Elsevier

Clinical Radiology

Volume 74, Issue 12, December 2019, Pages 978.e1-978.e7
Clinical Radiology

Improved display of abdominal contrast-enhanced MRA using gadobutrol: comparison with Gd-DTPA

https://doi.org/10.1016/j.crad.2019.08.012Get rights and content

Highlights

  • Gadobutrol is superior to Gd-DTPA for small vessels MRA quality analyses.

  • Large vessels MRA quantity analyses show Gadobutrol with higher SNR than Gd-DTPA.

  • No statistic difference in visceral organ enhancement in two contrast-enhanced images.

  • Gadobutrol may be more suitable than Gd-DTPA in abdominal one-stop shop examination.

AIM

To qualitatively and quantitatively compare gadobutrol with gadopentetate dimeglumine (Gd-DTPA) in abdominal contrast-enhanced magnetic resonance angiography (CE-MRA) and contrast-enhanced magnetic resonance imaging (CE-MRI) during one-stop imaging.

MATERIALS AND METHODS

This prospective, blinded, multicentre, intra-individual comparison study was approved by the institutional review board. All patients underwent gadobutrol- and Gd-DTPA-enhanced MRA and MRI. Qualitative analysis for vessels was performed using a three-point scale while quantity analysis was performed by signal-to-noise ratio (SNR). Visceral organs enhancements were also analysed. A Wilcoxon matched-pair signed-rank test was used to evaluate the quality and quantity results.

RESULTS

One hundred and twelve patients were enrolled. Quality analyses results for large vessels and small vessels of gadobutrol and Gd-DTPA were 18.38±1.51 and 6.76±1.58 and 17.87±1.84 and 6.09±1.55, respectively. Wilcoxon signed-rank tests revealed gadobutrol was significantly superior to Gd-DTPA (p=0.036) for small vessels. For large vessel quantity analysis, gadobutrol demonstrated significantly higher signal-to-noise ratios (SNR; p=0.041) than Gd-DTPA, with mean values of 948.156±349.731 and 838.925±248.197. There was no statistically significant in enhancement of liver, spleen, and renal tissue during gadobutrol- and Gd-DTPA-enhanced imaging (p>0.05). One patient reported an adverse event. Dizziness and vomiting occurred after injection of Gd-DTPA.

CONCLUSIONS

The present study demonstrates gadobutrol-enhanced MRA was superior to that of Gd-DTPA without statistical significance in visceral organ enhancement. It indicates gadobutrol may be more suitable for abdominal one-stop imaging for CE-MRA and CE-MRI by improving depiction of vessels in MRA images.

Introduction

Contrast-enhanced (CE) magnetic resonance angiography (MRA) and CE magnetic resonance imaging (MRI) have been recognised as non-invasive powerful and accurate imaging tools, which are crucial for diagnostic medicine. Compared to computed tomography, CE-MRA and CE-MRI provide high soft-tissue resolution without the risk of exposure to ionising radiation. They can also provide improved reproducibility and a lower propensity for inter-reader variability than ultrasonography.

Gadolinium-based contrast agents (GBCAs) enhance tissue contrast and are essential for CE-MRA and CE-MRI.1 Gadobutrol (Gadovist, Bayer Healthcare Pharmaceuticals, Berlin, Germany) is a non-ionic macrocyclic GBCA displaying with high relaxivity and low osmolarity and viscosity.2, 3, 4 The physical properties of this extracellular neutral gadolinium chelate allow for a concentration of 1 mmol Gd/ml, which is double the concentration of gadopentetate dimeglumine (Gd-DTPA, Magnevist, Bayer Healthcare Pharmaceuticals, Berlin, Germany). It has been assumed that the reduced injection volume of gadobutrol facilitates a sharper bolus peak and increased intravascular first-pass gadolinium concentration.5 Previous studies report gadobutrol improving delineation of small vessels with comparatively increased signal-noise ratios (SNRs) and contrast-to-noise ratio (CNRs) in the vascular territory.6, 7, 8 Whereas contradictory results showed no advantage of gadobutrol for CE-MRA.9, 10 For CE-MRI of the abdominal visceral organs, the value of gadobutrol still needs to be defined.11, 12, 13

In recent years, improvements in MRI hardware and techniques have greatly increased image spatial resolution and reduced acquisition time.14 A comprehensive MRI protocol is used to assess the arteries and organ parenchyma, called one-stop imaging. It allows simultaneous acquisition of both MRA and post-enhancement images in the same examination. This approach can reduce the injection of contrast agents and make reasonable use of medical resources.15, 16

This study aims to qualitatively and quantitatively compare gadobutrol with Gd-DTPA at equimolar doses of gadolinium in abdominal CE-MRA and CE-MRI as part of a one-stop imaging protocol.

Section snippets

Materials and methods

This prospective designed, blinded, multicentre, intra-individual comparison study was approved by the institutional review board.

Patient characteristics

The demographic data of 112 patients are demonstrated in Table 2. Ninety-six (86.6%) patients had physical examinations. Fifty-six patients received gadobutrol in the first scan and Gd-DTPA in the second scan whereas the other 56 patients received GBCAs in opposite sequence. Paired sample t-tests showed there was no statistical difference among basic data of patients in Group A and Group B (p>0.05). Of 120 patients enrolled, one patient reported an adverse event. This patient had a diagnosis of

Discussion

CE-MRA and CE-MRI have been recognised as powerful and accurate non-invasive imaging tools in abdominal disease. A “one-stop” MRI approach is used to acquire MRA and organ parenchyma enhancement images in a single step. Previous studies determined the suitability and feasibility of one-stop abdominal imaging.15, 16, 20

The present study compared gadobutrol with Gd-DTPA qualitatively and quantitatively at equimolar doses of gadolinium during abdominal one-stop CE-MRA and CE-MRI. Qualitative

Conflict of interest

The authors declare no conflict of interest.

Acknowledgements

The authors thank all participants in Department of Radiology, First Hospital of Jilin University, China, Nanfang Hospital of Southern Medical University, China, the Third Affiliated Hospital of Zhongshan University, China, Tianjin First Central Hospital, China, and Sichuan Cancer Hospital, China. This study was supported by Bayer Healthcare Pharmaceuticals.

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