MultiHance
Gadolinium-Based MRI Contrast Agent for Liver Imaging
Quick Facts About MultiHance
Key Takeaways About MultiHance
- Specialised liver contrast agent: MultiHance provides unique dual-phase imaging with both dynamic vascular and delayed hepatobiliary enhancement, offering superior liver lesion detection
- Gadolinium retention awareness: Small amounts of gadolinium may remain in the body, including the brain, though no adverse effects from retention have been identified to date
- Kidney function must be assessed: Patients should have their kidney function tested before receiving MultiHance, especially those aged 65 and over, due to the risk of nephrogenic systemic fibrosis (NSF)
- Hospital administration only: MultiHance is given by trained healthcare professionals in a hospital or clinical setting equipped to manage potential allergic reactions
- Post-injection monitoring required: Patients must remain at the facility for at least one hour after injection for observation of potential adverse reactions
What Is MultiHance and What Is It Used For?
MultiHance is a gadolinium-based contrast agent (GBCA) that contains the rare earth metal gadolinium. It is injected intravenously to enhance the quality of magnetic resonance imaging (MRI) scans, primarily of the liver. MultiHance helps radiologists identify abnormalities in the liver by improving the contrast between normal and diseased tissue on MRI images.
Magnetic resonance imaging is a widely used diagnostic tool that creates detailed images of internal organs without using ionising radiation. However, in many clinical situations, the natural contrast between different tissues may not be sufficient to identify small lesions or accurately characterise pathology. This is where gadolinium-based contrast agents such as MultiHance play a crucial role, dramatically improving the diagnostic accuracy of MRI examinations.
MultiHance contains gadobenate dimeglumine, a paramagnetic gadolinium chelate that shortens the relaxation times (T1 and T2) of nearby water molecules when placed in a magnetic field. This results in a brighter signal on T1-weighted MRI sequences, creating enhanced contrast between areas of normal and abnormal tissue. The clinical effect is that liver lesions become more clearly visible, allowing radiologists to detect smaller lesions and more accurately determine whether they are benign or malignant.
What makes MultiHance unique among gadolinium-based contrast agents is its ability to provide dual-phase imaging. Unlike most other GBCAs that are purely extracellular agents (distributing only into the blood and interstitial space), approximately 3–5% of the injected dose of MultiHance is taken up by functioning hepatocytes (liver cells) and subsequently excreted through the biliary system. This hepatobiliary uptake allows for a delayed imaging phase, typically performed 40 to 120 minutes after injection, which provides additional information about liver lesion characterisation that is not available with standard extracellular contrast agents.
MultiHance is approved for use in adults and children over two years of age. It is intended solely for diagnostic purposes and is administered in a hospital or clinical setting under the supervision of qualified medical professionals. The medication is not intended for self-administration and is only available on prescription.
Indications and Clinical Applications
The primary approved indication for MultiHance is contrast-enhanced MRI of the liver. Within this indication, it serves several important clinical purposes:
- Detection of focal liver lesions: MultiHance improves the sensitivity of MRI for detecting small liver lesions, including metastatic disease, hepatocellular carcinoma, and other liver tumours
- Characterisation of liver lesions: The hepatobiliary phase provides valuable information that helps distinguish between different types of liver lesions, such as differentiating focal nodular hyperplasia from hepatic adenoma
- Pre-surgical planning: Enhanced imaging with MultiHance can help surgeons plan liver resections by providing more detailed information about the location, size, and relationship of lesions to vascular structures
- Monitoring treatment response: Serial contrast-enhanced MRI examinations can help assess how liver tumours respond to chemotherapy or other treatments
What Should You Know Before Receiving MultiHance?
MultiHance should only be administered in a hospital or clinical setting by trained healthcare professionals with access to resuscitation equipment. Before receiving this contrast agent, it is essential that your doctor is aware of your complete medical history, particularly any kidney problems, allergies, or previous reactions to contrast agents.
Because gadolinium-based contrast agents carry specific risks, careful patient evaluation is required before administration. Your healthcare provider will consider multiple factors before deciding whether MultiHance is appropriate for your examination. Understanding these considerations can help you communicate effectively with your medical team and ensure the safest possible experience.
