A bolus is a rapid infusion of high dose contrast agent. Dynamic and accumulation phase imaging can be performed after bolus injection. Since the transit time of the bolus through the tissue is only a few seconds, high temporal resolution imaging can be 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.
For the same injected dose of contrast agent the injection rate (and, consequently, the total injected volume) modifies the bolus peak profile. Increasing the injection rate produces a sharpening of the peak (Cmax increase, Tmax decrease, peak length decrease). At a low injection rate, the first pass presents a plateau form. Substantial changes in the gadolinium concentrations during signal acquisition induce artifacts. Furthermore, the haemodynamic parameters (cardiac output, blood pressure) influence the bolus profile. The characteristics of gadolinium agents are favorable in the early bolus phase, whereas the advantages of large complexes (e.g. blood pool agents) and ultrasmall superparamagnetic iron oxide (USPIO) are most evident in the distribution phase.

An iron-based contrast agent with large molecular size, which prevents diffusion into body tissues and will be developed for MR imaging of the liver (taken up by macrophages), tumor microvasculature and microvessel permeability. The blood half live of the particles with 11-20 nm diameter is 3-4 hours.
At this time the development of Clariscan™ is discontinued.

See also NC100150 Injection and Ultrasmall Superparamagnetic Iron Oxide.

Combidex® is the brand name (same as Sinerem®) for an ultrasmall superparamagnetic iron oxide (USPIO) in the development pipeline to detect metastatic disease in lymph nodes. Metastatic lymph 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. Combidex® has also potential to be used as a functional molecular imaging agent.
In March 2005, AMAG Pharmaceuticals Inc received an approvable letter from the U.S. Food and Drug Administration with respect to Combidex subject to certain conditions.
See also Ferumoxtran, Drug Development and Approval Process USA, Molecular Imaging and Classifications, Characteristics, etc.

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.

A brand name for ferumoxide (same as Feridex®)
Endoremâ„¢ is a black to reddish-brown aqueous colloid of superparamagnetic iron oxide associated with dextran for intravenous administration as a MRI contrast medium for the detection of liver lesions that are associated with an alteration in the RES.
Endoremâ„¢ is taken up by macrophages, found only in healthy liver cells but not in most tumors. Tissues such as metastases, primary liver cancer, cysts and various benign tumors, adenomas and hyperplasia retain their native signal intensity, so the contrast between normal and abnormal tissue is increased.

See also Ferumoxide.