Questions and Answers ​in MRI
  • Home
  • Complete List of Questions
  • …Magnets & Scanners
    • Basic Electromagnetism >
      • What causes magnetism?
      • What is a Tesla?
      • Who was Tesla?
      • What is a Gauss?
      • How strong is 3.0T?
      • What is a gradient?
      • Aren't gradients coils?
      • What is susceptibility?
      • How to levitate a frog?
      • What is ferromagnetism?
      • Superparamagnetism?
    • Magnets - Part I >
      • Types of magnets?
      • Brands of scanners?
      • Which way does field point?
      • Which is the north pole?
      • Low v mid v high field?
      • Advantages to low-field?
      • Disadvantages?
      • What is homogeneity?
      • Why homogeneity?
      • Why shimming?
      • Passive shimming?
      • Active shimming?
    • Magnets - Part II >
      • Superconductivity?
      • Perpetual motion?
      • How to ramp?
      • Superconductive design?
      • Room Temp supercon?
      • Liquid helium use?
      • What is a quench?
      • Is field ever turned off?
      • Emergency stop button?
    • Gradients >
      • Gradient coils?
      • How do z-gradients work?
      • X- and Y- gradients?
      • Open scanner gradients?
      • Eddy current problems?
      • Active shielded gradients?
      • Active shield confusion?
      • What is pre-emphasis?
      • Gradient heating?
      • Gradient specifications?
      • Gradient linearity?
    • RF & Coils >
      • Many kinds of coils?
      • Radiofrequency waves?
      • Phase v frequency?
      • RF Coil function(s)?
      • RF-transmit coils?
      • LP vs CP (Quadrature)?
      • Multi-transmit RF?
      • Receive-only coils?
      • Array coils?
      • AIR Coils?
    • Site Planning >
      • MR system layout?
      • What are fringe fields?
      • How to reduce fringe?
      • Magnetic shielding?
      • Need for vibration testing?
      • What's that noise?
      • Why RF Shielding?
      • Wires/tubes thru wall?
  • ...Safety and Screening
    • Overview >
      • ACR Safety Zones?
      • MR safety screening?
      • Incomplete screening?
      • Passive v active implants?
      • Conditional implants?
      • Common safety issues?
      • Projectiles?
      • Metal detectors?
      • Pregnant patients?
      • Postop, ER & ICU patients?
      • Temperature monitoring?
      • Orbital foreign bodies?
      • Bullets and shrapnel?
    • Static Fields >
      • "Dangerous" metals?
      • "Safe" metals?
      • Magnetizing metal?
      • Object shape?
      • Forces on metal?
      • Most dangerous place?
      • Force/torque testing?
      • Static field bioeffects?
      • Dizziness/Vertigo?
      • Flickering lights?
      • Metallic taste?
    • RF Fields >
      • RF safety overview?
      • RF biological effects?
      • What is SAR?
      • SAR limits?
      • Operating modes?
      • How to reduce SAR?
      • RF burns?
      • Estimate implant heating?
      • SED vs SAR?
      • B1+rms vs SAR?
      • Personnel exposure?
      • Cell phones?
    • Gradient Fields >
      • Gradient safety overview
      • Acoustic noise?
      • Nerve stimulation?
      • Gradient vs RF heating?
    • Safety: Neurological >
      • Aneurysm coils/clips?
      • Shunts/drains?
      • Pressure monitors/bolts?
      • Deep brain stimulators?
      • Spinal cord stimulators?
      • Vagal nerve stimulators?
      • Cranial electrodes?
      • Carotid clamps?
      • Peripheral stimulators?
      • Epidural catheters?
    • Safety: Head & Neck >
      • Additional orbit safety?
      • Cochlear Implants?
      • Bone conduction implants?
      • Other ear implants?
      • Dental/facial implants?
      • ET tubes & airways?
    • Safety: Chest & Vascular >
      • Breast tissue expanders?
      • Breast biopsy markers?
      • Airway stents/valves/coils?
      • Respiratory stimulators?
      • Ports/vascular access?
      • Swan-Ganz catheters?
      • IVC filters?
      • Implanted infusion pumps?
      • Insulin pumps & CGMs?
      • Vascular stents/grafts?
      • Sternal wires/implants?
    • Safety: Cardiac >
      • Pacemaker dangers?
      • Pacemaker terminology?
