OptiMARK® is a formulation of a nonionic gadolinium chelate of diethylenetriamine pentaacetic acid bismethoxyethylamide (gadoversetamide), for use as a paramagnetic MRI contrast agent. OptiMARK® (gadoversetamide injection) is to be administered by intravenous injection. OptiMARK® is indicated for MRI diagnostic procedures to provide increased enhancement and visualization of lesions of the brain, spine and liver, including tumors.

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.

A limitation of abdominal MRI can be the assessment of malignancies by difficulties to distinguish bowel from other organs or malignant masses. The use of oral contrast agents can reduce this problem. Properties of an ideal oral contrast agent are little or no absorption by the stomach or intestines, complete excretion, no motion or susceptibility artifacts, and uniform marking of the GI tract.
Gastrointestinal MRI contrast agents are divided in materials with bright appearance or dark appearance. The choice of a negative or a positive oral contrast agent depends on the specific problem or the pulse sequence.

See also Positive Oral Contrast Agents, Negative Oral Contrast Agents, Gastrointestinal Diamagnetic Contrast Agents, Gastrointestinal Paramagnetic Contrast Agents and Gastrointestinal Superparamagnetic Contrast Agents.

See also the related poll result: 'The development of contrast agents in MRI is'

Types of oral contrast agents with positive signal enhancement:
Ideal oral contrast agents are immiscible with water, biologically inert, have a low viscosity and surface tension. Oral positive contrast agents may improve the separation of bowel loops, the detection of polyps in colon MRI or the assessment of inflammatory bowel in the small intestine. Several positive oral contrast agents are available and they are safe to use, for example gadolinium solution, ferric ammonium citrate, different oil emulsions and pediatric formula.
Unfavorably motion artifacts caused by respiration and peristalsis may be increased in MR imaging. In addition, the signal of the positive contrast medium may decrease caused by dilution in gastrointestinal (GI) secretions. With the use of contrast agents that are immiscible with water, no dilution and accompanying signal loss occur even when the contrast agent is in contact with the intraluminal contents of the GI tract. Another disadvantage may be residual substances in the bowel, resembling masses when enclosed by bright signal. In addition, positive contrast agents may have a similar signal as bright masses, which make their (e.g. lipoma) detection difficult.

See also Gastrointestinal Paramagnetic Contrast Agents, Combination Oral Contrast Agents, Gastrointestinal Diamagnetic Contrast Agents.

Resovist® is an organ-specific MRI contrast agent, used for the detection and characterization of especially small focal liver lesions.
Resovist® consists of superparamagnetic iron oxide (SPIO) nanoparticles coated with carboxydextran, which are accumulated by phagocytosis in cells of the reticuloendothelial system (RES) of the liver. The uptake of Resovist® Injection in the reticuloendothelial cells results in a decrease of the signal intensity of normal liver parenchyma on both T2- and T1 weighted images.
Most malignant liver tumors do not contain RES cells and therefore do not uptake the iron particles. The resulting imaging effect is an improved contrast between the tumor (bright) and the surrounding tissue (dark).
Resovist® can be injected as an intravenous bolus, which allows immediate imaging of the liver and reduces the overall examination time. A dynamic imaging strategy after bolus injection supports to characterize lesions. In comprehensive clinical trials, it demonstrated an excellent safety profile.
In 2001, Resovist® was approved for the European market.

See also Superparamagnetic Iron Oxide.

Resovist® competed with Primovist™, the other liver imaging agent of Bayer Schering Pharma AG. Due to this reason, the production of Resovist® has been abandoned in 2009.

Liver imaging with gadolinium contrast enhanced MRI is sometimes not sufficient for a reliable diagnosis of liver lesions. For this reasons, special liver Contrast agents that are targeted to the reticuloendothelial system (RES), have been developed to improve both detection and characterization of liver and spleen lesions. Reticuloendothelial Contrast Agents, as e.g. superparamagnetic iron oxides (SPIO), are taken up by healthy liver tissue but not tumors.
These RES targeted contrast agents provide a prolonged imaging window and enough time for high spatial resolution or multiple breath hold images. Reticuloendothelial contrast agents have an increased sensitivity for the detection of small liver lesions (e.g., metastases), compared with gadolinium enhanced MRI and spiral CT. At higher field strengths with an increased signal to noise ratio the susceptibility effect with iron oxide particles may be enhanced.
Other new agents (Gadobenate Dimeglumine, Gadoxetic Acid) have both an initial extracellular circulation and a delayed liver-specific uptake. Since a considerable part of these contrast agents is excreted in the bile, functional biliary imaging can diagnose biliary anomalies, postoperative bile leaks, and anastomotic strictures. Other agents, such as liposomes (with encapsulated Gd-DTPA) or DOTA complexes are in different development stages.

See also Hepatobiliary Contrast Agents, Gadolinium Oxide, Superparamagnetic Iron Oxide and Liposomes.