Contrast agents in magnetic resonance imaging of the liver: present and future

Long-Term Evaluation of Biliary Reflux on Esogastric Mucosae after One-Anastomosis Gastric Bypass and Esojejunostomy in Rats

BACKGROUND

One-anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) remains controversial because it may cause chronic biliary reflux (BR). The risk of developing esogastric cancer due to BR after OAGB/MGB is based on the results of experimental rat studies using esojejunostomy (EJ). The aim of this study was to analyze the potential long-term consequences of BR on the esogastric mucosae in OAGB/MGB-operated rats and to compare these results to those from the use of EJ.

METHODS

Wistar rats received OAGB/MGB (n = 16), EJ (n = 16), and sham (n = 8) operations. Mortality and weight changes were evaluated throughout the experiment. BR was measured using magnetic resonance imaging (MRI). Rats received follow-ups for 30 weeks. A double-blinded histological analysis was performed in the esogastric segments.

RESULTS

BR was diagnosed in OAGB/MGB and EJ rats using the MRI technique; no BR occurred in the sham group. After a 30-week follow-up, no incidences of dysplasia or cancer were observed in the three groups. Additionally, esophageal intestinal metaplasia and mucosal ulcerations were observed in 41.7% and 50% of EJ rats, respectively, and no incidences of these conditions were observed in OAGB/MGB and sham rats. The incidence of esophagitis was significantly higher and more severe in the EJ group compared to those in the OAGB/MGB and sham groups (EJ = 100%, OAGB/MGB = 16.7%, sham = 8.3%; p < 0.001).

CONCLUSIONS

After a 30-week follow-up period, OAGB/MGB rats did not develop any precancerous or cancerous lesions when more than 40% of EJ rats had intestinal metaplasia.

Liver function quantification of patients with portal vein embolization using dynamic contrast-enhanced MRI for assessment of hepatocyte uptake and elimination

PURPOSE

We evaluated pharmacokinetic models which quantify liver function including biliary elimination based on a dynamic Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) technique with sparse data collection feasible in clinical routine.

METHODS

Twelve patients with embolized liver segments following interventional treatment of primary liver cancer or hepatic metastasis underwent MRI. During Gd-EOB-DTPA bolus administration, a 3D dynamic gradient-echo (GRE) MRI examination was performed over approx. 28 min. Interrupted data sampling was started approx. 5 min after contrast agent administration. Different implementations of dual-inlet models were tested, namely the Euler method (DE) and convolution with residue functions (C). A simple uptake model (U) and an uptake- elimination model (UE) extended by incorporating the biliary contrast agent elimination rate (K_e) were evaluated.

RESULTS

The uptake-elimination model, calculated via the simple Euler method (UE- DE) and by convolution (UE-C), yielded similar overall estimates in terms of fitting quality and agreement with published values. The Euler method was approx. 50 times faster and yielded a mean elimination rate of K_e=1.8±1.2mL/(min·100 mL) in nonembolized liver tissue, which was significantly higher (p=8.8·10^-4) than in embolized tissue K_e=0.4±0.4 mL/(min·100 mL). Fractional hepatocyte volume v_h was not significantly higher in nonembolized tissue (52.4 ± 13.4 mL/100 mL) compared to embolized tissue (44.4 ± 26.1 mL/100 mL).

CONCLUSIONS

Interrupted late enhancement MRI data sampling in conjunction with the uptake-elimination model, deconvolved by integration of the differential rate equation and combined with the simple uptake model implemented with the Euler method (U-DE), turned out to be a stable and practical method for reliable noninvasive assessment of liver function.

Metal-Based Complexes as Pharmaceuticals for Molecular Imaging of the Liver

This article reviews the use of metal complexes as contrast agents (CA) and radiopharmaceuticals for the anatomical and functional imaging of the liver. The main focus was on two established imaging modalities: magnetic resonance imaging (MRI) and nuclear medicine, the latter including scintigraphy and positron emission tomography (PET). The review provides an overview on approved pharmaceuticals like Gd-based CA and ^99mTc-based radiometal complexes, and also on novel agents such as ⁶⁸Ga-based PET tracers. Metal complexes are presented by their imaging modality, with subsections focusing on their structure and mode of action. Uptake mechanisms, metabolism, and specificity are presented, in context with advantages and limitations of the diagnostic application and taking into account the respective imaging technique.

