The brain tissue is provided with a tight endothelial layer on vessels that acts as a filter for substances that reach the brain through the blood stream. This filter is called the blood brain barrier.
The blood brain barrier is responsible for the absence of contrast agent enhancement in normal brain tissue after administration of the iodinated or paramagnetic contrast media used in brain MRI and computed tomography (CT) diagnostic. The absence of contrast uptake in normal tissue provides the basis for differentiation from pathological brain tissue, which is conversely characterized by a disruption of the blood brain barrier.

See also Contrast Enhanced MRI, MRI Safety, Adverse Reaction.

Omniscan® is a nonionic chelate complex with low osmolality used as a paramagnetic MRI contrast agent. The efficacy of Omniscan® is similar to that of Gd-DTPA. Omniscan® is given intravenously to enhance images of intracranial and spinal lesions where there is abnormal vascularity or an abnormal blood brain barrier. The complex does not cross an intact blood brain barrier so Omniscan® only accumulates in lesions such as neoplasm's and abscesses.

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 Gadodiamide, and Classifications, Characteristics, etc.

Dotarem® is a paramagnetic ionic MRI contrast agent. Extracellular contrast agents like Dotarem®, can be bolus injected because of the relatively low rate of side effects. This contrast medium is useable to enhance signal intensity in magnetic resonance imaging for intracranial and spinal lesions with an abnormal blood brain barrier or abnormal vascularity, and in whole body imaging.

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.

(Dy) The Dysprosium chelates are analogs of the extracellular gadolinium chelates, with substitution of the dysprosium ion for the gadolinium ion and offers advantages in application on first pass studies. The use of a dysprosium-based contrast agent (Dy-type) instead of a gadolinium-type (Gd-type) is an alternative in cases of a disrupted blood brain barrier. Because of its much smaller T1 enhancement, this contrast agent should give more accurate perfusion calculations in brain MRI.

Short name: Gd-HP-DO3A, generic name: Gadoteridol injection, chemical compound: Gd-1,4,7-tris(carbonylmethyl)-10-(2'-hydroxypropyl)-1,4,7,10-tetraazacyclododecane
(ProHance®) A nonionic MRI contrast agent with a low molecular weight complex of gadolinium (macrocyclic chelate, which tightly binds the Gd atom).
Gadoteridol does not cross the blood brain barrier. If the barrier is damaged, gadoteridol will penetrate into lesions such as tumors. It also highlights areas of increased vascularity so it has been used to improve the delimitation of lesions elsewhere in the body.
Apart from its paramagnetic effects, gadoteridol has no pharmacological activity in the body. After intravenous injection, most of the dose is excreted unchanged in the urine within 24 hours.

See also Contrast Agents and ProHance®.