Short name: Gd-DTPA-BMEA, generic name: Gadoversetamide
A paramagnetic extracellular MRI contrast agent with positive enhancement. When placed in a magnetic field, gadoversetamide decreases T1 and T2 relaxation times in tissues where it accumulates. At the recommended dose, the effect is primarily on T1 relaxation time, and produces an increase in signal intensity (brightness).

See Contrast Agents and OptiMARK™.

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.

Short name: Gd-EOB-DTPA, generic name: Gadoxetic acid, chemical compound: Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid
Primovist™ (formerly Eovist®) is a nonionic water-soluble liver tissue-specific MRI contrast agent with positive enhancement. The agent allows detection and differentiation of hepatic tumors due to specific uptake by healthy liver tissue, but not by tumors in the affected organ. Gd-EOB-DTPA has hepatocyte-specific properties, but provides earlier perfusion information acquired within first ten minutes. Hepatocyte uptake generally occurs beyond 10 minutes.

Diamagnetism occurs only by a substance in the presence of an externally applied magnetic field. Diamagnetic contrast agents are complexes in which the metal ion (e.g., Zn, Bi and Ca) is diamagnetic.
Potential diamagnetic materials in gastrointestinal MRI:
A suspension of clay minerals (Kaopectate with kaolin, a common over the counter drug) can be used as a negative oral contrast agent caused by the diamagnetic properties. By using this preparation as a gastrointestinal contrast agent e.g., in pancreas MRI or MRCP, the absence of signal is clearly visible in the stomach and duodenum. Barium sulfate commonly used as an X-ray contrast agent has also been tested for use in abdominal imaging. The diamagnetic properties of the barium particles are caused by a susceptibility effect around them, the resulting signal loss is strengthening by a replacement of water protons with barium.

See also Diamagnetism.

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.