On the use of superparamagnetic hydroxyapatite nanoparticles as an agent for magnetic and nuclear in vivo imaging

The identification of alternative biocompatible magnetic NPs for advanced clinical application is becoming an important need due to raising concerns about iron accumulation in soft issues associated to the administration of superparamagnetic iron oxide nanoparticles (NPs). Here, we report on the performance of previously synthetized iron-doped hydroxyapatite (FeHA) NPs as contrast agent for magnetic resonance imaging (MRI). The MRI contrast abilities of FeHA and Endorem® (dextran coated iron oxide NPs) were assessed by ¹H nuclear magnetic resonance relaxometry and their performance in healthy mice was monitored by a 7 Tesla scanner. FeHA applied a higher contrast enhancement, and had a longer endurance in the liver with respect to Endorem® at iron equality. Additionally, a proof of concept of FeHA use as scintigraphy imaging agent for positron emission tomography (PET) and single photon emission computed tomography (SPECT) was given labeling FeHA with ^99mTc-MDP by a straightforward surface functionalization process. Scintigraphy/x-ray fused imaging and ex vivo studies confirmed its dominant accumulation in the liver, and secondarily in other organs of the mononuclear phagocyte system. FeHA efficiency as MRI-T₂ and PET-SPECT imaging agent combined to its already reported intrinsic biocompatibility qualifies it as a promising material for innovative nanomedical applications.

STATEMENT OF SIGNIFICANCE

The ability of iron-doped hydroxyapatite nanoaprticles (FeHA) to work in vivo as imaging agents for magnetic resonance (MR) and nuclear imaging is demonstrated. FeHA applied an higher MR contrast in the liver, spleen and kidneys of mice with respect to Endorem®. The successful radiolabeling of FeHA allowed for scintigraphy/X-ray and ex vivo biodistribution studies, confirming MR results and envisioning FeHA application for dual-imaging.

Assessment of liver function and liver fibrosis with dynamic Gd-EOB-DTPA-enhanced MRI

RATIONALE AND OBJECTIVES

To evaluate the ability of segmental linear fitting analysis of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid liver perfusion magnetic resonance imaging (MRI) to assess liver function and liver fibrosis.

MATERIALS AND METHODS

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid liver perfusion MRI was performed in 41 patients, and perfusion estimates were generated by segmental linear fitting analysis of the time-intensity curves. The relationships of Tin, Tout, Kup, and the ratio between the signal intensities of the peak and the last phase with liver fibrosis stage and laboratory measurements of liver function were evaluated.

RESULTS

Serum prealbumin concentration was significantly positively correlated with Kup and the signal intensity ratio and was significantly negatively correlated with Tin and Tout. Tin and Tout were significantly higher and Kup and the signal intensity ratio were significantly lower in patients with advanced fibrosis than those without. Tout was the best predictor of advanced fibrosis, with an area under the receiving operating characteristic curve of 0.843, a sensitivity of 100%, and a specificity of 80%.

CONCLUSIONS

A new procedure of quantifying the hepatocyte-specific uptake of a T1-enhancing contrast agent can be used to assess impaired hepatobiliary function. The parameters obtained from perfusion MRI have the potential to predict advanced fibrosis.

Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI: a preliminary study comparing galactosyl human serum albumin scintigraphy with indocyanine green retention

OBJECTIVE

To investigate if tracer kinetic modelling of low temporal resolution dynamic contrast-enhanced (DCE) MRI with Gd-EOB-DTPA could replace technetium-99 m galactosyl human serum albumin (GSA) single positron emission computed tomography (SPECT) and indocyanine green (ICG) retention for the measurement of liver functional reserve.

