity as oxyhaemoglobin (brit. oxyhaemoglobin) is diamagnetic and deoxyhemoglobin (brit. deoxyhaemoglobin) is paramagnetic. Oxygen mapping will benefit from high field strength.

See also Blood Oxygenation Level Dependent Contrast, Haemoglobin, Perfusion Imaging, Diamagnetism, Paramagnetism.