(PWI - Perfusion Weighted Imaging) Perfusion MRI techniques (e.g. PRESTO - Principles of Echo Shifting using a Train of Observations) are sensitive to microscopic levels of blood flow. Contrast enhanced relative cerebral blood volume (rCBV) is the most used perfusion imaging. Both, the ready availability and the T2* susceptibility effects of gadolinium, rather than the T1 shortening effects make gadolinium a suitable agent for use in perfusion imaging. Susceptibility here refers to the loss of MR signal, most marked on T2* (gradient echo)-weighted and T2 (spin echo)-weighted sequences, caused by the magnetic field-distorting effects of paramagnetic substances.
T2* perfusion uses dynamic sequences based on multi or single shot techniques. The T2* (T2) MRI signal drop within or across a brain region is caused by spin dephasing during the rapid passage of contrast agent through the capillary bed. The signal decrease is used to compute the relative perfusion to that region. The bolus through the tissue is only a few seconds, high temporal resolution imaging is required to obtain sequential images during the wash in and wash out of the contrast material and therefore, resolve the first pass of the tracer. Due to the high temporal resolution, processing and calculation of hemodynamic maps are available (including mean transit time (MTT), time to peak (TTP), time of arrival (T0), negative integral (N1) and index.
An important neuroradiological indication for MRI is the evaluation of incipient or acute stroke via perfusion and diffusion imaging. Diffusion imaging can demonstrate the central effect of a stroke on the brain, whereas perfusion imaging visualizes the larger 'second ring' delineating blood flow and blood volume. Qualitative and in some instances quantitative (e.g. quantitative imaging of perfusion using a single subtraction) maps of regional organ perfusion can thus be obtained.
Echo planar and potentially echo volume techniques together with appropriate computing power offer real time images of dynamic variations in water characteristics reflecting perfusion, diffusion, oxygenation (see also Oxygen Mapping) and flow.
Another type of perfusion MR imaging allows the evaluation of myocardial ischemia during pharmacologic stress. After e.g., adenosine infusion, multiple short axis views (see cardiac axes) of the heart are obtained during the administration of gadolinium contrast. Ischemic areas show up as areas of delayed and diminished enhancement. The MRI stress perfusion has been shown to be more accurate than nuclear SPECT exams. Myocardial late enhancement and stress perfusion imaging can also be performed during the same cardiac MRI examination.

(TrueFISP) True fast imaging with steady state precession is a coherent technique that uses a fully balanced gradient waveform. The image contrast with TrueFISP is determined by T2*//T1 properties and mostly depending on TR. The speed and relative motion insensitivity of acquisition help to make the technique reliable, even in patients who have difficulty with holding their breath.
Recent advances in gradient hardware have led to a decreased minimum TR. This combined with improved field shimming capabilities and signal to noise ratio, has allowed TrueFISP imaging to become practical for whole-body applications. There's mostly T2* weighting. With the used ultrashort TR-times T1 weighting is almost impossible. One such application is cardiac cine MR with high myocardium-blood contrast. Spatial and temporal resolution can be substantially improved with this technique, but contrast on the basis of the ratio of T2* to T1 is not sufficiently high in soft tissues. By providing T1 contrast, TrueFISP could then document the enhancement effects of T1 shortening contrast agents. These properties are useful for the anatomical delineation of brain tumors and normal structures. With an increase in SNR ratio with minimum TR, TrueFISP could also depict the enhancement effect in myoma uteri. True FSIP is a technique that is well suited for cardiac MR imaging. The imaging time is shorter and the contrast between the blood and myocardium is higher than that of FLASH.

See Steady State Free Precession.

Categories of negative oral contrast agents:
Negative oral contrast media are usually based on superparamagnetic particles and act by inducing local field inhomogeneities, which results in shortening of both T1 and T2 relaxation times. Superparamagnetic contrast agents have predominant T2 weighted effects. Biphasic contrast media are agents that have different signal intensities on different sequences, depending on the concentration at which they are used.
Suitable materials for oral contrast agents should have little or no absorption by the stomach or intestines, complete excretion, no motion or susceptibility artifacts, affordability, and uniform marking of the gastrointestinal tract. Benefits of negative oral contrast agents are the reduction of ghosting artifacts caused by the lack of signal. Superparamagnetic iron oxides produce also in low concentrations a noticeable signal loss; but can generate susceptibility artifacts especially in gradient echo sequences. Perfluorochemicals do not dilute in the bowel because they are not miscible with water.
High cost, poor availability, and limited evaluations of side effects are possible disadvantages.
Negative oral contrast agents are used e.g., in MRCP, where the ingestion of 600-900 ml of SPIO cancels out the signal intensity of the lumen (in addition after the injection of a gadolinium-based contrast medium, the enhancement of the inflammatory tissues is clearer seen), and in MR abdominal imaging of Crohn's disease in combination with mannitol.

Blueberry or pineapple juices are useable for examinations of the pancreas (MRCP, upper abdominal imaging) as cheep contrast agents, because of the content of magnetic substances (e.g. manganese).

See also Ferristene, Ferumoxsil, Oral Magnetic Particles, Gastrointestinal Imaging.

Contrast agent with a preferential intracellular distribution.
Intracellular agents (such as manganese derivatives and ultrasmall superparamagnetic iron oxide), exhibit a flow- and metabolism-dependent uptake. These properties may allow delayed imaging, similar to isotopic methods.
Phospholipid liposomes are rapidly sequestered by the cells in the reticuloendothelial system (RES), primarily in the liver. For imaging of the liver, liposomes may be labeled with MR contrast medium, both positive (T1-shortening) paramagnetic media, and negative (T2-shortening) superparamagnetic media.
Several other nonliposome MR contrast media are also taken up by the RES, e.g.:
Other MR contrast agents accumulate selectively in the hepatocytes, e.g.:

Short name: Gd-DTPA, generic name: Gadopentetate dimeglumine, chemical compound: Gadolinium-diethylenetriaminepentaacetic acid
Gadopentetate dimeglumine was introduced in 1981, as the first paramagnetic MRI contrast agent (ionic). The Gd-induced dipole dipole interactions lead to shortening of T1, which results in contrast enhancement on T1 weighted images. The used metal ion Gd3+ (gadolinium) is toxic, and therefore bound in the renally excreted DTPA chelate, a very stable complex. The Gd-complex also induce susceptibility effects, as a result of the magnetic field gradient between the contrast agent in the blood vessels and the surrounding tissue, that lead to shortening of T2 or T2*.
Following intravenous administration, the compound is distributed rapidly in the extracellular space and is eliminated unchanged by glomerular filtration via the kidneys. Up to 6 hours, post injection an average of 83% of the dose is eliminated renal.

See also Magnevist®, Gadolinium and Contrast Agents.