METHODS

Twenty eight patients awaiting liver resection for various cancers were included in this retrospective study that was approved by the institutional review board. The Gd-EOB-DTPA MRI sequence acquired five images: unenhanced, double arterial phase, portal phase, and 4 min after injection. Intracellular contrast uptake rate (UR) and extracellular volume (Ve) were calculated from DCE-MRI, along with the ratio of GSA radioactivity of liver to heart-plus-liver and per cent of cumulative uptake from 15-16 min (LHL15 and LU15, respectively) from GSA-scintigraphy. ICG retention at 15 min, Child-Pugh cirrhosis score (CPS) and postoperative Inuyama fibrosis criteria were also recorded. Statistical analysis was with Spearman rank correlation analysis.

RESULTS

Comparing MRI parameters with the reference methods, significant correlations were obtained for UR and LHL15, LU15, ICG15 (all 0.4-0.6, P < 0.05); UR and CPS (-0.64, P < 0.001); Ve and Inuyama (0.44, P < 0.05).

CONCLUSION

Measures of liver function obtained by routine Gd-EOB-DTPA DCE-MRI with tracer kinetic modelling may provide a suitable method for the evaluation of liver functional reserve.

KEY POINTS

• Magnetic resonance imaging (MRI) provides new methods of measuring hepatic functional reserve. • DCE-MRI with Gd-EOB-DTPA offers the possibility of replacing scintigraphy. • The analysis method can be used for preoperative liver function evaluation.

Assessing liver function using dynamic Gd-EOB-DTPA-enhanced MRI with a standard 5-phase imaging protocol

PURPOSE

To evaluate liver function obtained by tracer-kinetic modeling of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data acquired with a routine gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced protocol.

MATERIALS AND METHODS

Data were acquired from 25 cases of nonchronic liver disease and 94 cases of cirrhosis. DCE-MRI was performed with a dose of 0.025 mmol/kg Gd-EOB-DTPA injected at 2 mL/sec. A 3D breath-hold sequence acquired 5 volumes of 72 slices each: precontrast, double arterial phase, portal phase, and 4-minute postcontrast. Regions of interest (ROIs) were selected semiautomatically in the aorta, portal vein, and whole liver on a middle slice. A constrained dual-inlet two-compartment uptake model was fitted to the ROI curves, producing three parameters: intracellular uptake rate (UR), extracellular volume (Ve), and arterial flow fraction (AFF).

RESULTS

Median UR dropped from 4.46 10(-2) min(-1) in the noncirrhosis to 3.20 in Child-Pugh A (P = 0.001), and again to 1.92 in Child-Pugh B (P < 0.0001). Median Ve dropped from 6.64 mL 100 mL(-1) in the noncirrhosis to 5.80 in Child-Pugh A (P = 0.01). Other combinations of Ve and AFF changes were not significant for any group.

CONCLUSION

UR obtained from tracer kinetic analysis of a routine DCE-MRI has the potential to become a novel index of liver function.

Combined quantification of liver perfusion and function with dynamic gadoxetic acid-enhanced MR imaging

PURPOSE

To evaluate the feasibility of quantifying hepatic perfusion and function by using dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging with the hepatobiliary contrast agent gadoxetic acid and a dual-inlet two-compartment uptake model.

MATERIALS AND METHODS

The study was approved by the local institutional review board, and written informed consent was obtained from all patients. Data were acquired between October 2008 and November 2009 in 24 patients with hepatic metastases from neuroendocrine tumors (13 men, 11 women; mean age, 59.8 years). DCE MR imaging was performed at 3.0 T with a standard dose of gadoxetic acid and a three-dimensional sequence, with 48 sections of data acquired every 2.2 seconds for 5 minutes. For each patient, a plasma flow map was calculated by means of deconvolution and the model was fitted to six region-of-interest curves. Results were evaluated with goodness-of-fit analysis and, in normal-appearing liver tissue, by comparing perfusion parameters with those reported in the literature. Interobserver effects in the selection of arterial and venous input functions were assessed.