      • New/'Safe" Pacemakers?
      • Old/Legacy Pacemakers?
      • Violating the conditions?
      • Epicardial pacers/leads?
      • Cardiac monitors?
      • Heart valves?
      • Miscellaneous CV devices?
    • Safety: Abdominal >
      • PIllCam and capsules?
      • Gastric pacemakers?
      • Other GI devices?
      • Contraceptive devices?
      • Foley catheters?
      • Incontinence devices?
      • Penile Implants?
      • Sacral nerve stimulators?
      • GU stents and other?
    • Safety: Orthopedic >
      • Orthopedic hardware?
      • External fixators?
      • Traction and halos?
      • Bone stimulators?
      • Magnetic rods?
  • …The NMR Phenomenon
    • Spin >
      • What is spin?
      • Why I = ½, 1, etc?
      • Proton = nucleus = spin?
      • Predict nuclear spin (I)?
      • Magnetic dipole moment?
      • Gyromagnetic ratio (γ)?
      • "Spin" vs "Spin state"?
      • Energy splitting?
      • Fall to lowest state?
      • Quantum "reality"?
    • Precession >
      • Why precession?
      • Who was Larmor?
      • Energy for precession?
      • Chemical shift?
      • Net magnetization (M)?
      • Does M instantly appear?
      • Does M also precess?
      • Does precession = NMR?
    • Resonance >
      • MR vs MRI vs NMR?
      • Who discovered NMR?
      • How does B1 tip M?
      • Why at Larmor frequency?
      • What is flip angle?
      • Spins precess after 180°?
      • Phase coherence?
      • Release of RF energy?
      • Rotating frame?
      • Off-resonance?
      • Adiabatic excitation?
      • Adiabatic pulses?
    • Relaxation - Physics >
      • Bloch equations?
      • What is T1?
      • What is T2?
      • Relaxation rate vs time?
      • Why is T1 > T2?
      • T2 vs T2*?
      • Causes of Relaxation?
      • Dipole-dipole interactions?
      • Chemical Exchange?
      • Spin-Spin interactions?
      • Macromolecule effects?
      • Which H's produce signal?
      • "Invisible" protons?
      • Magnetization Transfer?
      • Bo effect on T1 & T2?
      • How to predict T1 & T2?
    • Relaxation - Clincial >
      • T1 bright? - fat
      • T1 bright? - other oils
      • T1 bright? - cholesterol
      • T1 bright? - calcifications
      • T1 bright? - meconium
      • T1 bright? - melanin
      • T1 bright? - protein/mucin
      • T1 bright? - myelin
      • Magic angle?
      • MT Imaging/Contrast?
  • …Pulse Sequences
    • MR Signals >
      • Origin of MR signal?
      • Free Induction Decay?
      • Gradient echo?
      • TR and TE?
      • Spin echo?
      • 90°-90° Hahn Echo?
      • Stimulated echoes?
      • STEs for imaging?
      • 4 or more RF-pulses?
      • Partial flip angles?
      • How is signal higher?
      • Optimal flip angle?
    • Spin Echo >
      • SE vs Multi-SE vs FSE?
      • Image contrast: TR/TE?
      • Opposite effects ↑T1 ↑T2?
      • Meaning of weighting?
      • Does SE correct for T2?
      • Effect of 180° on Mz?
      • Direction of 180° pulse?
    • Inversion Recovery >
      • What is IR?
      • Why use IR?
      • Phase-sensitive IR?
      • Why not PSIR always?
      • Choice of IR parameters?
      • TI to null a tissue?
      • STIR?
      • T1-FLAIR
      • T2-FLAIR?
      • IR-prepped sequences?
      • Double IR?
    • Gradient Echo >
      • GRE vs SE?
      • Multi-echo GRE?
      • Types of GRE sequences?
      • Commercial Acronyms?
      • Spoiling - what and how?
      • Spoiled-GRE parameters?
      • Spoiled for T1W only?
      • What is SSFP?
      • GRASS/FISP: how?
      • GRASS/FISP: parameters?
      • GRASS vs MPGR?
      • PSIF vs FISP?
      • True FISP/FIESTA?
      • FIESTA v FIESTA-C?
      • DESS?
      • MERGE/MEDIC?
      • GRASE?
      • MP-RAGE v MR2RAGE?
