Low-Dose Gadobenate Dimeglumine Versus Standard-Dose Gadopentate Dimeglumine for Delayed Contrast-Enhanced Cardiac Magnetic Resonance Imaging

doi:10.1016/j.acra.2006.04.002

Academic Radiology

Volume 13, Issue 7, July 2006, Pages 833-839

https://doi.org/10.1016/j.acra.2006.04.002 Get rights and content

Rationale and Objectives

The purpose of our study was to compare gadopentate dimeglumine (Gd-DTPA) and gadobenate dimeglumine (Gd-BOPTA) for the evaluation of myocardial infarction (MI) and in the grading transmural extent on late-contrast enhanced cardiac magnetic resonance imaging.

Materials and Methods

Twenty-three patients with clinically proven MI were examined with the use of 0.2 mmol/kg Gd-DTPA and 0.1 mmol/kg Gd-BOPTA in 2 days interval. All patients were examined with the use of segmented two-dimensional inversion-recovery turbo fast-field echo pulse sequence with an inversion time 210–300 milliseconds. Fifteen minutes time delay was used on both examinations after the injection of contrast agent. Contrast-to-noise ratio between normal myocardium and infarcted myocardium and signal intensity ratio (SIR) of the enhanced myocardium to blood pool was derived and compared for each contrast agent.

Results

A total of 61 infarcted segments were analyzed. All of the infarcted segments were visualized on both Gd-BOPTA and Gd-DTPA enhanced images. There was statistically no significant difference between 0.2 mmol/kg Gd-DTPA and 0.1 mmol/kg Gd-BOPTA in the mean contrast-to-noise ratio (10.19 versus 10.22; P = .96), SNR (14.29 versus 14.25; P = .96), and SIR (4.34 versus 4.21; P = .38) of the infarcted segments. Intraobserver agreement (kappa) between Gd-DTPA and Gd-BOPTA were R1 = 91% and R2 = 86%. Interobserver agreements between the readers were Gd-DTPA = 85% and Gd-BOPTA = 88%.

Conclusion

According to our data, the diagnostic efficacy of 0.1 mmol/kg dose Gd-BOPTA is equivalent to that of 0.2 mmol/kg Gd-DTPA for the assessment of MI on delayed enhanced magnetic resonance images.

Section snippets

Patients

Twenty-three patients (15 men and 8 women; age range 45–78 years; mean age 68 years) entered in this study who were scheduled for the assessment of myocardial viability by contrast-enhanced MRI. All patients had clinically diagnosed myocardial infarction. The clinical diagnosis of myocardial infarction relied on enzyme elevations and electrocardiographic changes.

Nine patients had a history of chronic myocardial infarction for more than 6 months (mean 6.7 months), and 14 patients had a history

Results

All the patients had myocardial hyperenhancement. A total of 61 segments revealed myocardial infarction. In 18 patients, multiple segments were involved. The distribution of the infarcted segments is presented in Table 1. Forty-five segments revealed transmural and 16 segments revealed subendocardial infarcts. All infarcts that were visualized on 0.2 mmol/kg dose Gd-DTPA scans were also visualized on 0.1 mmol/kg Gd-BOPTA–enhanced images (Figure 1, Figure 2, Figure 3). The mean SIE and SIN

Discussion

Gd-BOPTA is a gadolinium-based MR contrast agent that has been used for MRI of the central nervous system and liver. This contrast agent reveals a dual route of elimination through both the renal and hepatobiliary pathways; thus both dynamic and delayed-phase imaging of the liver can be performed. Diagnostic efficacy of Gd-BOPTA in liver imaging was compared with Gd-DTPA in several studies. In one comparative study, no significant difference was observed between half-dose (0.05 mmol/kg)

References (12)

