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.

Automatic bolus detection is used to trigger the begin of the MRI scan with the time the contrast agent reaches the region of interest. The acquisition process is started once the signal is increased in this region. There are similar methods used by the scanner manufacturer (see MRI Acronyms for Automatic Bolus Detection). After injection of the contrast agent the region of interest is monitored (e.g. with a spin echo or gradient echo sequence). When the signal increases the scan is automatically triggered or the operator is informed.

See also Abdominal Imaging, Bolus Injection, Fluoroscopic Triggering, Care Bolus, and Bolus Tracking.

A large network of interconnecting blood vessels at the base of the brain that when visualized resembles a circle, the arteries effectively act as anastomoses for each other. This means that if any one of the communicating arteries becomes blocked, blood can flow from another part of the circle to ensure that blood flow is not compromised.
The circle of Willis is formed by both the internal carotid arteries, entering the brain from each side and the basilar artery, entering posteriorly. The connection of the vertebral arteries forms the basilar artery. The basilar artery divides into the right and left posterior cerebral arteries. The internal carotid arteries trifurcate into the anterior cerebral artery, middle cerebral artery, and posterior communicating artery. The two anterior cerebral arteries are joined together anteriorly by the anterior communicating artery. The posterior communicating arteries join the posterior cerebral arteries, completing the circle of Willis.
The time of flight angiography MRI technique allows imaging of the circle of Willis without the need of a contrast medium (best results with high field MRI). A cerebrovasular contrast enhanced magnetic resonance angiography (MRA) depicts the circle of Willis in addition to the vessels of the neck (carotid and vertebral arteries) with one bolus injection of a contrast agent.

For Ultrasound Imaging (USI) see Cerebrovascular Ultrasonography at Medical-Ultrasound-Imaging.com.

(CE MRA) Contrast enhanced MR angiography is based on the T1 values of blood, the surrounding tissue, and paramagnetic contrast agent.
T1-shortening contrast agents reduces the T1 value of the blood (approximately to 50 msec, shorter than that of the surrounding tissues) and allow the visualization of blood vessels, as the images are no longer dependent primarily on the inflow effect of the blood. Contrast enhanced MRA is performed with a short TR to have low signal (due to the longer T1) from the stationary tissue, short scan time to facilitate breath hold imaging, short TE to minimize T2* effects and a bolus injection of a sufficient dose of a gadolinium chelate.
Images of the region of interest are performed with 3D spoiled gradient echo pulse sequences. The enhancement is maximized by timing the contrast agent injection such that the period of maximum arterial concentration corresponds to the k-space acquisition. Different techniques are used to ensure optimal contrast of the arteries e.g., bolus timing, automatic bolus detection, bolus tracking, care bolus. A high resolution with near isotropic voxels and minimal pulsatility and misregistration artifacts should be striven for. The postprocessing with the maximum intensity projection (MIP) enables different views of the 3D data set.
Unlike conventional MRA techniques based on velocity dependent inflow or phase shift techniques, contrast enhanced MRA exploits the gadolinium induced T1-shortening effects. CE MRA reduces or eliminates most of the artifacts of time of flight angiography or phase contrast angiography. Advantages are the possibility of in plane imaging of the blood vessels, which allows to examine large parts in a short time and high resolution scans in one breath hold. CE MRA has found a wide acceptance in the clinical routine, caused by the advantages:

Eovist® (other brand name Primovist™) is a organ 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. Excretion of Gd-EOB-DTPA in the bile may also permit visualization of both the gall bladder and the bile ducts.
Eovist® brightens the signal of T1 weighted MR images immediately after contrast administration. Dynamic and accumulation phase imaging can also be performed after bolus injection of Eovist®. The hepatocytes uptake will increase the signal intensity of normal liver parenchyma at 10 to 20 minutes after injection. 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.

See also Drug Development and Approval Process USA, Contrast Medium, Hepatobiliary Contrast Agents, Tumor Specific Agents and Molecular Imaging.