    • Susceptibility Imaging >
      • What is susceptibility (χ)?
      • What's wrong with GRE?
      • Making an SW image?
      • Phase of blood v Ca++?
      • Quantitative susceptibility?
    • Diffusion: Basic >
      • What is diffusion?
      • Iso-/Anisotropic diffusion?
      • "Apparent" diffusion?
      • Making a DW image?
      • What is the b-value?
      • b0 vs b50?
      • Trace vs ADC map?
      • Light/dark reversal?
      • T2 "shine through"?
      • Exponential ADC?
      • T2 "black-out"?
      • DWI bright causes?
    • Diffusion: Advanced >
      • Diffusion Tensor?
      • DTI (tensor imaging)?
      • Whole body DWI?
      • Readout-segmented DWI?
      • Small FOV DWI?
      • IVIM?
      • Diffusion Kurtosis?
    • Fat-Water Imaging >
      • Fat & Water properties?
      • F-W chemical shift?
      • In-phase/out-of-phase?
      • Best method?
      • Dixon method?
      • "Fat-sat" pulses?
      • Water excitation?
      • STIR?
      • SPIR?
      • SPAIR v SPIR?
      • SPIR/SPAIR v STIR?
  • …Making an Image
    • From Signals to Images >
      • Phase v frequency?
      • Angular frequency (ω)?
      • Signal squiggles?
      • Real v Imaginary?
      • Fourier Transform (FT)?
      • What are 2D- & 3D-FTs?
      • Who invented MRI?
      • How to locate signals?
    • Frequency Encoding >
      • Frequency encoding?
      • Receiver bandwidth?
      • Narrow bandwidth?
      • Slice-selective excitation?
      • SS gradient lobes?
      • Cross-talk?
      • Frequency encode all?
      • Mixing of slices?
      • Two slices at once?
      • Simultaneous Multi-Slice?
    • Phase Encoding >
      • Phase-encoding gradient?
      • Single PE step?
      • What is phase-encoding?
      • PE and FE together?
      • 2DFT reconstruction?
      • Choosing PE/FE direction?
    • Performing an MR Scan >
      • What are the steps?
      • Automatic prescan?
      • Routine shimming?
      • Coil tuning/matching?
      • Center frequency?
      • Transmitter gain?
      • Receiver gain?
      • Dummy cycles?
      • Where's my data?
      • MR Tech qualifications?
    • Image Quality Control >
      • Who regulates MRI?
      • Who accredits?
      • Mandatory accreditation?
      • Routine quality control?
      • MR phantoms?
      • Geometric accuracy?
      • Image uniformity?
      • Slice parameters?
      • Image resolution?
      • Signal-to-noise?
      • Ghosting?
  • …K-space & Rapid Imaging
    • K-space (Basic) >
      • What is k-space?
      • Parts of k-space?
      • What does "k" stand for?
      • Spatial frequencies?
      • Locations in k-space?
      • Data for k-space?
      • Why signal ↔ k-space?
      • Spin-warp imaging?
      • Big spot in middle?
      • K-space trajectories?
      • Radial sampling?
    • K-space (Advanced) >
      • K-space grid?
      • Negative frequencies?
      • Field-of-view (FOV)
      • Rectangular FOV?
      • Partial Fourier?
      • Phase symmetry?
      • Read symmetry?
      • Why not use both?
      • ZIP?
    • Rapid Imaging (FSE &EPI) >
      • What is FSE/TSE?
      • FSE parameters?
      • Bright Fat?
      • Other FSE differences?
      • Dual-echo FSE?
      • Driven equilibrium?
      • Reduced flip angle FSE?
      • Hyperechoes?
      • SPACE/CUBE/VISTA?
      • Echo-planar imaging?
      • HASTE/SS-FSE?
    • Parallel Imaging (PI) >
      • What is PI?
      • How is PI different?
      • PI coils and sequences?
      • Why and when to use?
      • Two types of PI?
      • SENSE/ASSET?
      • GRAPPA/ARC?
      • CAIPIRINHA?
      • Compressed sensing?
      • Noise in PI?
      • Artifacts in PI?
  • …Contrast Agents
    • Contrast Agents: Physics >
      • Why Gadolinium?
      • Paramagnetic relaxation?
      • What is relaxivity?
      • Why does Gd shorten T1?
      • Does Gd affect T2?