A. Spinazzi et al.
MultiHance clinical pharmacologybiodistribution and MR enhancement of the liver
Acad Radiol
(1998)
A. Spinazzi et al.
Safety, tolerance, biodistribution and MR imaging enhancement of the liver with gadobenate dimeglumine
Acad Radiol
(1999)
M.A. Kirchin et al.
Gadobenate dimeglumine (Gd- BOPTA)an overview
Invest Radiol
(1998)
J. Petersein et al.
Evaluation of the efficacy of gadobenate dimeglumine in MR imaging of focal liver lesionsa multicenter Phase III clinical study
Radiology
(2000)
G. Schneider et al.
Low-dose gadobenate dimeglumine versus standard dose gadopentetate dimeglumine for contrast-enhanced magnetic resonance imaging of the liveran intra-individual crossover comparison
Invest Radiol
(2003)
O.P. Simonetti et al.
An improved MR imaging technique for the visualization of myocardial infarction
Radiology
(2001)

There are more references available in the full text version of this article.

Cited by (39)

Non-clinical assessment of safety and gadolinium deposition after cumulative administration of gadobenate dimeglumine (MultiHance<sup>®</sup>) to neonatal and juvenile rats
2018, Regulatory Toxicology and Pharmacology
Citation Excerpt :
Numerous intra-individual comparative studies across a range of applications have shown that the greater SI enhancement achievable with gadobenate translates into significantly improved imaging and diagnostic performance (Seidl et al., 2012; Vaneckova et al., 2015; Martincich et al., 2011; Gerretsen et al., 2010). A benefit of the greater SI enhancement achievable is that the dose of gadobenate administered can be reduced without loss of diagnostic performance relative to that achievable with standard doses of other approved GBCAs (Vaneckova et al., 2015; Balci et al., 2006; Schneider et al., 2003; Crisi et al., 2017; Khouri Chalouhi et al., 2014). Following initial reports of increased SI in the brain (principally the dentate nucleus [DN] and globus pallidus [GP]) on unenhanced T1-weighted images following multiple injections of GBCAs (Kanda et al., 2014; Quattrocchi et al., 2015; Radbruch et al., 2015), numerous studies have looked to evaluate the extent and possible consequences of retained gadolinium (Gd) in the body.
To determine the impact of single and cumulative doses of MultiHance on toxicity, pharmacokinetics, tissue gadolinium presence, behavior and neurological function in juvenile rats. Juvenile male and female rats received either physiological saline or MultiHance at 0.6, 1.25 or 2.5 mmol/kg bodyweight. Animals received either single or six consecutive MultiHance administrations and were sacrificed the day after the last administration or after a 60-day treatment-free period. Animals were assessed for behavior, cognitive function, grip strength, gait, pupillary reflex, and auditory reflex, as well as for physical development, sexual maturation and histopathology. Gadolinium presence in brain, femur, kidneys, liver and skin was determined using inductively coupled plasma-mass spectrometry (ICP-MS). No effects of MultiHance on behavior, cognitive function or any other parameter were noted, even for the highest administered cumulative dose (15 mmol/kg). Gadolinium presence was variable across tissues and decreased during the 60-day treatment-free period. The highest levels were noted in the femur and the lowest levels in the brain. Gadolinium presence in juvenile rat brain following single or repeated MultiHance administrations was minimal and non-impactful.
Early myocardial gadolinium enhancement in patients with myocarditis: Validation of “Lake Louise consensus” criteria using a single bolus of 0.1 mmol/Kg of a high relaxivity gadolinium-based contrast agent
2017, European Journal of Radiology
Citation Excerpt :