Contraindications
MultiHance must not be used in the following circumstances:
- Known allergy: Do not receive MultiHance if you have a known allergy to gadobenate dimeglumine or any of its ingredients
- Previous contrast reaction: If you have previously experienced an allergic or hypersensitivity reaction (such as rash, hives, itching, or breathing difficulties) after receiving any gadolinium-based MRI contrast agent, you should not receive MultiHance
- Children under two years: MultiHance is not approved for use in children younger than two years of age
Tell your doctor immediately if any of these contraindications apply to you. Using MultiHance despite a known allergy could result in a severe, potentially life-threatening allergic reaction (anaphylaxis).
Warnings and Precautions
Inform your doctor before receiving MultiHance if any of the following conditions apply to you:
- Heart problems or high blood pressure: Cardiovascular conditions may increase the risk of adverse reactions
- History of epilepsy or brain injury: Gadolinium-based contrast agents may lower the seizure threshold in susceptible individuals
- Implanted medical devices: Pacemakers, metal clips, screws, or plates in your body may be affected by or may affect the MRI magnetic field. Inform your medical team about all metal implants
- Kidney problems: Impaired renal function significantly increases the risk of nephrogenic systemic fibrosis (NSF), a serious condition (see below)
- Liver transplantation: If you have recently undergone or are about to undergo a liver transplant, the risk of acute kidney injury and NSF may be elevated
MultiHance works because it contains the metal gadolinium. Studies have demonstrated that small amounts of gadolinium can remain in the body after injection, including in the brain. To date, no adverse health effects have been attributed to gadolinium retention in patients with normal kidney function. Regulatory bodies including the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) continue to monitor this area. Your doctor should use the lowest dose necessary for diagnostic purposes and avoid unnecessary repeat examinations.
Nephrogenic Systemic Fibrosis (NSF)
Nephrogenic systemic fibrosis is a rare but serious condition that has been reported in association with the use of certain gadolinium-based contrast agents, particularly in patients with severe kidney impairment (glomerular filtration rate below 30 ml/min/1.73m²). NSF causes progressive thickening and hardening of the skin, which can also affect connective tissues and internal organs, potentially leading to significant disability.
Patients undergoing liver transplantation are at particularly high risk because of the high incidence of acute kidney failure in this population. For this reason, the use of MultiHance should be avoided in patients with severe kidney impairment and in patients in the perioperative phase of liver transplantation, unless the diagnostic information is absolutely essential and cannot be obtained through non-contrast MRI.
If use of MultiHance cannot be avoided in these high-risk patients, the dose must not exceed 0.05 mmol/kg body weight, and repeat injections should not be given with an interval of less than 7 days. Haemodialysis shortly after administration may help remove MultiHance from the body, although there is no definitive evidence that dialysis prevents NSF.
Pregnancy and Breastfeeding
If you are pregnant, think you might be pregnant, or are planning to become pregnant, you must inform your doctor before receiving MultiHance. Gadobenic acid can cross the placenta, and its effects on the developing baby are not fully understood. For this reason, MultiHance should not be used during pregnancy unless the examination is considered absolutely necessary and non-contrast alternatives are insufficient.
If you are breastfeeding, inform your doctor before the procedure. Together, you and your doctor will decide whether to continue or temporarily suspend breastfeeding for a period of 24 hours following the injection. This precautionary measure is recommended because small amounts of contrast agent may be excreted in breast milk, although the clinical significance of this is considered minimal.
Benzyl Alcohol Content
Small amounts of benzyl alcohol may be released into the MultiHance solution during storage. Inform your doctor if you have a known allergy to benzyl alcohol. This is particularly important for neonates and young infants, although MultiHance is not approved for use in children under two years of age.
Driving and Operating Machinery
There is limited information regarding the effect of MultiHance on the ability to drive or operate machinery. If you experience any side effects such as dizziness after the injection, you should not drive or operate machinery until the symptoms have completely resolved. Consult your doctor if you are unsure whether it is safe for you to drive after receiving MultiHance.