      • Gd & field strength?
      • Best T1-pulse sequence?
      • Triple dose and MT?
      • Dynamic CE imaging?
      • Gadolinium on CT?
    • Contrast Agents: Clinical >
      • So many Gd agents!
      • Important properties?
      • Ionic v non-ionic?
      • Intra-articular/thecal Gd?
      • Gd liver agents (Eovist)?
      • Mn agents (Teslascan)?
      • Feridex & Liver Agents?
      • Lymph node agents?
      • Ferumoxytol?
      • Blood pool (Ablavar)?
      • Bowel contrast agents?
    • Contrast Agents: Safety >
      • Gadolinium safety?
      • Allergic reactions?
      • Renal toxicity?
      • What is NSF?
      • NSF by agent?
      • Informed consent for Gd?
      • Gd protocol?
      • Is Gd safe in infants?
      • Reduced dose in infants?
      • Gd in breast milk?
      • Gd in pregnancy?
      • Gd accumulation?
      • Gd deposition disease?
  • …Cardiovascular and MRA
    • Flow effects in MRI >
      • Defining flow?
      • Expected velocities?
      • Laminar v turbulent?
      • Predicting MR of flow?
      • Time-of-flight effects?
      • Spin phase effects?
      • Flow void?
      • Why GRE ↑ flow signal?
      • Slow flow v thrombus?
      • Even-echo rephasing?
      • Flow-compensation?
      • Flow misregistration?
    • MR Angiography - I >
      • MRA methods?
      • Dark vs bright blood?
      • Time-of-Flight (TOF) MRA?
      • 2D vs 3D MRA?
      • MRA parameters?
      • Magnetization Transfer?
      • Ramped flip angle?
      • MOTSA?
      • Fat-suppressed MRA?
      • TOF MRA Artifacts?
      • Phase-contrast MRA?
      • What is VENC?
      • Measuring flow?
      • 4D Flow Imaging?
      • How accurate?
    • MR Angiography - II >
      • Gated 3D FSE MRA?
      • 3D FSE MRA parameters?
      • SSFP MRA?
      • Inflow-enhanced SSFP?
      • MRA with ASL?
      • Other MRA methods?
      • Contrast-enhanced MRA?
      • Timing the bolus?
      • View ordering in MRA?
      • Bolus chasing?
      • TRICKS or TWIST?
      • CE-MRA artifacts?
    • Cardiac I - Intro/Anatomy >
      • Cardiac protocols?
      • Patient prep?
      • EKG problems?
      • Magnet changes EKG?
      • Gating v triggering?
      • Gating parameters?
      • Heart navigators?
      • Dark blood/Double IR?
      • Why not single IR?
      • Triple IR?
      • Polar plots?
      • Coronary artery MRA?
    • Cardiac II - Function >
      • Beating heart movies?
      • Cine parameters?
      • Real-time cine?
      • Ventricular function?
      • Tagging/SPAMM?
      • Perfusion: why and how?
      • 1st pass perfusion?
      • Quantifying perfusion?
      • Dark rim artifact
    • Cardiac III - Viability >
      • Gd enhancement?
      • TI to null myocardium?
      • PS (phase-sensitive) IR?
      • Wideband LGE?
      • T1 mapping?
      • Iron/T2*-mapping?
      • Edema/T2-mapping?
      • Why/how stress test?
      • Stess drugs/agents?
      • Stress consent form?
  • …MR Artifacts
    • Tissue-related artifacts >
      • Chemical shift artifact?
      • Chemical shift in phase?
      • Reducing chemical shift?
      • Chemical Shift 2nd Kind?
      • In-phase/out-of phase?
      • IR bounce point?
      • Susceptibility artifact?
      • Metal suppression?
      • Dielectric effect?
      • Dielectric Pads?
    • Motion-related artifacts >
      • Why discrete ghosts?
      • Motion artifact direction?
      • Reducing motion artifacts?
      • Saturation pulses?
      • Gating methods?
      • Respiratory comp?
      • Navigator echoes?
      • PROPELLER/BLADE?
    • Technique-related artifacts >
      • Partial volume effects?
      • Slice overlap?
      • Aliasing?
      • Wrap-around artifact?
      • Eliminate wrap-around?
      • Phase oversampling?
      • Frequency wrap-around?
      • Spiral/radial artifacts?