RESULTS

With an arterial delay parameter, the model provided a good fit to all data. Values for arterial and venous plasma flow and extracellular volume in normal-appearing liver tissue were comparable to those in the literature. The mean intracellular uptake rate is 3.4/100/min with a standard deviation of 1.9/100/min The model also provided a good fit in all tumor data, producing high arterial flow fraction (87%) and lower uptake (1.7/100/min) . Bias due to observer-dependent differences in the selection of the input functions was negligible.

CONCLUSION

The analysis of dynamic gadoxetic acid-enhanced MR images with the dual-inlet two-compartment uptake model presents a new and practical approach for measuring arterial and venous perfusion and hepatic function in a single acquisition.

Multimodal 3D imaging of cells and tissue, bridging the gap between clinical and research microscopy

Absorption dyes are widely used in traditional cytology and pathology clinical practice, while fluorophores and nanoparticles are more often used in biologic research. Optical projection tomographic microscopy (OPTM) is a platform technology that can image the same specimen in multiple modes in 3D, providing morphologic and molecular information concurrently and in exact co-registration. The depth-of-field of a high numerical aperture objective is extended by scanning the focal plane through the sample to generate an optical projection image. Samples of cells or tissue are brought into the OPTM instrument through a microcapillary tube filled with optical index-matching gel. Multiple optical projection images are taken from different perspectives by rotating the tube. Computed tomography (CT) algorithms are applied to these optical projection images to reconstruct 3D structure of the sample. Image segmentation and analysis based on these 3D images provide quantitative biosignatures for cancer diagnosis that represents a clear improvement over conventional 2D image analysis. In this article, we introduce the OPTM platform, optical Cell-CT, and Tissue-CT instruments, and some applications using these OPTM instruments.

Use of magnetic resonance imaging contrast agents to detect transplanted liver cells

Liver transplantation saves the lives of millions of patients every year. The advent of cell rather than organ transplantation could potentially further improve the success of this approach. However, one problem facing the delivery and the monitoring of cell transplants is their noninvasive in vivo visualization. Noninvasive imaging is needed for this. To distinguish transplanted cells from the host liver, it is necessary to either tag these using exogenous contrast agents (eg, iron oxide nanoparticles) or insert a reporter gene that could selectively identify transplanted cells. Nevertheless, these approaches face significant challenges such as providing sufficient signal-to-noise, cellular toxicity, or unequivocal detection. Preclinical studies are currently under way to refine these approaches with initial clinical trials being on the horizon for the next few years. A gradual refinement of these approaches and a robust clinical implementation promise a significant step in ensuring greater efficacy of cell transplants for the diseased liver.

Magnetic nanoparticles in MR imaging and drug delivery

Magnetic nanoparticles (MNPs) possess unique magnetic properties and the ability to function at the cellular and molecular level of biological interactions making them an attractive platform as contrast agents for magnetic resonance imaging (MRI) and as carriers for drug delivery. Recent advances in nanotechnology have improved the ability to specifically tailor the features and properties of MNPs for these biomedical applications. To better address specific clinical needs, MNPs with higher magnetic moments, non-fouling surfaces, and increased functionalities are now being developed for applications in the detection, diagnosis, and treatment of malignant tumors, cardiovascular disease, and neurological disease. Through the incorporation of highly specific targeting agents and other functional ligands, such as fluorophores and permeation enhancers, the applicability and efficacy of these MNPs have greatly increased. This review provides a background on applications of MNPs as MR imaging contrast agents and as carriers for drug delivery and an overview of the recent developments in this area of research.

