A safe new contrast agent for multiparametric MRI of the prostate

Multiparametric MRI (mpMRI) for prostate cancer is a type of MRI that uses three different imaging sequences during a single scanning session. Imaging sequences are called parameters. Each separate parameter highlights a particular characteristic, or function, of cell behavior. This functional imaging enables us to distinguish cancer cells from healthy cells. One sequence involves a contrast agent that had raised safety questions in the past. Now there’s an even safer new contrast agent.

Why multiple parameters?

If only two parameters are used, it is called biparametric MRI (bi = two). On the other hand, when more than two parameters are used, it is called multiparametric MRI (multi = many). For prostate cancer imaging, as many as five sequences could be used in combination. However, three specific parameters are standard, as we use at the Sperling Prostate Center.

• T2 weighted MRI (T2W MRI) shows prostate anatomy
• Diffusion Weighted Imaging (DWI-MRI) highlights the motion of water molecules in tissue
• Contrast-enhanced MRI (CE-MRI) detects unusual blood flow caused by tumor blood vessels.

When these three parameters are applied, we get a complete portrait of the prostate gland and the index lesion it contains. The index lesion is the term used for the main tumor that drives the disease; it contains the dangerous cells that require treatment (also called significant prostate cancer.)

Why is a contrast-enhanced parameter important?

Since T2 weighted MRI and Diffusion Weighted Imaging reveal prostate anatomy, along with suspicious tumor activity that restricts the motion of water molecules, you may wonder if biparametric MRI gives sufficient information to proceed with a biopsy into the suspicious area. If so, you are not alone.

Many researchers are exploring the accuracy and economy of biparametric MRI as a screening tool to detect prostate cancer. Biparametric MRI is far more accurate than a PSA blood test, it takes less time than multiparametric MRI (average 15-20 minutes vs. 30-45 minutes), and therefore it is cheaper. Plus, less magnet time means more men can be screened. Still, a key identifier is missing.

Biparametric MRI is shorter because it does not include the third parameter, contrast-enhanced MRI. This third sequence involves an IV injection of a special agent that “lights up” blood flow as it washes in and out of blood vessels. Cancer tumors build a chaotic network of blood vessels to bring them the oxygen and nutrients the cancer cells need. Their blood flow is a telltale sign of cancer! It’s virtually impossible to miss.

When the contrast agent reaches the prostate gland, we literally watch the tumor’s blood flow activity. This clearly identifies the suspicious area as cancer, distinguishing it from any other type of abnormal area that could be mistaken for a cancer tumor on less informative imaging.

Are there concerns over injecting a contrast agent?

For prostate cancer blood flow, the contrast agent contains gadolinium. In the past, there were some concerns over injecting an agent formulated with gadolinium, which is a rare-earth metal. It has certain magnetic properties that increase signal intensity (“light up”) in the tumor’s tangle of abnormal blood vessels—proof that cancer is present.

Objections over its use arose over 10 years ago. Researchers discovered evidence that very small traces of gadolinium were sometimes deposited in the body, inadequately flushed out by the body’s natural mechanisms. In particular, patients who lacked normal kidney function appeared most affected.

Since then, gadolinium was reformulated so the body can excrete it. In 2024, the American Journal of Roentgenology published a thorough update on gadolinium safety. The article highlighted 3 points:

• The most common risk is an immediate allergic-like reaction, but it’s much lower than for other types of contrast agents that contain iodine.
• Early formulations caused a rare kidney condition in people with impaired kidney function, but with more recent formulations and testing for kidney function it no longer occurs.
• No scientific evidence has linked gadolinium deposits to any adverse clinical outcomes.^[i]

A new FDA-approved contrast agent with less gadolinium

In June, 2026 it was announced by Bayer Pharmaceuticals that the FDA has approved their new low-dose gadolinium-based formulation called gadoquatrane (trade name Ambelvist). It is approved for MRI detection and visualization of abnormal blood flow.^[ii]

The Sperling Prostate Center has always used only the safest formulation of gadolinium-based contrast agents, and we screen patient kidney function. We have never had a patient problem with contrast. However, we are excited at the prospect of 60% less gadolinium exposure with gadoquatrane, compared with other existing formulas. We will be following release of gadoquatrane, as we anticipate gaining the necessary vascular proof of a tumor’s existence without placing a patient at risk. This is good news for all of us.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Starekova J, Pirasteh A, Reeder SB. Update on Gadolinium-Based Contrast Agent Safety, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol. 2024 Sep;223(3):e2330036.
[ii] Jeff Hall. “FDA Approves Low-Dose MRI Contrast Agent Gadoquatrane.” Diagnostic Imaging, June 15, 2026. https://www.diagnosticimaging.com/view/fda-approves-low-dose-mri-contrast-agent-gadoquatrane