Our data demonstrates that a single dose of 0.1 mmol/kg of gadobenate dimeglumine is sufficient for both EGE and LGE assessment in acute myocarditis, with reduction of patient discomfort and costs. This finding is in line with findings in other clinical settings such as acute myocardial infarction [29,30] and may be particularly important given increasing emphasis on the need to lower contrast medium doses wherever possible. In this regard, a recent concern has been raised in the scientific community about the utilization of linear Gadolinium-based contrast agents, which have been shown to accumulate in the dentate nucleus and globus pallidus in patients undergone to contrast-enhanced MRI studies, with a dose-dependent mechanism [31].
Global early gadolinium enhancement (EGE) is an accepted cardiac magnetic resonance (CMR) criterion for diagnosis of myocarditis. However, recommended enhancement thresholds are based specifically on standard-relaxivity Gd-chelates. We evaluated the performance of a high relaxivity MR contrast agent for detection of myocardial hyperemia in patients referred for endomyocardial biopsy (EMB).
We retrospectively enrolled 54 patients (mean age: 44.1 years [range = 18–77 years]; 72% men) with suspected myocarditis who underwent CMR and EMB within four weeks of clinical onset. CMR imaging protocol included T2-weighted short tau inversion-recovery sequence, EGE and late gadolinium enhanced (LGE) imaging.
For EGE imaging, free-breathing ECG-gated turbo spin echo T1-weighted (TSE T1w) sequences were acquired before and within the first three minutes after gadobenate dimeglumine (0.1 mmol/Kg) administration. The ratio (EGEr) between myocardial and musculoskeletal early enhancement was calculated. Myocardial edema, EGE and late gadolinium enhancement (LGE) were correlated with EMB results. Receiver operating characteristic (ROC) curve analysis of EGE values was applied on the overall population.
EMB revealed myocarditis in 34/54 patients. Sensitivity, specificity and accuracy values of 0.61, 0.85 and 0.70, respectively, were obtained for a standard EGE threshold (EGEr > 4.0). ROC analysis revealed an area under the curve of 0.701 for EGEr (IC95%:0.556–0.846, p = 0.014) and 0.706 for absolute enhancement (IC95%:0.563–0.849, p = 0.012).
Sensitivity, specificity and accuracy values were 0.67, 0.80 and 0.72, respectively, for myocardial edema and 0.76, 0.75 and 0.76, respectively, for LGE.
High relaxivity contrast agents provide comparable results to standard-relaxivity chelates for EGE assessment in diagnosing myocarditis.
Ultra low-dose of gadobenate dimeglumine for late gadolinium enhancement (LGE) imaging in acute myocardial infarction: A feasibility study
2014, European Journal of Radiology
Citation Excerpt :
Moving in this direction, our study demonstrated that the use of an ultra-low dose (0.05 mmol/kg BW) of a high relaxivity contrast media is generally sufficient to obtain an acceptable image quality for late enhancement imaging in AMI setting. As previously reported by other authors [15–18,20], a gadobenate dimeglumine dose of 0.1 mmol/kg BW generally provides an excellent image quality for determinations of IM size and volume. Our data not only suggests that image datasets acquired with 0.05 mmol/kg gadobenate dimeglumine at the delay of 5–10 min are comparable to those obtained with 0.1 mmol/kg gadobenate dimeglumine at later time-points, but even that at this dose regimen an entire LGE imaging protocol may be completed within 10 min after contrast injection.
To assess the feasibility of using an ultra-low dose (0.05 mmol/kg of body weight [BW]) of high relaxivity contrast agent for late gadolinium enhancement (LGE) imaging in patients with acute myocardial infarction (AMI).
17 consecutive patients (mean age, 60.1 ± 10.3 years) with ST-segment elevation AMI underwent two randomized cardiac magnetic resonance studies (exam intervals between 24 and 48 h) on a 1.5 T unit during the first week after the event using gadobenate dimeglumine (Gd-BOPTA) at the dose of 0.1 mmol/kg BW (standard dose or SD group) and 0.05 mmol/kg BW (half dose or HD group). Image quality was qualitatively assessed. Quantitative analysis of LGE were performed by measuring signal intensity (SI), signal-to-noise ratio (SNR) in the infarcted myocardium (IM), non-infarcted myocardium (N-IM) and left ventricular cavity (LVC) in images acquired at 1, 3, 5, 10, 15 and 20 min after administration of Gd-BOPTA using both contrast media protocol. Contrast-to-noise ratio (CNR) between IM and N-IM (CNR IM/N-IM) and between IM and LVC (CNR IM/LVC) were also quantified for each time point. Moreover the extent of infarcted myocardium was measured.