Fractionated Feridex and positive contrast: in vivo MR imaging of atherosclerosis

Macrophages have been identified as a critical factor in the pathogenesis of atherosclerosis. Ultrasmall iron oxide particles (USPIOs) have been used to passively target intraplaque macrophages. For dextran-based USPIOs, uptake into macrophages may be modulated by particle size. The aim of the current study was to test the efficacy of fractionated Feridex with respect to macrophage uptake in atherosclerotic rabbits. Fractionation of Feridex resulted in a 15-nm USPIO that exhibited a blood half-life of 15.9 h and liver retention of 6.4%. Blood clearance and liver retention of Feridex was 0.46 h and 60%, following administration of 4.8 mg Fe/kg Feridex. Atherosclerotic rabbits were administered 0.5 or 4.8 mg Fe/kg dosages of either fractionated Feridex or Feridex. MRI was performed at 1.5T over a 24-h time period postinjection. Perls and RAM-11 staining was performed to identify iron deposition. MRI showed a dose-dependent signal loss using conventional gradient echo (GRE) sequences following administration of fractionated Feridex. Even at low dose, significant signal loss was observed that correlated with histology. No signal attenuation or iron deposition was observed in the vessel wall of rabbits administered Feridex. Results of this study suggest that it may be possible to optimize USPIOs for intraplaque macrophage detection.

Model-based analysis of Gd-BOPTA-induced MR signal intensity changes in cirrhotic rat livers

OBJECTIVE

To quantify the hepatic transport of the hepatobiliary contrast agent gadobenate dimeglumine (Gd-BOPTA) in rats with biliary cirrhosis of various severity degrees from magnetic resonance (MR) signal intensities using a population pharmacokinetic approach.

MATERIALS AND METHODS

MR signal intensity was recorded during the Gd-BOPTA perfusion of normal and cirrhotic isolated rat livers. Similar experiments were conducted with Gd-labeled Gd-BOPTA to quantify Gd-BOPTA content in liver, bile, and perfusate. All experimental data were analyzed together according to a population pharmacokinetic approach.

RESULTS

A 6-compartment model developed from the radioactivity data adequately fit all MRI data when 4 image parameters were added to describe the relationship between the amount of contrast agent and the signal intensity. The model showed that entry of Gd-BOPTA into hepatocytes was decreased in cirrhotic livers when compared to normal livers.

CONCLUSIONS

Although the MR signal intensity is similar in normal and cirrhotic livers, the population pharmacokinetic approach developed in this study shows a decreased entry of Gd-BOPTA into cirrhotic hepatocytes.

Quantification of Gd-BOPTA uptake and biliary excretion from dynamic magnetic resonance imaging in rat livers: model validation with 153Gd-BOPTA

OBJECTIVES

We sought to develop and validate a pharmacokinetic model allowing description of the magnetic resonance (MR) signal intensity induced by the hepatobiliary contrast agent Gd-BOPTA and to quantify the overall Gd-BOPTA transport in rat liver.

MATERIALS AND METHODS

MR signal intensity was recorded during the perfusion of rat livers with Gd-DTPA, an extracellular contrast agent, and Gd-BOPTA, a hepatobiliary contrast agent. Similar experiments were conducted with Gd-labeled contrast agents for quantitative measurement in liver, bile and perfusate.

RESULTS

A complete 6-compartment, 8 parameter open model was first developed to describe the pharmacokinetics of the compound based on the radioactivity data analysis. Because perfusate and bile data were not available in MRI experiments, a reduced model (6-compartment, 5 parameters) was considered for the MRI data. The performance of the reduced model was tested using the radioactivity data. The reduced model successfully described the contrast agent amount in the liver and correctly predicted amounts in bile and perfusate.

CONCLUSIONS

Pharmacokinetic modeling of MR signal intensity induced by Gd-BOPTA permits quantification of Gd-BOPTA uptake and biliary excretion in rat livers.

Evaluation of Gd-EOB-DTPA Uptake in a Perfused and Isolated Mouse Liver Model

OBJECTIVES

The aim of this work was to quantitatively evaluate the pharmacokinetic pattern of Gd-EOB-DTPA in a model of isolated and perfused mouse liver by using magnetic resonance imaging (MRI) and monochromatic quantitative computed tomography (MQCT).