How Does MultiHance Interact with Other Drugs?
No clinically significant drug interactions have been reported with MultiHance. However, you should always inform your healthcare team about all medications you are currently taking, including prescription medicines, over-the-counter drugs, and herbal supplements.
Gadolinium-based contrast agents such as MultiHance are administered as single doses and are rapidly cleared from the body, which limits the potential for drug interactions. Clinical studies and post-marketing surveillance have not identified any significant interactions between gadobenate dimeglumine and other commonly used medications.
However, there are some pharmacological considerations that healthcare professionals should be aware of when administering MultiHance:
| Drug/Category | Consideration | Clinical Relevance |
|---|---|---|
| Nephrotoxic drugs | NSAIDs, aminoglycosides, and other nephrotoxic agents may compound renal stress | Monitor kidney function more closely in patients taking nephrotoxic medications |
| Beta-blockers | May reduce the effectiveness of adrenaline used to treat anaphylaxis | May require higher doses of adrenaline or alternative treatments for severe allergic reactions |
| Metformin | Not directly interactive, but kidney function assessment is recommended | Ensure adequate renal function before contrast administration in diabetic patients on metformin |
| Anti-epileptic drugs | Gadolinium agents may theoretically lower seizure threshold | Maintain anti-epileptic medication schedule; monitor post-injection in susceptible patients |
| Other contrast agents | Previous use of other GBCAs or iodinated contrast within a short interval | Allow adequate time between contrast injections; cumulative gadolinium exposure should be minimised |
Although no formal drug interaction studies have demonstrated clinically meaningful interactions, the general principle of full medication disclosure remains important. Your healthcare team needs a complete picture of your current medications to ensure the safest possible MRI experience. This includes any herbal supplements or complementary medicines you may be taking, as some products may affect kidney function or bleeding risk.
What Is the Correct Dosage of MultiHance?
MultiHance is administered by a healthcare professional as an intravenous injection. The standard dose for liver MRI is 0.1 ml per kilogram of body weight (0.05 mmol/kg), given immediately before the MRI examination. You will not need to prepare or administer this medication yourself.
MultiHance is always administered by trained medical personnel in a controlled clinical environment. The medication is drawn up into a syringe immediately before use and must not be diluted. Any unused solution is discarded and must not be used for other patients or examinations. The healthcare team will ensure that the intravenous cannula is correctly placed before injecting the contrast agent.
Adults
Standard Adult Dose – Liver MRI
Dose: 0.1 ml/kg body weight (equivalent to 0.05 mmol/kg)
Route: Intravenous injection, either as a bolus or slow injection (10 ml/min)
Dynamic imaging: Performed immediately after bolus injection
Delayed imaging: Performed between 40 and 120 minutes after injection, depending on clinical needs
The injection should be followed by a flush with 0.9% sodium chloride solution.
Children (Over 2 Years)
Paediatric Dose – Liver MRI
Dose: 0.1 ml/kg body weight (equivalent to 0.05 mmol/kg)
Route: Intravenous injection
The same dose per kilogram of body weight is used as in adults. MultiHance must not be given to children under two years of age.
Elderly Patients
Elderly Dose (65 Years and Over)
Dose: No dose adjustment is required based on age alone
Important: Blood tests to assess kidney function should be performed before administration, as renal clearance of MultiHance may be reduced in older patients
The decision to use MultiHance in elderly patients should include careful consideration of the individual's renal function status.