      • Gibbs artifact?
      • Nyquist (N/2) ghosts?
      • Zipper artifact?
      • Data artifacts?
      • Surface coil flare?
      • MRA Artifacts (TOF)?
      • MRA artifacts (CE)?
  • …Functional Imaging
    • Perfusion I: Intro & DSC >
      • Measuring perfusion?
      • Meaning of CBF, MTT etc?
      • DSC v DCE v ASL?
      • How to perform DSC?
      • Bolus Gd effect?
      • T1 effects on DSC?
      • DSC recirculation?
      • DSC curve analysis?
      • DSC signal v [Gd]
      • Arterial input (AIF)?
      • Quantitative DSC?
    • Perfusion II: DCE >
      • What is DCE?
      • How is DCE performed?
      • How is DCE analyzed?
      • Breast DCE?
      • DCE signal v [Gd]
      • DCE tissue parmeters?
      • Parameters to images?
      • K-trans = permeability?
      • Utility of DCE?
    • Perfusion III: ASL >
      • What is ASL?
      • ASL methods overview?
      • CASL?
      • PASL?
      • pCASL?
      • ASL parameters?
      • ASL artifacts?
      • Gadolinium and ASL?
      • Vascular color maps?
      • Quantifying flow?
    • Functional MRI/BOLD - I >
      • Who invented fMRI?
      • How does fMRI work?
      • BOLD contrast?
      • Why does BOLD ↑ signal?
      • Does BOLD=brain activity?
      • BOLD pulse sequences?
      • fMRI Paradigm design?
      • Why "on-off" comparison?
      • Motor paradigms?
      • Visual?
      • Language?
    • Functional MRI/BOLD - II >
      • Process/analyze fMRI?
      • Best fMRI software?
      • Data pre-processing?
      • Registration/normalization?
      • fMRI statistical analysis?
      • General Linear Model?
      • Activation "blobs"?
      • False activation?
      • Resting state fMRI?
      • Analyze RS-fMRI?
      • Network/Graphs?
      • fMRI at 7T?
      • Mind reading/Lie detector?
      • fMRI critique?
  • …MR Spectroscopy
    • MRS I - Basics >
      • MRI vs MRS?
      • Spectra vs images?
      • Chemical shift (δ)?
      • Measuring δ?
      • Backward δ scale?
      • Predicting δ?
      • Size/shapes of peaks?
      • Splitting of peaks?
      • Localization methods?
      • Single v multi-voxel?
      • PRESS?
      • STEAM?
      • ISIS?
      • CSI?
    • MRS II - Clinical ¹H MRS >
      • How-to: brain MRS?
      • Water suppression?
      • Fat suppression?
      • Normal brain spectra?
      • Choice of TR/TE/etc?
      • Hunter's angle?
      • Lactate inversion?
      • Metabolite mapping?
      • Metabolite quantitation?
      • Breast MRS?
      • Gd effect on MRS?
      • How-to: prostate MRS?
      • Prostate spectra?
      • Muscle ¹H-MRS?
      • Liver ¹H-MRS?
      • MRS artifacts?
    • MRS III - Multi-nuclear >
      • Other nuclei?
      • Why phosphorus?
      • How-to: ³¹P MRS
      • Normal ³¹P spectra?
      • Organ differences?
      • ³¹P measurements?
      • Decoupling?
      • NOE?
      • Carbon MRS?
      • Sodium imaging?
      • Xenon imaging?
  • ...Artificial Intelligence
    • AI Part I: Basics >
      • Artificial Intelligence (AI)?
      • What is a neural network?
      • Machine Learning (ML)?
      • Shallow v Deep ML?
      • Shallow networks?
      • Deep network types?
      • Data prep and fitting?
      • Back-Propagation?
      • DL 'Playground'?
    • AI Part 2: Advanced >
      • What is convolution?
      • Convolutional Network?
      • Softmax?
      • Upsampling?
      • Limitations/Problems of AI?
      • Is the Singularity near?
    • AI Part 3: Image processing >
      • AI in clinical MRI?
      • Super-resolution?
  • ...Tissue Properties Imaging
    • MRI of Hemorrhage >
      • Hematoma overview?
      • Types of Hemoglobin?
      • Hyperacute/Oxy-Hb?
      • Acute/Deoxy-Hb?
      • Subacute/Met-Hb?