MATERIALS AND METHODS

For MQCT, perfusions were realized with the gallbladder spared; for MRI, with gallbladder spared, severed, or clamped. Inductively coupled plasma (ICP) was performed at the end of the imaging protocols.

RESULTS

MQCT, MRI, and ICP showed that perfused mice livers with spared gallbladder can be divided in 2 groups depending on their uptake profile of the contrast agent. Livers with severed gallbladders behave as the group internalizing more contrast agent, whereas Gd-EOB-DTPA uptake looks impaired in the case of a clamped gallbladder.

CONCLUSIONS

For the first time, MQCT and MRI have been performed in parallel to investigate the same physiological problem. The existence of 2 liver groups seems to be the result of some instability of the protocol likely to be related to surgery.

Cellular MR Imaging

Cellular MR imaging is a young field that aims to visualize targeted cells in living organisms. In order to provide a different signal intensity of the targeted cell, they are either labeled with MR contrast agents in vivo or prelabeled in vitro. Either (ultrasmall) superparamagnetic iron oxide [(U)SPIO] particles or (polymeric) paramagnetic chelates can be used for this purpose. For in vivo cellular labeling, Gd3+- and Mn2+- chelates have mainly been used for targeted hepatobiliary imaging, and (U)SPIO-based cellular imaging has been focused on imaging of macrophage activity. Several of these magneto-pharmaceuticals have been FDA-approved or are in late-phase clinical trials. As for prelabeling of cells in vitro, a challenge has been to induce a sufficient uptake of contrast agents into nonphagocytic cells, without affecting normal cellular function. It appears that this issue has now largely been resolved, leading to an active research on monitoring the cellular biodistribution in vivo following transplantation or transfusion of these cells, including cell migration and trafficking. New applications of cellular MR imaging will be directed, for instance, towards our understanding of hematopoietic (immune) cell trafficking and of novel guided (stem) cell-based therapies aimed to be translated to the clinic in the future.

Direct evidence of the temperature dependence of Gd-BOPTA transport in the intact rat liver

The aim was to study the influence of temperature on the transport of the hepatobiliary contrast agent Gadobenate dimeglumine (Gd-BOPTA). Rat livers were isolated and perfused with Gd-BOPTA at 12, 25, 30, 36 and 38 degrees C. After the perfusion period, biopsies were collected and the MR signal intensity was measured. Uptake and biliary excretion were quantified with radiolabeled Gd-BOPTA. MR signal intensity decreased with temperature of perfusion. This phenomenon was appropriately quantified with 153Gd and 153Sm labeling, in contrast to 67Ga.

New criteria for assessing fit quality in dynamic contrast-enhancedT1-weighted MRI for perfusion and permeability imaging

Contrast-enhanced (CE) MRI provides in vivo physiological information that cannot be obtained by conventional imaging methods. This information is generally extracted by using models to represent the circulation of contrast agent in the body. However, the results depend on the quality of the fit obtained with the chosen model. Therefore, one must check the fit quality to avoid working on physiologically irrelevant parameters. In this study two dimensionless criteria-the fraction of modeling information (FMI) and the fraction of residual information (FRI)-are proposed to identify errors caused by poor fit. These are compared with more conventional criteria, namely the quadratic error and the correlation coefficient, both theoretically and with the use of simulated and real CE-MRI data. The results indicate the superiority of the new criteria. It is also shown that these new criteria can be used to detect oversimplified models.

In vitro stability analyses as a model for metabolism of ferromagnetic particles (Clariscan), a contrast agent for magnetic resonance imaging