Patients with Impaired Kidney Function
Renal Impairment Dosing
Mild to moderate impairment: Use with caution; assess kidney function before administration
Severe impairment (GFR <30 ml/min/1.73m²): Use is not recommended. If deemed essential, the dose must not exceed 0.05 mmol/kg body weight
Repeat dosing in severe impairment: A minimum interval of 7 days between injections is required
Haemodialysis shortly after administration may be considered to help remove MultiHance from the body in patients already receiving dialysis.
| Patient Group | Dose | Special Considerations |
|---|---|---|
| Adults | 0.1 ml/kg (0.05 mmol/kg) | Standard dose; flush with saline after injection |
| Children (>2 years) | 0.1 ml/kg (0.05 mmol/kg) | Not for children under 2 years |
| Elderly (≥65 years) | 0.1 ml/kg (0.05 mmol/kg) | Assess kidney function before use |
| Severe renal impairment | ≤0.05 mmol/kg (if essential) | Not recommended; min 7-day interval between doses |
| Liver transplant patients | ≤0.05 mmol/kg (if essential) | Avoid if possible; high NSF risk |
Extravasation
To minimise the risk of extravasation (leakage of the contrast agent outside the vein into surrounding tissue), healthcare professionals will verify that the cannula is correctly positioned before injection. If you feel any pain or a burning sensation at the injection site during administration, inform the medical team immediately, as this may indicate extravasation.
Post-Injection Observation
After receiving MultiHance, you must remain at the hospital or clinical facility for at least one hour. This observation period is a standard safety precaution because allergic reactions, including rare but potentially severe anaphylactic reactions, can occur following administration of gadolinium-based contrast agents. The facility should be equipped with resuscitation equipment and staffed by personnel trained to manage adverse reactions.
What Are the Side Effects of MultiHance?
Like all medicines, MultiHance can cause side effects, although not everyone experiences them. Most reported side effects are mild and temporary, resolving on their own without treatment. However, severe and potentially life-threatening reactions have been reported rarely.
The safety profile of MultiHance has been established through extensive clinical trials and post-marketing surveillance. Most adverse reactions are mild in intensity and transient in nature. However, it is important to be aware of the full spectrum of possible side effects so that you can alert medical staff promptly if you experience any concerning symptoms during or after the procedure.
Tell the medical staff immediately if you experience difficulty breathing, swelling of the face, throat, or tongue, severe dizziness, widespread hives, or chest pain during or after receiving MultiHance. These may be signs of a serious allergic reaction that requires urgent treatment.
Common Side Effects
May affect up to 1 in 10 patients
- Headache
- Nausea
Uncommon Side Effects
May affect up to 1 in 100 patients
- Dizziness, tingling sensation, taste disturbance
- Changes in blood pressure, heart rate, or heart rhythm
- Flushing
- Vomiting, diarrhoea, dry mouth
- Itching, skin rash, hives (urticaria)
- Sensation of warmth, fever
- Injection site reactions: pain, burning, cold/warm sensation, redness, itching, or discomfort
- Abnormal laboratory results: ECG changes, altered liver function tests, abnormal blood or urine tests
Rare Side Effects
May affect up to 1 in 1,000 patients
- Severe allergic reaction causing breathing difficulties or dizziness (anaphylactoid reaction)
- Fainting, tremor, seizures, disturbance in sense of smell
- Reduced sensitivity to touch, pain, or other stimulation
- Visual disturbances
- Insufficient blood supply to the heart, slow heart rate
- Fluid in the lungs (pulmonary oedema), shortness of breath, wheezing, throat constriction
- Swollen and irritated nasal passages, cough
- Increased salivation, abdominal pain
- Facial swelling, excessive sweating
- Muscle pain
- Chest pain, feeling of weakness, chills, general malaise
Frequency Not Known
Reported from post-marketing surveillance
- Chest pain radiating to the neck or left arm (Kounis syndrome – a potentially serious allergic cardiac reaction)
- Severe anaphylactic shock
- Loss of consciousness
- Eye inflammation
- Heart attack, bluish discolouration of skin and mucous membranes (cyanosis)
- Inability to breathe, throat swelling, oxygen deprivation
- Swelling of the mouth
- Severe allergic reaction causing swelling of face or throat (angioedema)
- Injection site swelling or blistering
- Inflammation of veins caused by blood clots (thrombophlebitis)
Nephrogenic Systemic Fibrosis (NSF)
Reports of nephrogenic systemic fibrosis have been documented in patients who received MultiHance together with other gadolinium-containing contrast agents. NSF causes progressive thickening of the skin and may also affect soft tissues and internal organs. This condition has primarily been reported in patients with severe renal impairment. If you notice any unusual skin changes, stiffness, or joint problems following an MRI examination with contrast, contact your doctor promptly.
