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.

(FLASH) A fast sequence producing signals called gradient echo with low flip angles. FLASH sequences are modifications, which incorporate or remove the effects of transverse coherence respectively.
FLASH uses a semi-random spoiler gradient after each echo to spoil the steady state (to destroy any remaining transverse magnetization) by causing a spatially dependent phase shift. The transverse steady state is spoiled but the longitudinal steady state depends on the T1 values and the flip angle. Extremely short TR times are possible, as a result the sequence provides a mechanism for gaining extremely high T1 contrast by imaging with TR times as brief as 20 to 30 msec while retaining reasonable signal levels. It is important to keep the TE as short as possible to suppress susceptibility artifacts.
The T1 contrast depends on the TR as well as on flip angle, with short TE.
Small flip angles and short TR results in proton density, and long TR in T2* weighting.
With large flip angles and short TR result T1 weighted images.

TR and flip angle adjustment:
TR 3000 ms, Flip Angle 90°
TR 1500 ms, Flip Angle 45°
TR 700 ms, Flip Angle 25°
TR 125 ms, Flip Angle 10°

The apparent ability to trade TR against flip angle for purposes of contrast and the variation in SNR as the scan time (TR) is reduced.

See also Gradient Echo Sequence.

A solution of ferric ammonium citrate (Geritol) used to enhance the delineation of the bowel. With T1 weighted magnetic resonance imaging (MRI) the predominantly positive enhancement helps to distinguish organs and tissues that are adjacent to the upper regions of the gastrointestinal tract. Product name found as both Ferriseltz® and FerriSeltz®.

Short name: AMI-25, generic name: Ferumoxide (SPIO)
Ferumoxides are superparamagnetic (T2*) MRI contrast agents, so the largest signal change is on T2 and T2* weighted images.
The agent distributes relatively rapidly to organs with reticuloendothelial cells primarily the liver, spleen and bone marrow. The liver shows decreased signal intensity, as does the spleen and marrow. The agent is taken up by the normal liver, resulting in increased CNR between tumor and normal liver. Hepatocellular lesions, such as adenoma or focal nodular hyperplasia, contain reticuloendothelial cells, so they will behave similar to the liver, with decreased signal on T2 weighted images. On T1 images, there is typically some circulating contrast agent, and blood vessels show increased signal intensity.
Current MRI protocols involve T1 weighted breath-hold gradient echo images of the liver, and fast spin echo T2 weighted pictures. This requires about 15 minutes. The patient is then removed from the scanner, and the contrast agent administered. After contrast administration, the same pulse sequences are again repeated.

Short name: Gd-DTPA, generic name: Gadopentetate dimeglumine, chemical compound: Gadolinium-diethylenetriaminepentaacetic acid
Gadopentetate dimeglumine was introduced in 1981, as the first paramagnetic MRI contrast agent (ionic). The Gd-induced dipole dipole interactions lead to shortening of T1, which results in contrast enhancement on T1 weighted images. The used metal ion Gd3+ (gadolinium) is toxic, and therefore bound in the renally excreted DTPA chelate, a very stable complex. The Gd-complex also induce susceptibility effects, as a result of the magnetic field gradient between the contrast agent in the blood vessels and the surrounding tissue, that lead to shortening of T2 or T2*.
Following intravenous administration, the compound is distributed rapidly in the extracellular space and is eliminated unchanged by glomerular filtration via the kidneys. Up to 6 hours, post injection an average of 83% of the dose is eliminated renal.

See also Magnevist®, Gadolinium and Contrast Agents.