Clariscan is a new contrast agent for magnetic resonance imaging. It is an aqueous suspension of ferromagnetic particles injected for blood pool and liver imaging. Previous experiments showed that particles made of 59Fe were taken up by the mononuclear phagocytic system and then solubilised. The present work aims at explaining a possible mechanism for the dissolution of these ferromagnetic particles in the body. The particles were diluted in 10-mM citrate or 10-mM acetate buffers at pH 4.5, 5.0 and 5.5 and incubated at 37 degrees C for up to 22 days, protected from light. The mixtures were analysed at different times during this incubation period using photon correlation spectroscopy, magnetic relaxation, visible spectroscopy and reactivity of the iron with the chelator, bathophenanthroline disulphonic acid. The data obtained with these techniques showed that the particles were almost completely solubilised within 4-7 days when incubated in 10 mM citrate, pH 4.5. Incubation in 10 mM citrate buffer, pH 5.0 revealed a slower solubilisation of the particles, as the changes observed after 72 h of incubation at pH 5.0 were 43-71% of the changes observed at pH 4.5. Incubation in 10 mM citrate, pH 5.5 revealed an even slower solubilisation of the particles, as the changes observed after 72 h of incubation at pH 5.5 were 12-34% of those observed at pH 4.5. Incubation of the particles in 10 mM acetate at pH 4.5, 5.0 and 5.5, as well as incubation of the particles in water pH adjusted to pH 5.1, resulted in only minor or no solubilisation of the particles. The results indicate that the low pH of endosomes and lysosomes, as well as endogenous iron-complexing substances, may be important for the solubilisation of these ferromagnetic particles following i.v. injection of Clariscan.

Assessing gene expression in vivo: magnetic resonance imaging and spectroscopy

Recent developments in magnetic resonance imaging and spectroscopy afford the possibility of detecting and assessing transfer, expression and subsequent therapeutic changes of effector or marker transgenes noninvasively. In the field of MR imaging, 'smart' MR contrast agents are being developed, so called because they change their conformational structure and in so doing induce MR detectable changes in a given tissue. These agents become 'switched on' in response to physiological changes brought about by the enzymatic action of a given gene product (enzymes), and are being developed for use in intact cells, isolated organs and animal models. Ultimately, these agents hold the promise of bridging the gap between the laboratory and the patient with noninvasive detection of transgene expression in vivo in man. Similarly, magnetic resonance spectroscopy is being developed as a noninvasive method to assess transgene expression indirectly by means of MR visible intracellular markers. These markers take the form of intracellular endo/exogenous metabolites associated with exogenous enzyme expression and function. Again, this technique will be applicable to a variety of different situations, from cell suspensions through to clinical imaging of the whole body. In this article the unique opportunities for laboratory-based and clinical studies afforded by MR techniques are discussed.

Synthesis, characterization, and imaging performance of a new class of macrocyclic hepatobiliary MR contrast agents

RATIONALE AND OBJECTIVES

To investigate the effect of substituent lipophilicity, substituent position, and overall charge on the hepatobiliary clearance and tolerance of a series of aromatic ring-containing macrocyclic Gd chelates to select a candidate compound for evaluation as a hepatobiliary imaging agent.

METHODS

Hepatobiliary clearance was studied in rats. Tissue distribution and tolerance were studied in mice. Imaging was performed in cats, rabbits, and Rhesus monkeys using T1-weighted pulse sequences or T1-weighted breath-hold pulse sequences.

RESULTS

All the compounds were excreted bimodally. Gd-2,5-BPA-DO3A (15d) was found to have the optimal combination of hepatobiliary clearance (47% in rats, 29% in mice) and tolerance (minimum lethal dose 5.0 mmol/kg). Initial imaging studies in cats demonstrated the feasibility of Gd-2,5-BPA-DO3A for hepatic imaging. In rabbits with implanted VX-2 adenocarcinoma as a model for metastatic liver disease, Gd-2,5-BPA-DO3A provided sustained hepatic signal intensity (SI) enhancement and lesion conspicuity over a 120-minute imaging time course. In Rhesus monkeys with normal liver function, Gd-2,5-BPA-DO3A afforded sustained hepatic SI enhancement and a time-dependent increase in gallbladder SI over the entire 90-minute imaging time course.

CONCLUSIONS

Gd-2,5-BPA-DO3A provides dramatic and sustained SI enhancement of hepatic tissue in cats, rabbits, and Rhesus monkeys that was superior in all respects to the extracellular space MRI agent, Gd-HP-DO3A, that was employed as a control.