Reporting Side Effects
If you experience any side effects after receiving MultiHance, inform the medical staff supervising your MRI examination immediately. Reporting of suspected adverse reactions is important for ongoing safety monitoring. Healthcare professionals are encouraged to report adverse reactions to their national pharmacovigilance authority, and patients can also report suspected side effects directly.
How Should MultiHance Be Stored?
MultiHance is stored and handled by healthcare professionals in a hospital or clinical setting. As a patient, you will not need to store this medication yourself. However, understanding the storage requirements helps ensure the quality and safety of the product you receive.
MultiHance must be kept out of the sight and reach of children. It should not be used after the expiry date printed on the label (EXP), where the expiry date refers to the last day of the stated month. The solution must not be frozen at any time, as freezing may affect the stability and integrity of the product.
Once drawn into a syringe, MultiHance must be used immediately. The solution should not be stored in the syringe for later use. Any unused product must be discarded and cannot be used for other MRI examinations or other patients. Before use, the healthcare professional will inspect the solution: MultiHance should not be administered if the container or closure appears damaged, or if the solution is discoloured or contains visible particles. The solution should appear clear and colourless to slightly yellow.
Disposal of unused contrast agent and waste materials should follow local regulations for pharmaceutical waste to protect the environment. In a hospital setting, pharmacists and nursing staff manage the proper disposal of unused and expired contrast agents according to institutional protocols.
What Does MultiHance Contain?
MultiHance contains the active substance gadobenic acid (334 mg per ml, equivalent to 0.5 mmol) as gadobenate dimeglumine (529 mg per ml). The only other ingredient is water for injections.
The active substance in MultiHance is gadobenic acid, which is present as the dimeglumine salt (gadobenate dimeglumine). Each millilitre of solution contains 334 mg of gadobenic acid (0.5 mmol), corresponding to 529 mg of gadobenate dimeglumine. Gadobenic acid is a paramagnetic gadolinium chelate, meaning that the gadolinium ion is bound within a stable molecular cage (the chelate) that keeps it in a non-toxic form while still allowing it to exert its contrast-enhancing properties.
The excipient is simply water for injections. Unlike some other pharmaceutical products, MultiHance does not contain buffers, preservatives, or other additives. This simple formulation minimises the risk of excipient-related adverse reactions.
Appearance and Packaging
MultiHance is a sterile aqueous solution that appears clear and colourless to slightly yellow. It is supplied for hospital use in single-dose glass vials containing 5 ml, 10 ml, 15 ml, or 20 ml of solution. MultiHance is also available in packages that include administration equipment: 15 ml and 20 ml vials with syringes designed for automatic MRI power injectors (65 ml or 115 ml syringes made of polyethylene terephthalate/polycarbonate), connector pieces, spike adapters, and a 20G safety catheter. Not all pack sizes may be available in every market.
Manufacturer
MultiHance is manufactured by Bracco Imaging S.p.A., based in Milan, Italy. Production facilities include Patheon Italia S.p.A. in Ferentino, Italy; BIPSO GmbH in Singen, Germany; and Bracco Imaging S.p.A. at the Bioindustry Park in Colleretto Giacosa, Italy. The marketing authorisation is held by Bracco Imaging S.p.A.
Frequently Asked Questions About MultiHance
MultiHance (gadobenate dimeglumine) differs from most other gadolinium-based contrast agents in its ability to provide dual-phase imaging. While standard extracellular gadolinium agents distribute only into the blood and interstitial space, approximately 3–5% of MultiHance is taken up by liver cells and excreted via the bile ducts. This enables a delayed hepatobiliary imaging phase (40–120 minutes after injection) that provides additional information for characterising liver lesions. MultiHance also has higher relaxivity than most other extracellular GBCAs, which means it produces stronger contrast enhancement at equivalent doses.
