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.

Macromolecular Gd labeled albumins are a new class of contrast agents with a wide range of use e.g., MR angiography, breast MRI, perfusion MRI, Lung perfusion, etc.
Marketed gadolinium-based albumin-bound contrast media are e.g., MultiHance®, and Vasovist™; other prototypes are in development. Malignant tumors often show an increased uptake and metabolism of plasma proteins, especially albumin. Contrast agents with large molecules are delivered to all tissues, but only accumulate in those with leaky vessels by tumor capillaries (tumor neovessels). MRI tumor perfusion studies with Gd labeled albumin can show the success of tumor therapy by quantitative decrease in MR signal of the malignant tissue after therapy compared to before. In addition, the study of tumor sensitivity to a therapy with drug-labeled albumins seems possible.
After renal transplantation, MRI may diagnose albuminuria caused by glomerular disease with an albumin-bound blood pool contrast agent

See also Blood Pool Agents, Intravascular Contrast Agents, Contrast Enhanced MRI.

(MRA) Magnetic resonance angiography is a medical imaging technique to visualize blood filled structures, including arteries, veins and the heart chambers. This MRI technique creates soft tissue contrast between blood vessels and surrounding tissues primarily created by flow, rather than displaying the vessel lumen. There are bright blood and black blood MRA techniques, named according to the appearance of the blood vessels. With this different MRA techniques both, the blood flow and the condition of the blood vessel walls can be seen. Flow effects in MRI can produce a range of artifacts. MRA takes advantage of these artifacts to create predictable image contrast due to the nature of flow.
Technical parameters of the MRA sequence greatly affect the sensitivity of the images to flow with different velocities or directions, turbulent flow and vessel size.
This are the three main types of MRA:
All angiographic techniques differentially enhance vascular MR signal. The names of the bright blood techniques TOF and PCA reflect the physical properties of flowing blood that were exploited to make the vessels appear bright. Contrast enhanced magnetic resonance angiography creates the angiographic effect by using an intravenously administered MR contrast agent to selectively shorten the T1 of blood and thereby cause the vessels to appear bright on T1 weighted images.
MRA images optimally display areas of constant blood flow-velocity, but there are many situations where the flow within a voxel has non-uniform speed or direction. In a diseased vessel these patterns are even more complex. Similar loss of streamline flow occurs at all vessel junctions and stenoses, and in regions of mural thrombosis. It results in a loss of signal, due to the loss of phase coherence between spins in the voxel.
This signal loss, usually only noticeable distal to a stenosis, used to be an obvious characteristic of MRA images. It is minimized by using small voxels and the shortest possible TE. Signal loss from disorganized flow is most noticeable in TOF imaging but also affects the PCA images.
Indications to perform a magnetic resonance angiography (MRA):
Conventional angiography or computerized tomography angiography (CT angiography) may be needed after MRA if a problem (such as an aneurysm) is present or if surgery is being considered.

See also Magnetic Resonance Imaging MRI.

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.

The basis of T1 weighted imaging is the longitudinal relaxation. A T1 weighted magnetic resonance image is created typically by using short TE and TR times.
The final image is a reflection of more than one of these pulse sequence parameters, weighted according to the type of sequence and its timing. T1 signals determine predominantly the contrast and brightness in this type of images but proton density will always contribute to the image intensity. The T1 dependence is mainly determined by the repetition time or any pre-pulses (such as in an inversion recovery pulse sequence).
Due to the larger longitudinal and transverse magnetization, fat has a higher signal and will appear bright on a T1 contrast MR image. Conversely, water has less longitudinal magnetization prior to a RF pulse, therefore less transverse magnetization after a RF pulse yielding low signal appearing dark on a T1 contrast image. Often, a paramagnetic contrast agent, a gadolinium compound, is administered, and both pre-contrast T1 weighted images and post-contrast T1 weighted images are obtained.