Gadopiclenol Shows Promise in Dynamic Contrast-Enhanced MR Lymphangiography

Gadopiclenol, a novel gadolinium-based contrast agent (GBCA), has demonstrated safety and the ability to produce diagnostic-quality images in a first-in-human experience involving nodal and dermal injections for dynamic contrast-enhanced MR lymphangiography (DCE-MRL).

Recent findings published in Radiology: Cardiothoracic Imaging suggest that gadopiclenol may provide a robust imaging signal while utilizing a lower gadolinium dosage. However, direct comparisons with other GBCA products remain necessary to substantiate these findings.

Scott M. Thompson, MD, PhD, from the Department of Radiology at Mayo Clinic, expressed the team's interest in gadopiclenol for lymphangiography due to its significant T1 shortening potential and lower gadolinium ion dosage. “This new agent had some of the highest T1 shortening, which gives us potentially brighter signal,” Dr. Thompson noted.

DCE-MRL is a specialized MRI technique that assesses the lymphatic system's structure and lymphatic fluid movement. The procedure entails injecting a GBCA into lymph nodes or dermally, enabling visualization of lymphatic vessels during MRI scans.

Concerns regarding the retention of gadolinium in patients necessitate exploring alternatives offering reduced gadolinium exposure while maintaining image quality. Gadopiclenol received FDA approval for MR imaging in 2022 and for use in Europe in 2023, based on clinical evidence demonstrating its safety and efficacy. However, its application for DCE-MRL was previously untested.

In their study, Dr. Thompson and colleagues conducted a first-in-human evaluation with 23 patients diagnosed with various lymphatic diseases, ranging in age from seven to 89 years. Administration methods included inguinal lymph node injections for the majority and interstitial transpedal injection for one patient, determined based on the clinical requirements specified by the referring physician.

The researchers assessed both the technique's safety and image quality. Dr. Thompson acknowledged the swift optimization process, facilitated by medical physicists led by Dr. Eric Stinson, who utilized experimental modeling to refine imaging parameters in real-time to enhance signal quality.

The imaging produced allowed for effective evaluation of central lymphatic anatomy and drainage into the central venous system. For the patient with a transpedal injection, images also revealed superficial lymphatic anatomy of the lower extremities, aiding in diagnosing lymphatic pathologies and informing future intervention strategies.

Dr. Thompson confirmed excellent signal quality and safety during the trials, stating, “There were no adverse events reported by any patient.” He emphasized that the reduced gadolinium usage without compromising image quality significantly impacts patient safety in the long term.

Currently, Dr. Thompson and his team have adopted gadopiclenol as their standard contrast agent. As of August 2026, they have expanded their research cohort to 75 patients, reporting favorable outcomes.