The use of gadolinium chelates in ECCA is responsible for shorter T1 relaxation

The use of gadolinium chelates in ECCA is responsible for shorter T1 relaxation (11). Reduction of T1 relaxation is an important element because it contributes to the improvement of visualization of arteries hence benefit to vascular pathology (9, 11, 13). As a result of shorter T1 relaxation, ECCA is easily eliminated.

By definition, a contrast agent (14, 16) satisfies conditions for classification as a blood pool contrast agent if the contrast agent demonstrates the capacity to slow elimination from a circulatory system. ECCA is eliminated fast from the circulatory system (4, 17). The retention of IVCA in the circulatory system is based on the capacity of IVCA to exhibit reversible binding that contributes to the establishment of dynamic equilibrium. Reversible binding as a characteristic property of IVCA is responsible for the failure of IVCA leakage into interstitial space (2, 3). IVCA increases in size. The increase in volume reduces opportunities for IVCA leakage via endothelial pores. A chemical change occurs after binding with protein molecules like albumin which contributes to a change of mechanism for IVCA elimination into interstitial space (10, 14, 16).

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The sizes of ECCA and IVCA are different. ECCA is much bigger than IVCA. IVCA is much smaller. It is due to the small sizes that IVCA can diffuse from extra-cellular space into interstitial space (6). Upon binding with albumin, a large complex structure is formed. The increase in size contributes to the retention of IVCA in the interstitial space. This makes IVCA have a higher half-life compared to ECCA. This contributes to an increase in time that imaging could be carried out (12). Due to the increase in the size of IVCA after reversible binding, relaxation time for water molecules is enhanced. This influences shorter T1 relaxation times which improves efficiency compared to ECCA (14, 16, 17). This implies smaller doses of IVCA could be used. ECCA uses higher doses compared to IVCA.

The small sizes of IVCA for instance in cases of ultra superparamagnetic iron oxides, there is a demonstration of lower relaxivities (8, 9). This implies IVCA could share similar low relaxivities with ECCA. The IVCA lower relaxivities are preferred to ECCA lower relaxivities because of the sustainability of the IVCA T1/T2 ratio (15, 16). The T1/T2 ratio is important as a measure of outcomes in MRA and T1 weighted MRA techniques. The IVCA-albumin complex in interstitial spaces demonstrates slow rotation. These results in a rotational correlation time that is greater compared to smaller molecular weight gadolinium contrast agents (5, 7, 12). This property contributes to an increase of relaxivity which ECCA cannot achieve at clinical field strengths.

In the recent past, Contrast-Enhanced MRA (CE MRA) has been carried out via the use of ECCA. The ECCA doesn’t have binding properties to macromolecules like protein. Due to the flow of extracellular contrast agents through the extra-cellular spaces, the ECCA is readily excreted from the body (3). EVCA has binding properties. Different IVCA has different binding affinities for different molecules. ECCA utilizes gadolinium chelates that don’t demonstrate binding properties. As a result of the fast excretion of ECCA, their half-life is very short (7). The half-life of commonly available ECCA is documented to be 15 minutes

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