102 LGE images were evaluated for each dose group. Quality score was significantly higher for SD at 1, 15 and 20 min (0.002 < p < 0.046) and for HD at 5 min (p = 0.013). SNR has been higher in the SD group compared to the HD group even though not statistically significant at any time-point for both IM (SD vs. HD: 87.7 ± 73 vs. 65 ± 66; 0.15 < p < 0.38) and N-IM (SD vs. HD: 22 ± 61 vs. 9.9 ± 6.5; 0.09 < p < 0.43). LVC SNR was significantly higher with SD at 10 min (p = 0.03), 15 min (p = 0.001) and 20 min (p = 0.004). CNR between the IM and N-IM was significantly higher using SD compared to HD (1382.24 ± 1049 vs. 695.4 ± 500; 0.000 < p < 0.028) at 10, 15 and 20 min. No significant differences in CNR IM/LVC were noted for HD acquired 5 min after CM administration compared to SD acquired at 10 (p = 0.34), 15 (p = 0.96) and 20 (p = 0.41) min, and between HD at 10 min compared to SD acquired at 15 min (p = 0.78) and 20 min (p = 0.32). Good correlation between SD and HD (0.56 < r² < 0.85, p < 0.024) was found at all time-points in the measuring of IA.
The use of a 0.05 mmol/kg dose of gadobenate dimeglumine is feasible for LGE imaging of acute MI and the best image quality is obtained at 5 min after contrast administration. It could be beneficial in patient with renal failure and a solution to improve the identification of subendocardial infarction reducing examination time, costs and total gadolinium load. However, the standard dose of 0.1 mmol/kg provides overall better image quality, with the best performance obtained at the delay of 10 min or more after Gd-BOPTA administration, and it should be routinely preferred.
Intraindividual comparison of T1 relaxation times after gadobutrol and Gd-DTPA administration for cardiac late enhancement imaging
2014, European Journal of Radiology
To evaluate T1-relaxation times of chronic myocardial infarction (CMI) using gadobutrol and gadopentetate dimeglumine (Gd-DTPA) over time and to determine the optimal imaging window for late enhancement imaging with both contrast agents.
Twelve patients with CMI were prospectively included and examined on a 1.5 T magnetic resonance (MR) system using relaxivity-adjusted doses of gadobutrol (0.15 mmol/kg) and Gd-DTPA (0.2 mmol/kg) in random order. T1-relaxation times of remote myocardium (RM), infarcted myocardium (IM), and left ventricular cavity (LVC) were assessed from short-axis TI scout imaging using the Look–Locker approach and compared intraindividually using a Wilcoxon paired signed-rank test (α < 0.05).
Within 3 min of contrast agent administration (CA), IM showed significantly lower T1-relaxation times than RM with both contrast agents, indicating beginning cardiac late enhancement. Differences between gadobutrol and Gd-DTPA in T1-relaxation times of IM and RM were statistically not significant through all time points. However, gadobutrol led to significantly higher T1-relaxation times of LVC than Gd-DTPA from 6 to 9 min (220 ± 15 ms vs. 195 ± 30 ms p < 0.01) onwards, resulting in a significantly greater ΔT1 of IM to LVC at 9–12 min (−20 ± 35 ms vs. 0 ± 35 ms, p < 0.05) and 12–15 min (−25 ± 45 ms vs. −10 ± 60 ms, p < 0.05). Using Gd-DTPA, comparable ΔT1 values were reached only after 25–35 min.
This study indicates good delineation of IM to RM with both contrast agents as early as 3 min after administration. However, we found significant differences in T1 relaxation times with greater ΔT1 IM–LVC using 0.15 mmol/kg gadobutrol compared to 0.20 mmol/kg Gd-DTPA after 9–15 min post-CA suggesting earlier differentiability of IM and LVC using gadobutrol.
Assessment of coronary microvascular dysfunction in hypertrophic cardiomyopathy: First-pass myocardial perfusion cardiovascular magnetic resonance imaging at 1.5 T
