(PARACEST) The alteration of the proton density or total water signal changes contrast and can be detected by the MRI scanner. Paramagnetic chemical exchange saturation transfer contrast agents are based upon the magnetization transfer mechanism.
Lanthanide ion complexes formed with tetra-amide based ligands display unusually slow water exchange kinetics and this feature may be used to alter image contrast by applying a selective presaturation pulse in an imaging sequence. This results in chemical exchange saturation transfer (CEST) from the lanthanide-bound water to bulk water thereby altering image contrast.
Chemical Exchange Saturation Transfer (CEST) agents are a class of contrast agents that could potentially revolutionize the MRI field because of their improved sensitivity and can have a great impact on functional magnetic resonance imaging.

The ability of magnetic compounds to increase the relaxation rates of the surrounding water proton spins.
Relaxivity is used to improve the contrast of the image, and to study tissue specific areas where the contrast agent better diffuses or to perform functional magnetic resonance imaging.
The relaxivity of MRI contrast agents depends on the molecular structure and kinetic of the complex. To increase the number of water molecules that are in the inner sphere of the complex, or to slow down the molecular rotational correlation time, are possibilities to improve the water relaxivity.
Relaxivity units (r1, r2) are mM-1 * sec-1 (at varying temperatures).

The mobile intraoperative iMotion system produces real-time images used for MR guided surgery and offers functional magnetic resonance imaging, MR spectroscopy, perfusion imaging, and diffusion weighted imaging capabilities.
The iMotion 1.5 T magnet moves to the patient, gliding in and out of place as needed, without affecting surgical, anesthetic, and nursing management.

See also Intraoperative Magnetic Resonance Imaging, MR Guided Interventions.

Contrast enhanced MRI is a commonly used procedure in magnetic resonance imaging. The need to more accurately characterize different types of lesions and to detect all malignant lesions is the main reason for the use of intravenous contrast agents.
Some methods are available to improve the contrast of different tissues. The focus of dynamic contrast enhanced MRI (DCE-MRI) is on contrast kinetics with demands for spatial resolution dependent on the application. DCE-MR imaging is used for diagnosis of cancer (see also liver imaging, abdominal imaging, breast MRI, dynamic scanning) as well as for diagnosis of cardiac infarction (see perfusion imaging, cardiac MRI). Quantitative DCE-MRI requires special data acquisition techniques and analysis software.
Contrast enhanced magnetic resonance angiography (CE-MRA) allows the visualization of vessels and the temporal resolution provides a separation of arteries and veins. These methods share the need for acquisition methods with high temporal and spatial resolution.
Double contrast administration (combined contrast enhanced (CCE) MRI) uses two contrast agents with complementary mechanisms e.g., superparamagnetic iron oxide to darken the background liver and gadolinium to brighten the vessels. A variety of different categories of contrast agents are currently available for clinical use.
Reasons for the use of contrast agents in MRI scans are:
Common Indications:
Brain MRI : Preoperative/pretreatment evaluation and postoperative evaluation of brain tumor therapy, CNS infections, noninfectious inflammatory disease and meningeal disease.
Spine MRI : Infection/inflammatory disease, primary tumors, drop metastases, initial evaluation of syrinx, postoperative evaluation of the lumbar spine: disk vs. scar.
Breast MRI : Detection of breast cancer in case of dense breasts, implants, malignant lymph nodes, or scarring after treatment for breast cancer, diagnosis of a suspicious breast lesion in order to avoid biopsy.

For Ultrasound Imaging (USI) see Contrast Enhanced Ultrasound at Medical-Ultrasound-Imaging.com. See also Blood Pool Agents, Myocardial Late Enhancement, Cardiovascular Imaging, Contrast Enhanced MR Venography, Contrast Resolution, Dynamic Scanning, Lung Imaging, Hepatobiliary Contrast Agents, Contrast Medium and MRI Guided Biopsy.

Special imaging primarily means advanced MRI techniques used for qualitative and quantitative measurement of biological metabolism as e.g., spectroscopy, perfusion imaging (PWI, ASL), diffusion weighted imaging (DWI, DTI, DTT) and brain function (BOLD, fMRI). This physiological magnetic resonance techniques offer insights into brain structure, function, and metabolism.
Spectroscopy provides functional information related to identification and quantification of e.g. brain metabolites. MR perfusion imaging has applications in stroke, trauma, and brain neoplasm. MRI provides the high spatial and temporal resolution needed to measure blood flow to the brain. arterial spin labeling techniques utilize the intrinsic protons of blood and brain tissue, labeled by special preparation pulses, rather than exogenous tracers injected into the blood.
MR diffusion tensor imaging characterizes the ability of water to spread across the brain in different directions. Diffusion parallel to nerve fibers has been shown to be greater than diffusion in the perpendicular direction. This provides a tool to study in vivo fiber connectivity in brain MRI.
FMRI allows the detection of a functional activation in the brain because cortical activity is intimately related to local metabolism changes.

See also Diffusion Tensor Tractography.