Contrast-enhanced MRI advances at ECR

Lynda Williams

medwireNews: Here are our oral presentation picks on contrast-enhanced MRI from the European Congress of Radiology (ECR) 2026 in Vienna, Austria. The theme of the meeting was Rays of Knowledge and the sessions shone light on a wide range of topics.

Wednesday 4^th March – ESMRMB-GREC neurology guidelines

Our meeting opened with an educational session on the updates and recommendations from the European Society for Magnetic Resonance in Medicine Gadolinium Research and Education Committee (ESMRMB-GREC) regarding when gadolinium-based contrast agents (GBCA) should and should not be used in neurology, as chaired by Carlo Cosimo Quattrocchi (Italy) and Aart Van Der Molen (the Netherlands)¹. During this session, Àlex Rovira (Spain) told delegates that the latest consensus is that GBCA was essential for multiple sclerosis diagnosis but unnecessary for annual monitoring unless a new lesion was suspected in the past month. Fabio Doniselli (Italy) talked through GBCA guidelines for diagnosis, staging, and monitoring for meningioma, glioma, pituitary adenoma, cranial nerve tumors, and metastases, and Marco Parillo (Italy) shared the equivalent advice for patients with head and neck cancer. Finally, Aïna Venkatasamy (France) said ESMRMB-GREC guidelines were in progress for inner ear and internal auditory canal imaging, summarizing that contrast is useful for tumors, inflammation and infection, and hydrops, but less so before cochlear implantation, and managing typical cases of nerve impingement and stable schwannoma.

Thursday 5^th March – AI and prostate cancer imaging advances

The plenary lecture on AI in Radiology – Did we open Pandora’s box? was introduced by ESR President Minerva Becker (Switzerland) and presented by Charles Edward Kahn (USA) and Nina Kottler (USA). Kottler emphasized the need for AI assistance to combat the “profound and growing mismatch between imaging volume and radiologist capacity” and “unprecedent burnout.” 

While Kahn emphasized that acknowledging challenges with AI was the “first step towards navigating them responsibly,” he also observed that radiologists are not all equal in ability, and that it was both unnecessary and unrealistic to “expect AI to mimic the best of the best.”

Sharing examples of how AI can add value and reduce workload burden for radiologists, Kottler told delegates that “as technology advances, the scope of information we can access will expand, both within and beyond imaging,” and that through imaging biomarkers and patient wearable devices it may become possible to deliver “truly individualized healthcare.”

She concluded that thoughtful and courageous engagement with AI will ensure what ultimately emerges from Pandora’s box will strengthen the radiology profession and serve our patients².

Two phase 3 MRI trials of prostate cancer were presented at a key oncology and AI session. The PRIME trial (Aqua Asif, UK) indicated that biparametric MRI without contrast was non-inferior to multiparametric MRI for determining eligibility for surgery, focal therapy, or radiotherapy, and for planning the surgical approach, energy source, and target volume of these therapies, respectively³. Use of dynamic contrast enhancement had “minimal overall impact” on biparametric decisions, with changes to eligibility and planning in just 4.3% and 3.1% of 488 men, respectively, Asif concluded.

The PROSTAPROGRESS trial (Jelle Barentsz, the Netherlands) pointed to significantly improved sensitivity and non-inferior specificity for positive lymph node (LN) detection in intermediate-to-high risk disease with ferumoxtran than unenhanced MRI. Ferumoxtran also revealed 157 positive nodes, just 52 of which were identified by extensive pelvic LN dissection, including LNs of 2–5 mm in size, although micrometastases below this size “remains challenging even for [multiparametric]-MRI,” Barentsz noted⁴.

Friday 6^th March – High relaxivity GBCA and AI imaging

In the morning, Giles Roditi (UK) reviewed the potential of high-relaxivity GBCAs and their role in minimizing gadolinium exposure for patients and the environment without loss of image quality⁵. This was supported by a number of abstracts later in the day at the neuroimaging session for the two next-generation GBCAs, gadopiclenol and gadoquatrane.

Gadopiclenol 0.05 mmol/kg was as likely as gadoterate 0.1 mmol/kg to achieve excellent or good quality dynamic susceptibility contrast images for blood volume perfusion mapping of adults with glioma, reported Simonetta Gerevini (Italy). Both agents were able to significantly differentiate between high-grade and low-grade glioma by relative cerebral blood volume, and the GBCA had a similar safety profile without serious adverse events⁶.

Aaron Rulseh (Czech Republic) reported that significantly more brain metastases were identified among 156 patients with lung cancer and other malignancies when the gadopiclenol dose was increased from 0.05 to 0.01 mmol/kg and the images were taken approximately 15 minutes after contrast versus immediately after administration,  whereas there was no difference in the number of metastases when images were taken immediately after the standard dose. The clinical impact of the additional metastases included new diagnoses, upstaging and downstaging, prompting Rulseh to say that “[d]etection of all mets is especially important before Leksell Gamma Knife or CyberKnife treatment”⁷.

