(MTC) This MRI method increases the contrast by removing a portion of the total signal in tissue. An off resonance radio frequency (RF) pulse saturates macromolecular protons to make them invisible (caused by their ultra-short T2* relaxation times). The MRI signal from semi-solid tissue like brain parenchyma is reduced, and the signal from a more fluid component like blood is retained.
E.g., saturation of broad spectral lines may produce decreases in intensity of lines not directly saturated, through exchange of magnetization between the corresponding states; more closely coupled states will show a greater resulting intensity change. Magnetization transfer techniques make demyelinated brain or spine lesions (as seen e.g. in multiple sclerosis) better visible on T2 weighted images as well as on gadolinium contrast enhanced T1 weighted images.
Off resonance makes use of a selection gradient during an off resonance MTC pulse. The gradient has a negative offset frequency on the arterial side of the imaging volume (caudally more off resonant and cranially less off resonant). The net effect of this type of pulse is that the arterial blood outside the imaging volume will retain more of its longitudinal magnetization, with more vascular signal when it enters the imaging volume. Off resonance MTC saturates the venous blood, leaving the arterial blood untouched.
On resonance has no effect on the free water pool but will saturate the bound water pool and is the difference in T2 between the pools. Special binomial pulses are transmitted causing the magnetization of the free protons to remain unchanged. The z-magnetization returns to its original value. The spins of the bound pool with a short T2 experience decay, resulting in a destroyed magnetization after the on resonance pulse.

See also Magnetization Transfer.

Magnevist® is a paramagnetic ionic contrast agent for use in magnetic resonance imaging. Contrast enhanced MRI with Magnevist® allows additional diagnostic information of tumors, inflammation and vascular lesions and the determination or differentiation of such lesions.
The contrast enhancing effect is produced by the di-N-methylglucamine salt of gadopentetate (Gd-DTPA), the gadolinium complex of diethylenetriamine pentaacetic acid. Magnevist® has the strongest effect on T1 weighted images, by increasing T1 signal intensity in tissues where Magnevist® has accumulated.

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.

See also Ionic Intravenous Contrast Agents and Gadopentetate Dimeglumine.

For a contrast enhanced MR angiography of the peripheral blood vessels, the patient reclines on a moveable table that moves under the MR machine to provide images of the abdomen, upper and lower legs in one procedure. A time optimized 3D gradient echo protocol with contrast agent and tabletop movement in several stages is used.

(LE) Myocardial late enhancement in contrast enhanced cardiac MRI has the ability to precisely delineate myocardial scar associated with coronary artery disease. Viability imaging implies evaluating infarcted myocardium to see whether there is enough viable tissue available for revascularization. The reversal of myocardial dysfunction is particularly relevant in patients with depressed ventricular function because revascularization improves long-term survival. In comparison to SPECT and PET imaging, myocardial late enhancement MRI demonstrates areas of delayed enhancement exactly in correlation with the infarcted region.
Viability on cardiac MRI (CMR) is based on the fact that all infarcts enhance vividly 10-15 minutes after the administration of intravenous paramagnetic contrast agents. This enhancement represents the accumulation of gadolinium in the extracellular space, due to the loss of membrane integrity in the infarcted tissue. This phenomenon of delayed hyperenhancement has been proven to correlate with the actual extent of the infarct.
MRI myocardial late enhancement can quantify the size, location and transmural extent of the infarct. If the transmural extent of the infarct (region of enhancement on MRI) is less than 50% of the wall thickness, there will be improved contractility in that segment following revascularization. In areas of hypokinesia, if there is a rim of "black" or non-infarcted myocardium that is not contracting well, it indicates the presence of hibernating myocardium, which is likely to improve after revascularization of the artery supplying that particular territory.
The total duration of a myocardial late enhancement MR imaging protocol for viability is approximately 30 minutes, including scout images, first-pass images, cine images in two planes, and delayed myocardial enhancement images. In order to assess viable myocardium, the gadolinium contrast agent is injected at a dose of 0.15 to 0.2 mmol/kg. After about 10 minutes, short axis and long axis views (see cardiac axes) of the heart are obtained using an inversion prepared ECG gated gradient echo sequence. The inversion pulse is adjusted to suppress normal myocardium. Areas of nonviable myocardium retain extremely high signal intensity, black areas show normal tissue.

For Ultrasound Imaging (USI) see Myocardial Contrast Echocardiography at Medical-Ultrasound-Imaging.com.

(NSF) Nephrogenic systemic fibrosis is a rare and highly debilitating disorder that involves extensive thickening and hardening of the skin with fibrotic nodules and plaques.
MRI contrast media have very low side effects, but accumulating data indicate that gadolinium-based contrast agents increase the risk for the development of NSF among patients with severe renal insufficiency or renal dysfunction due to the hepato-renal syndrome or in the perioperative liver transplantation period.
Due to this reason, gadolinium contrast agents are now considered contraindicated in patients with an estimated glomerular filtration rate fewer than 30 mL/min/1.73m². In these patients, avoid use of gadolinium-based contrast agents unless the diagnostic information is essential and not available with non-contrast enhanced magnetic resonance imaging (MRI).

Recognized or possibly associated factors for NSF:
When administering a gadolinium-based contrast agent, do not exceed the recommended dose and allow a sufficient period of time for elimination of the contrast medium from the body prior to any readminstration. Screen all patients for renal dysfunction by obtaining a history and/or laboratory tests.

See also Contrast Medium, Adverse Reaction, MRI Risks, MRI Safety, Ionic Intravenous Contrast Agents, Nonionic Intravenous Contrast Agents, and Contraindications.