Sinerem® is the brand name (same as Combidex®) for an ultrasmall superparamagnetic iron oxide (USPIO) to detect metastatic disease in lymph nodes. Metastatic nodes show less uptake of this MRI contrast agent, which results in less signal decrease and allows the differentiation of normal lymph nodes from normal-sized, metastatic nodes.
Lymph node imaging with Sinerem® is performed 24 to 36 hours after slow infusion. Normal lymph nodes turn black post contrast, namely on T2* weighted images. Metastatic lymph nodes remain unchanged in signal intensity.
Indication and Diseases: Cancer, Imaging for diagnosis, Lymphatic disorders.
See Ferumoxtran, and Classifications, Characteristics, etc.

Guerbet decided in 2007 to withdraw its Marketing Authorisation Application (MAA) for Sinerem.

Superparamagnetism occurs when the material is composed of very small crystallites (1-10 nm). In this case, even though the temperature is below the Curie or Néel temperature and the thermal energy is not sufficient to overcome the coupling forces between neighboring atoms, the thermal energy is sufficient to change the direction of magnetization of the entire crystallite. The resulting fluctuations in the direction of magnetization cause the magnetic field to average to zero. The material behaves in a manner similar to paramagnetism, except that instead of each individual atom being independently influenced by an external magnetic field, the magnetic moment of the entire crystallite tends to align with the magnetic field.
In MRI superparamagnetic iron oxide is used as a contrast agent.

See also magnetism, ferromagnetism, paramagnetism, and diamagnetism.

Quick Overview

Materials with magnetic susceptibility cause this artifact. There are in general three kinds of materials with magnetic susceptibility: ferromagnetic materials (iron, nickel etc.) with a strong influence and paramagnetic/diamagnetic (aluminium, platinum etc./gold, water, most organic compounds etc.) materials with a minimal/non influence on magnetic fields. In MRI, susceptibility artifacts are caused for example by medical devices in or near the magnetic field or by implants of the patient. These materials with magnetic susceptibility distort the linear magnetic field gradients, which results in bright areas (misregistered signals) and dark areas (no signal) nearby the magnetic material.

Use a spin echo or a fast spin echo sequence, because gradient echo sequences are more sensitve to susceptibility artifacts. A high bandwidth (small water fat shift) and a short echo time help also to reduce this artifact.
In some cases it is even beneficial to use a gradient echo sequence, e.g. a cavernom contains some iron-rich haemosiderin, which also causes a signal void on gradient echo sequences and for this purpose increases the diagnostic image quality.

Every tissue in the human body has its own T1 and T2 value. This term is used to indicate an image where most of the contrast between tissues is due to differences in the T1 value.
This term may be misleading in that the potentially important effects of tissue density differences and the range of tissue T1 values are ignored.
If the machine parameters are chosen, so that TR less than T1 (typically under 500 ms) and TE less than T2 (typically under 30 ms), a power series expansion of the exponential functions and then neglecting second and higher order terms yields
Mxy = Mxy0 TR/T1
thus the expression becomes independent of T2 and yields the condition for T1 weighting. Therefore a T1 contrast is approached by imaging with a short TR, compared to the longest tissue T1 of interest and short TE, compared to tissue T2 (to reduce T2 contributions to image contrast). Due to the wide range of T1 and T2 and tissue density values that can be found in the body, an image that is T1 weighted for some tissues may not be so for others.
Lesions with short T1 are (bright in T1 weighted sequences):
fat (lipoma, dermoid)
sub-acute haemorrhage (metHb)
paramagnetic agent (Gd, pituitary)
protein-containing fluid (colloid cyst)
metastatic melanoma (melanotic).

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.