25 Years of Contrast-Enhanced MRI: Developments, Current Challenges and Future Perspectives

Abstract

In 1988, the first contrast agent specifically designed for magnetic resonance imaging (MRI), gadopentetate dimeglumine (Magnevist(®)), became available for clinical use. Since then, a plethora of studies have investigated the potential of MRI contrast agents for diagnostic imaging across the body, including the central nervous system, heart and circulation, breast, lungs, the gastrointestinal, genitourinary, musculoskeletal and lymphatic systems, and even the skin. Today, after 25 years of contrast-enhanced (CE-) MRI in clinical practice, the utility of this diagnostic imaging modality has expanded beyond initial expectations to become an essential tool for disease diagnosis and management worldwide. CE-MRI continues to evolve, with new techniques, advanced technologies, and novel contrast agents bringing exciting opportunities for more sensitive, targeted imaging and improved patient management, along with associated clinical challenges. This review aims to provide an overview on the history of MRI and contrast media development, to highlight certain key advances in the clinical development of CE-MRI, to outline current technical trends and clinical challenges, and to suggest some important future perspectives.

Funding: Bayer HealthCare.

Keywords: Body imaging; Contrast enhancement; Gadolinium; MRI; Multimodality imaging; Relaxivity.

Fig. 1

Magnetic resonance image of the kidneys following the first human application of 0.05 mmol/kg gadopentetate dimeglumine (1 min p.i.) [20]. Reproduced from Laniado et al. [20] by permission of Physiol Chem Phys & Med NMR

Fig. 2

Contrast-enhanced magnetic resonance imaging images of brain metastases [80]. Reproduced by permission of SAGE publications Ltd., Los Angeles, New Delhi, Singapore and Washington DC, from Anzalone et al. [80], Copyright (© Informa Healthcare, 2014)

Fig. 3

MR perfusion images for a pathologically proven mixed oligoastrocytoma. Images a–d show baseline examination (a FLAIR; b T2-weighted pre-contrast; c T1-weighted post-gadopentetate dimeglumine; d dynamic susceptibility-weighted perfusion image with relative CBV color overlay map), which demonstrated a high baseline rCBV of 4.23, indicative of a high-grade tumor. Images e–h show the equivalent sequences at 18-week follow-up, and demonstrate substantial increase in tumor volume and a rCBV of 13.37 [100]. rCBV relative cerebral blood volume, FLAIR fluid-attenuated inversion recovery, MR magnetic resonance. Reproduced from Law et al. [100], Copyright 2014, with permission from The Radiological Society of North America (RSNA^®)

Fig. 4

Magnetic resonance imaging of the liver in a patient with chronic hepatitis C. Images a and b show pre-contrast T2- and T1-weighted images, respectively; images c–f were obtained 20 s, 1, 5 and 25 min, respectively, after injection of gadoxetic acid. A lesion in segment VII of the liver demonstrates hyperintensity on pre-contrast T2-weighted image, and hypointensity on T1. Post-contrast, the mass has peripheral puddling of contrast in the arterial phase (c) which progressively coalesce (d, e). In the hepatocyte phase (f), the mass is hypointense to the liver with similar signal intensity to blood vessels. Imaging features are characteristic of haemangioma [135]. Reprinted from Cruite et al. [135], with permission from the American Journal of Roentgenology

Fig. 5

a Schematic dynamic contrast enhancement curves in CE-MRI of the breast; b bilateral CE-MRI breast images: dynamic post-contrast injection non-subtracted (top) and subtracted (bottom) images. Mass showed irregular shape, spiculated borders, heterogeneous internal enhancement and fast initial enhancement followed by early washout (signal intensity/time curve; right), suggestive of a malignant lobular invasive carcinoma [161] CE-MRI contrast-enhanced magnetic resonance imaging. Reproduced from Kuhl [161], Copyright 2014, with permission from The Radiological Society of North America (RSNA^®)

Fig. 6

Schematic diagram of a gadolinium contrast agent molecular complex, and intrinsic factors affecting its T1-relaxivity