#06 "MRI Applications: Tips & Tricks From a Specialist"

Hello MRI Community,
As promised during the recent AI & Innovation Forum, we're excited to announce a new episode of the Everything MRI Podcast, featuring a deep dive into MRI applications led by the renowned Stephen Mhiribidi. Join us as we tap into Stephen's wealth of experience as an MRI application specialist. Together, we'll explore essential tips & tricks for image optimisation, effective training techniques, and more.
You can find this episode on all the major streaming platforms including KZbin, Spotify, Amazon Music, and many more 🎙️
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Thank you for your continued support, and we look forward to connecting with you on all of our platforms 🧲
#EverythingMRI #MRI #MagneticResonanceImaging #Radiography #Radiology #AppsTraining #ImageOptimisation #Tips&Tricks #MedicalImaging #Innovation #Healthcare

[@stoyanvalentinov1861]

Hello. Can you please elaborate on why ProHance is "the worst" contrast agent for cardiac MRIs? I'm just curious as in my (also big) clinic there is only Primovist (liver) and ProHance (everything else), so our cardiac MRIs are also done with ProHance.

[@everything-mri]

Hello. Thank you for watching. We have forwarded your question to Stephen. Here below is his replay: I shall stick to the everyday macrocylic contrast agents. The first clue is in the medication charts that come with the contrast media- Prohance is indicated for "use in MRI in adults to visualize lesions in the head and neck" (Bracco). Gadovist is indicated for use in MRI in adults and children of all ages to visualise lesions and MRA in all parts of the body, as is Dotarem- this is all from the manufacturers charts and FDA. From research, of the 3, Gadovist has the highest T1 relaxivity (5.2 L/mmol-s) followed by Prohance (4.1) and then Dotarem (3.6), which means that Gadovist produces the highest signal intensity (SI) for comparable dosages. As Gadovist is twice the strength of both Prohance and Dotarem, half the dose of Gadovist can be used as compared to the other 2, although 0.15 mmol/kg is recommended rather than 0.1. Additionally Gadovist has a much higher viscosity and osmolality (5cP and 1603 mOsm/kg) than both Prohance (1.3 and 630) and Dotarem (2.4 and 1350). Gadovist has higher SI at first pass perfusion and sticks around longer for tissue characterisation (LGE) than both Prohance and Dotarem (for cardiac MRI). Also from experience, for the equivalent dose of Dotarem and Prohance, Dotarem performs better both for first pass and LGE. With regards to Prohance (sticking to the question), a single dose will have left the myocardium within 3 minutes of administration; even a double dose barely allows LGE assessment at 4 minutes. If you must use Prohance, I would recommend a triple (also approved by the manufacturer & FDA) or quadruple dose for full cardiac MRI assessment; bare in mind though that you'd need to work out the appropriate split for perfusion if doing stress and rest perfusion before topping up for LGE.

[@stoyanvalentinov1861]

@@everything-mri Thank you very much for the detailed answer! We are applying twice 0,2 mmol/kg for a total of 0,4, so we are already at the quadruple dose. Our LGEs start 8 minutes after contrast injection, which seems bit late in this context now.