OBJECTIVES: This study was designed to determine the enhancement profile of a necrosis-specific contrast agent (gadophrin III) in comparison to a standard extracellular agent on T1-weighted magnetic resonance (MR) images in acute and chronic myocardial infarctions (MIs). BACKGROUND: Contrast-enhanced MR imaging demonstrated the ability to accurately quantify infarct size; however, some controversies persist about which contrast medium is best suited. METHODS: Fifteen rabbits underwent thoracotomy and permanent occlusion of a branch of the left coronary artery. Two animals died before imaging, eight were examined 48 h after occlusion and five animals were imaged six weeks following induction of infarction. All animals received 50 μmol/kg of gadophrin-3 24 h before the MR examination. Continuous short-axis views were collected using an inversion recovery turbo fast low angle shot sequence. Imaging was repeated 5 to 10 rain following additional injection of 100 μmol/kg of Magnevist. The area of hyperenhancement demarcated following gadophrin-3 injection was compared with the region of hyperenhancement seen on gadophrin-3 plus Magnevist enhanced image using triphenyltetrazolium chloride (TTC) staining as the standard of reference. RESULTS: In acute MI the mean difference in size of hyperenhancement seen on the two different in vivo MR scans was -1.8 ± 6.0 mm2 (p > 0.05). Both measurements showed excellent agreement with TTC staining. Chronic MIs showed no enhancement with gadophrin-3, whereas application of Magnevist resulted in hyperenhancement. CONCLUSIONS: Standard extracellular contrast agents do not overestimate the size of acute MI. The combination of gadophrin-3 and Magnevist can distinguish acute and chronic myocardial injury because chronic MIs do not enhance with gadophrin-3.