In MultiHance, the gadolinium ion is bound within a stable chelate complex, which prevents it from interacting with body tissues in a harmful way. Free (unchelated) gadolinium would be toxic, but the chelation process makes it safe for clinical use. Studies have shown that small amounts of gadolinium can remain in the body after injection, but no adverse health effects from this retention have been identified in patients with normal kidney function. The main safety concern relates to patients with severe kidney disease, where the risk of nephrogenic systemic fibrosis (NSF) is increased.
The MRI procedure itself typically takes 30 to 60 minutes, depending on the clinical protocol. When MultiHance is used with delayed hepatobiliary-phase imaging, additional images may be acquired between 40 and 120 minutes after injection, which can extend the total examination time. You will also need to remain at the facility for at least one hour after the injection for observation. Your radiology department will advise you on the expected total time for your specific examination.
Fasting requirements for MRI with MultiHance may vary depending on your hospital's protocol and the specific type of examination. Some centres may ask you to fast for 4–6 hours before the scan, while others may allow light meals. Your radiology department will provide specific instructions when scheduling your appointment. If you have diabetes or take medications that require food, discuss this with your healthcare team in advance.
MultiHance is only administered in facilities equipped with resuscitation equipment and staffed by medical professionals trained to manage allergic reactions. If you develop signs of an allergic reaction (such as hives, facial swelling, breathing difficulties, or dizziness), the medical team will provide immediate treatment. This may include adrenaline (epinephrine), antihistamines, corticosteroids, and supportive care. The one-hour post-injection observation period is specifically designed to ensure that any delayed reactions are detected and treated promptly.
There is no strict maximum number of MultiHance injections for patients with normal kidney function. However, given that small amounts of gadolinium may be retained in the body after each injection, current guidelines recommend using the lowest dose necessary and avoiding unnecessary repeat examinations. Your doctor will carefully weigh the diagnostic benefit against the potential risks for each examination. In patients with impaired kidney function, a minimum interval of 7 days between injections is required.
References and Sources
- European Medicines Agency (EMA). MultiHance Summary of Product Characteristics (SmPC). EMA, updated 2024.
- US Food and Drug Administration (FDA). MultiHance (gadobenate dimeglumine) Prescribing Information. FDA, 2023.
- American College of Radiology (ACR). ACR Manual on Contrast Media, Version 2024. ACR Committee on Drugs and Contrast Media.
- European Society of Urogenital Radiology (ESUR). ESUR Guidelines on Contrast Agents, Version 10.0, 2023.
- Kanda T, et al. Gadolinium-based Contrast Agent Accumulates in the Brain Even in Subjects without Severe Renal Dysfunction. Radiology. 2015;276(1):228–232.
- Thomsen HS, et al. Nephrogenic Systemic Fibrosis and Gadolinium-based Contrast Media: Updated ESUR Contrast Medium Safety Committee Guidelines. European Radiology. 2013;23(2):307–318.
- Runge VM. Safety of the Gadolinium-Based Contrast Agents for Magnetic Resonance Imaging, Focusing in Part on Their Accumulation in the Brain and Especially the Dentate Nucleus. Investigative Radiology. 2016;51(5):273–279.
- Bracco Imaging S.p.A. MultiHance Package Insert (Patient Information Leaflet). Revised December 2024.
- World Health Organization (WHO). WHO Model List of Essential Medicines, 23rd Edition, 2023.
- Schneider G, et al. Gadobenate Dimeglumine-Enhanced MRI of the Liver: Simultaneous Assessment of Dynamic and Hepatobiliary-Phase Imaging. AJR American Journal of Roentgenology. 2006;187(3):684–692.
Editorial Team
iMedic Medical Editorial Team – specialists in radiology, diagnostic imaging, and clinical pharmacology with extensive experience in contrast agent safety and MRI protocols.
iMedic Medical Review Board – independent panel of physicians who verify clinical accuracy, evidence quality, and adherence to international guidelines (EMA, ACR, ESUR).
All content follows the GRADE evidence framework and is based on peer-reviewed research, regulatory documents, and international clinical guidelines. This article has been reviewed for clinical accuracy, completeness, and readability. No pharmaceutical company funding or sponsorship is involved. Last medical review: .