Key abstracts on gadoquatrane use included subanalysis of 298 participants in a phase 2 dose-finding study and the phase 3 QUANTI CNS trial by Benjamin Liu (USA). Patients underwent imaging twice with gadoquatrane 0.04 mmol Gd/kg and gadobutrol 0.1 mmol Gd/kg, or another comparator GBCA given at the same dose, most commonly for brain tumors. The gadoquatrane images were non-inferior to comparator GBCA images in terms of enhancement, delineation, or morphology. Gadoquatrane had approximately 60% lower plasma concentration than comparator GBCA; after normalizing doses, the pharmacokinetic (PK) profiles over 24 hours were “superimposable,” indicating that gadoquatrane’s large molecular size has “no relevant impact on imaging properties or PK behavior,” Liu said⁸.

Gabriele Sutter (Germany) also reported PK results for gadoquatrane, this time information for regulatory submission from nine phase 1–3 clinical trials including 871 adults and 92 children. Again, gadoquatrane had superimposable PK profiles after dose normalization, she said, adding that renal function was the “main driver” of PK variability, with no “clinically relevant differences” between adults and children, supporting use of the 0.04 mmol Gd/kg diagnostic dose in both⁹.

The neuroimaging session also included a presentation by Barbara Wichtmann (Germany) showing that a portable ultra-low-field MRI can detect contrast-enhanced brain lesions as small as 6–8 mm. While less powerful than high-field MRI, she explained that this would allow “bedside imaging” for intensive care unit patients and others with limited mobility¹⁰.

Finally, a presentation by T Campbell Arnold (USA) demonstrated that T1 images can be generated from T2 and T2 FLAIR images by a deep learning algorithm. Reducing patient scanning time, the AI process resulted in fewer movement artefacts than the standard T1 imaging, he said¹¹.

Saturday 7^th March – Innovations in abdominal and pediatric radiology

Jeanette Schulz-Menger (Germany) reported cardiac subanalysis data from the phase 3 QUANTI OBR trial of 36 patients with cardiomyopathy and other diagnoses, also confirming that the new-generation GBCA was superior to no contrast and non-inferior to comparator GBCA for enhancement, delineation, or morphology¹².

Use of SPIO-enhanced MRI is an “accurate” means of differentiating between intrapancreatic ectopic spleen and noninvasive pancreatic neuroendocrine tumors, with better diagnostic accuracy than conventional contrast-enhanced MRI, CT, CT/PET, and SPECT, said Philipp Sorgo. The technique “facilitated reliable and efficient” treatment planning and “reduces the need of unnecessary biopsies,” he summarized¹³.

Andrea Vanzulli (Italy) opened the Hot Topic AI and pediatric radiology session with a plenary highlighting the importance of ethics, training, and regulation of pediatric datasets, as set out in these recommendations¹⁴. The session continued with a virtual presentation by K Saravanan (India) demonstrating that AI enhancement of contrast MRI was able to detect microstructural and textual biomarkers of pre-eclampsia 5 weeks before clinical onset, allowing prophylaxis against irreversible placental injury¹⁵.

This independent medical education program is supported by an educational grant from Bayer HealthCare Pharmaceuticals Inc. 

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2026 Springer Healthcare Ltd, part of Springer Nature

Session abstracts

1. Becker M, Kahn CE, Kottler N. AI in Radiology: Did we open Pandora’s box? 05.03.26
2. How 1: How We Do It: Fundamentals of Radiological Practice with or without GBVCA. Updates and recommendations from the ESMRMB-GREC. 04.03.26
3. Asif A. Impact of dynamic contrast-enhanced MRI on treatment eligibility and planning in suspected prostate cancer: final analysis from the PRIME trial. 05.03.26
4. Barentsz JO. Nodal staging in intermediate- and high-risk prostate cancer with ferumoxtran-enhanced MRI: Results from the phase 3 PROSTAPROGRESS trial. 05.03.26
5. Roditi G. High relaxivity gadolinium-based contrast agents: when do these add value? 06.03.26
6. Gerevini S. Performance of gadopiclenol in dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) perfusion of brain gliomas. 06.03.26
7. Rulseh A. Experience with gadopiclenol in the detection of brain metastases: Single and double doses, comparison of standard and delayed imaging. 06.03.26
8. Liu B. Gadoquatrane demonstrates similar pharmacokinetics and imaging compared to other macrocyclic extracellular GBCAs in phase 2 and 3 CNS CE-MRI studies. 06.03.26
9. Sutter G. Population PK modeling of gadoquatrane: Supporting regulatory submission for use in patients of all ages. 06.03.26
10. Wichtmann B. First prospective evaluation of post-contrast ultra-low field brain MRI across diverse neurological pathologies. 06.03.26
11. Pathology-aware targeted T1 synthesis from T2 and FLAIR images using multi-contrast multi-scale vision transformers. 06.03.26
12. Schulz-Menger J. Subgroup analysis of cardiac MRI in a phase 3 trial investigating safety and efficacy of gadoquatrane for low-dose contrast-enhanced MRI of the body. 07.03.26
13. Sorgo P. Accurate noninvasive differentiation of intrapancreatic ectopic spleen from pancreatic NET with SPIO-enhanced MRI. 07.03.26
14. Vanzulli A. Keynote lecture: AI in Paediatric Radiology. 07.03.26
15. Saravanan K. AI-enhanced placental radiomics on diffusion and T2 MRI for early prediction of preeclampsia and fetal growth restriction. 07.03.26