Mangafodipir trisodium: review of its use as an injectable contrast medium for magnetic resonance imaging

Abstract

Mangafodipir trisodium is a hepatobiliary contrast agent, taken up by the hepatocytes and largely excreted via the bile ducts. The agent increases the signal intensity of the normal liver, and to a lesser extent of the pancreas, adrenal glands, kidneys and myocardium, on T1-weighted imaging. The increase of the signal intensity on the T1 images allows better visualization of focal lesions, especially of those that are of non-hepatocitary origin such as metastases. For this reason the most important indication for the use of mangafodipir trisodium is in detecting liver metastases, especially when the information may influence therapeutic planning, which in many cases is surgical resection. New data show that this liver-specific contrast agent is accurate in detecting small lesions and in assessing the liver status following neoadjuvant chemotherapy, where other imaging techniques, such as CT and PET, fail. Other lesser indications for studies with mangafodipir trisodium are: in characterizing liver and pancreatic lesions; in identifying biliary leakage following bile duct and/or liver surgery; and possibly in the future in the assessment of the extent of myocardial damage.

MnDPDP: Contrast Agent for Imaging and Protection of Viable Tissue

“…Since interstitial [Mn 2+ ] after clinical doses of MnDPDP in humans is probably less than 1–5 μ M [ 41 ] and, in nonmedicated conscious dogs, high plasma [Mn 2+ ] may activate adrenal release of catecholamines [ 8 ], negative inotropy and hypotension will hardly occur in humans. This is also confirmed by broad clinical experience [ 6 , 7 , 17 – 19 , 22 – 25 ].…”

“…With MnDPDP, preclinical studies were frequent prior to or just after the millenium shift, and readers are referred to comprehensive reviews from that time [ 8 , 9 , 11 , 13 , 16 , 39 , 40 ]. In patients, MnDPDP, i.e., Teslascan™, has been successfully applied for diagnostic imaging of diseases in liver and pancreas where it demonstrated efficacy in detecting tumor lesions including metastatic disease [ 7 ]. Off-label use has mainly included cardiac imaging in human volunteers [ 16 – 18 , 71 ] and in patients with ischemic cardiomyopathy [ 19 , 72 – 74 ].…”

“…As a consequence, MnDPDP (Teslascan™, GE Healthcare, Oslo, Norway) became the only i.v. Mn agent for human use ( Figure 1 ) approved for imaging of liver and pancreas [ 6 , 7 ]. After a decade low product earning led to cessation of marketing (USA 2003) or direct market withdrawal (Europe 2011).…”

Manganese‐enhanced MRI of salivary glands and head and neck tumors in living subjects

“…First, ME‐MRI can potentially be applied for examination of neoplastic and nonneoplastic inflammatory diseases of salivary glands when manganese is administered judiciously in doses clinically proven to cause little or no cardiac and neurotoxicity. Indeed, studies have demonstrated that Mn‐based contrast agents can be safely used for diagnosis of hepatic lesions and bile duct leaks for MR cholangiopancreatography (23, 24). Second, given that maximal contrast enhancement of salivary gland tissues was observed at 24 h after MnCl 2 administration, perhaps delayed imaging could be considered for clinical ME‐MRI studies.…”

Uptake and retention of manganese contrast agents for PET and MRI in the rodent brain

“…The T 1 ‐weighted signal‐enhancing MRI contrast agent manganese (Mn 2+ ) has been studied and applied in preclinical animal models and human subjects for imaging liver disease, cancer, cardiac viability, and brain function and structure . To avoid the toxic effects of this metal when using the large doses required for MR signal enhancement, only the chelated form, Mn‐DPDP (Magnafodipir, Teslascan®), and an oral MnCl 2 agent (LumenHance®) have been approved for use in human patients .…”