Primovist™ (U.S brand name Eovist®) is a highly specific MRI contrast agent for the imaging, detection and characterization of liver conditions, including liver tumors, cysts, as well as other malignant and benign lesions. It is a water-soluble ethoxybenzyl derivative of Gd-DTPA. This compound is taken up by the hepatocytes (approximately 30% of the dose goes to the hepatocytes) and is equally excreted renal and biliary in humans.
Primovist™ brightens the signal of T1 weighted MR images immediately after contrast administration. Dynamic scanning and imaging of the accumulation phase (best after 20 min.) can also be performed after bolus injection of Primovistâ„¢. The hepatocytes uptake will increase the signal intensity of normal liver parenchyma. This results in improved lesion-to-liver contrast because malignant tumors (metastases, the majority of hepatocellular carcinomas) do not contain either hepatocytes or their functioning is hampered.

WARNING: 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.

MRI of the shoulder with its excellent soft tissue discrimination, and high spatial resolution offers the best noninvasive way to study the shoulder. MRI images of the bone, muscles and tendons of the glenohumeral joint can be obtained in any oblique planes and projections. MRI gives excellent depiction of rotator cuff tears, injuries to the biceps tendon and damage to the glenoid labrum. Shoulder MRI is better than ultrasound imaging at depicting structural changes such as osteophytic spurs, ligament thickening, and acromial shape that may have predisposed to tendon degeneration.
A dedicated shoulder coil and careful patient positioning in external rotation with the shoulder as close as reasonably possible to the center of the magnet is necessary for a good image quality. If possible, the opposite shoulder should be lifted up, so that the patient lies on the imaged shoulder in order to rotate and fix this shoulder to reduce motion during breathing.
Axial, coronal oblique, and sagittal oblique proton density with fat suppression, T2 and T1 provide an assessment of the rotator cuff, biceps, deltoid, acromio-clavicular joint, the glenohumeral joint and surrounding large structures. If a labral injury is suspected, a Fat Sat gradient echo sequence is recommended. In some cases, a direct MR shoulder arthrogram with intra-articular injection of dilute gadolinium or an indirect arthrogram with imaging 20 min. after intravenous injection may be helpful.

See also Imaging of the Extremities.

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.

(USPIO) The class of the ultrasmall superparamagnetic iron oxide includes several chemically and pharmacologically very distinct materials, which may or may not be interchangeable for a specific use. Some ultrasmall SPIO particles (median diameter less than 50nm) are used as MRI contrast agents (Sinerem®, Combidex®), e.g. to differentiate metastatic from inflammatory lymph nodes. USPIO shows also potential for providing important information about angiogenesis in cancer tumors and could possibly complement MRI helping physicians to identify dangerous arteriosclerosis plaques.
Because of the disadvantageous large T2*//T1 ratio, USPIO compounds are less suitable for arterial bolus contrast enhanced magnetic resonance angiography than gadolinium complexes. The tiny ultrasmall superparamagnetic iron oxides do not accumulate in the RES system as fast as larger particles, which results in a long plasma half-life. USPIO particles, with a small median diameter (less than 10 nm), will accumulate in lymph nodes after an intravenous injection by e.g. direct transcapillary passage through endothelial venules. Once within the nodal parenchyma, phagocytic cells of the mononuclear phagocyte system take up the particles.
As a second way, USPIOs are subsequently taken up from then interstitium by lymphatic vessels and transported to regional lymph nodes. A lymph node with normal phagocytic function takes up a considerable amount and shows a reduction of the signal intensity caused by T2 shortening effects and magnetic susceptibility. Caused by the small uptake of the USPIOs in metastatic lymph nodes, they appear with less signal reduction, and permit the differentiation of healthy lymph nodes from normal-sized, metastatic nodes.

See also Superparamagnetic Contrast Agents, Superparamagnetic Iron Oxide, Very Small Superparamagnetic Iron Oxide Particles, Blood Pool Agents, Intracellular Contrast Agents.

Vasovist™ is an albumin-targeted intravascular contrast agent. It is indicated for contrast enhanced MR angiography (CE-MRA) for the visualization of abdominal or limb vessels in patients with suspected or known vascular disease. After IV injection, Vasovist™ binds reversibly to human albumin in plasma, which results in long-lasting increased relaxivity. Imaging from 5 to 50 min is possible. A small unbound portion is, by glomerular filtration, eliminated by the kidneys.
AngioMARK® was the formerly trade name and MS-325 the research name. Currently the phase III clinical trials are completed to determine its efficacy for peripheral vascular disease and coronary artery disease.
In the U.S., EPIX received an approvable letter from the U.S. Food and Drug Administration (FDA) for Vasovist™ in January 2005. In 2009, Epix Pharmaceuticals has sold the U.S., Canadian and Australian rights for its blood pool agent (now named ABLAVAR™), to Lantheus Medical Imaging, Inc..

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 the liver transplantation period.

See also MRI Safety.