2013, Clinical Radiology
Citation Excerpt :
Imaging parameters were: 3.7 ms repetition time (TR), 1.6 ms echo time (TE), 320 mm × 320 mm field of view (FOV), 224 × 192 matrix, 45° flip angle, 8 mm section thickness, 2 mm intersection gap, acceleration factor of 2, and an acquisition time per section of 8–10 s. A gadolinium chelate contrast agent [gadobenate dimeglumine (MultiHance),8–10 0.5 mmol/ml; Bracco, Milan, Italy] was then administered intravenously at a dose of 0.1 mmol/kg bodyweight and an injection rate of 3.5 ml/s, followed by a 12 ml saline flush injected at the same rate. Short-axis first-pass perfusion CMR was performed using a T1-weighted fast gradient-echo sequence with saturation-recovery magnetization preparation (FGRET).
To evaluate the integrity of the coronary microvasculature in patients with hypertrophic cardiomyopathy (HCM) using first-pass magnetic resonance perfusion imaging.
Twenty-two patients with HCM and 13 healthy volunteers underwent cardiac magnetic resonance imaging (CMR) at rest. Imaging protocols included short axis cine, first-pass myocardial perfusion, and late-phase contrast-enhanced imaging. Left ventricular end-diastolic wall thickness (EDTH), myocardial thickening, maximal upslope of time–intensity curve (slope_max), and late myocardial gadolinium enhancement (LGE) were assessed for each myocardial segment. The differences in slope_max, myocardial thickening, and EDTH between healthy volunteers and HCM patients were evaluated as were differences among hypertrophic segments of different severities (mild, moderate, and severe hypertrophy) in a one-way analysis of variance analysis. The differences in slope_max, myocardial thickening, and EDTH between the segments with and without LGE were compared by independent-sample t-test. A Pearson correlation test was used to determine the relationships between slope_max, EDTH, and myocardial thickening.
Slope_max was statistically significantly less in HCM patients; the degree of myocardial thickening was also significantly reduced (p < 0.001). Slope_max and the degree of thickening statistically significantly decreased with increasing degrees of myocardial hypertrophy (p < 0.05). Differences in slope_max, myocardial thickening, and EDTH were observed between segments with and without LGE (p < 0.05). Slope_max and myocardial thickening were negatively correlated with EDTH.
First-pass myocardial perfusion CMR with slope_max measurements demonstrates microvascular coronary dysfunction in patients with HCM, a determination that may aid in risk stratification, therapeutic planning, and determination of prognosis for HCM.
Dose-Lowering in Contrast-Enhanced MRI of the Central Nervous System: A Retrospective, Parallel-Group Comparison Using Gadobenate Dimeglumine
2021, Journal of Magnetic Resonance Imaging

View all citing articles on Scopus

View full text

Original investigationLow-Dose Gadobenate Dimeglumine Versus Standard-Dose Gadopentate Dimeglumine for Delayed Contrast-Enhanced Cardiac Magnetic Resonance Imaging

Rationale and Objectives

Materials and Methods

Results

Conclusion

Section snippets

Patients

Results

Discussion

MultiHance clinical pharmacologybiodistribution and MR enhancement of the liver

Acad Radiol

Safety, tolerance, biodistribution and MR imaging enhancement of the liver with gadobenate dimeglumine

Acad Radiol

Gadobenate dimeglumine (Gd- BOPTA)an overview

Invest Radiol

Evaluation of the efficacy of gadobenate dimeglumine in MR imaging of focal liver lesionsa multicenter Phase III clinical study

Radiology

Low-dose gadobenate dimeglumine versus standard dose gadopentetate dimeglumine for contrast-enhanced magnetic resonance imaging of the liveran intra-individual crossover comparison

Invest Radiol

An improved MR imaging technique for the visualization of myocardial infarction

Radiology

Original investigation
Low-Dose Gadobenate Dimeglumine Versus Standard-Dose Gadopentate Dimeglumine for Delayed Contrast-Enhanced Cardiac Magnetic Resonance Imaging