      • Deoxy-Hb v Met-Hb?
      • Extracellular met-Hb?
      • Chronic hematomas?
      • Hemichromes?
      • Ferritin/Hemosiderin?
      • Subarachnoid blood?
      • Blood at lower fields?
    • T2 cartilage mapping
    • MR Elastography?
    • Synthetic MRI?
    • Amide Proton Transfer?
    • MR thermography?
    • Electric Properties Imaging?
  • Copyright/Legal
    • Copyright Issues
    • Legal Disclaimers
  • Forums/Blogs/Links
  • What's New
  • Self-test Quizzes - NEW!
    • Magnets & Scanners Quiz
    • Safety & Screening Quiz
    • NMR Phenomenon Quiz
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    • K-space & Rapid Quiz
    • Contrast & Blood Quiz
    • Cardiovascular & MRA Quiz

Gadolinium for CT

Is iodine contrast visible on MRI?
Is gadolinium contrast visible on CT?  
gadolinium on CT

Iodine-based radiographic contrast agents contain 127I, the only stable isotope in nature. 127I has a spin of 5/2, so it can undergo NMR if placed in a magnetic field. Its gyromagnetic ratio is approximately 8.52 MHz/T, meaning it resonates at about 1/5 the rate of an 1H nucleus. 127I also has a powerful quadrupolar moment, so its signal decays very quickly. In brief, an MR signal from iodine contrast could be recorded by a special laboratory NMR spectrometer, but would would not be detectable in a conventional MRI system.

Gadolinium, like iodine, is a heavy metal capable of attenuating x-rays. The atomic number of gadolinium (Z=64) is higher than that of iodine (Z=53). The k-edge of gadolinium is also more closely matched to the peak of the CT spectrum, meaning gadolinium absorbs a greater fraction of the x-ray beam than does iodine. However, the lower concentration and total number of gadolinium atoms administered in current formulations means that gadolinium contrast has a much lower visibility on CT than iodine contrast.
From the early 1990's to the mid-2000's, gadolinium contrast was occasionally used in CT and angiography in patients with severe allergies to iodinated contrast. An example from our institution is shown below. With the recognition that high doses of gadolinium might precipitate nephrogenic systemic fibrosis, this technique was abandoned but still has some historical interest. Even today, a trace amount of contrast enhancement in the bladder or renal collecting systems may be noted in patients receiving a CT scan shortly after a gadolinium-enhanced MR study.
gadolinium on CT
High-dose Gd seen on CT. On left, noncontrast head image. On right CT obtained after intravenous administration of 60 cc of gadopentetate dimeglumine (Magnevist) shows weak enhancement of choroid plexus and vessels.

Advanced Discussion (show/hide)»

Notwithstanding the above discussion, the iodine-based contrast iopamidol has been investigated for potential use as an MR contrast agent. The iopamidol molecule is highly water-soluble with hydrophilic protons in three amide groups. These protons can undergo chemical exchange and decrease the signal intensity in free water through the so-called chemical exchange saturation transfer (CEST) mechanism. The CEST technique obtains images before and after application of a train of ~1000 Hz off-resonance saturation pulses, similar to those used in magnetization transfer (MT) experiments. By subtracting these images, subtle differences in image contrast may be observed. CEST contrast agents cause a decrease in T2 values, resulting in darkening of the areas of accumulation on T2-weighted images.

The potential use of iopamidol as a CEST MR contrast agent has nothing to do with the iodine moiety, just the amide protons. However, the presence of iodine raises the possibility that iopamidol might function as a dual-use contrast agent for both MR and CT.


References
     Aime S, Calabi L, Biondi L, et al. Iopamidol: exploring the potential use of a well-established contrast agent for MRI. Magn Reson Med 2005; 53:830-834. (see Advanced Discussion).     
     Bloem JL, Wondergem J. Gd-DTPA as a contrast agent in CT. Radiology 1989; 171:578-579.
     Quinn AD, O'Hare NJ, Wallis FJ, Wilson GF. Gd-DTPA: an alternative contrast medium for CT. J Comput Assist Tomogr 1994;18:634-636.

Related Questions
     Why are most MR contrast agents based on the element gadolinium?  
     Is gadolinium contrast nephrotoxic? Can it be given safely to patients with mild renal insufficiency? 

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