Comparison of Contrast Agents in Liver Magnetic Resonance (MR) for the Detection of Hepatic Metastases
Evaluation of Liver Magnetic Resonance (MR) With an Abbreviated Gadobenate Dimeglumine Hepatobiliary Phase Protocol in Comparison to Liver MR With Gadoxetate Disodium for the Detection of Hepatic Metastases
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The goal is to:
- Estimate and compare the diagnostic performance, including sensitivity, specificity, positive/negative predictive value, and area under the receiver operating characteristics (AUROC), of abbreviated protocol liver magnetic resonance (MR) with hepatobiliary phase (HBP) using gadobenate dimeglumine for detecting liver metastases, with 1) abbreviated protocol liver MR with HBP using gadoxetate disodium, 2) standard of care complete protocol liver MR using gadoxetate disodium, and 3) complete protocol liver MR using gadobenate dimeglumine.
- Estimate and compare quantitative measures of HBP images (liver enhancement ratio, lesion contrast to noise and signal to noise ratios [CNR and SNR]) for both gadobenate dimeglumine and gadoxetate disodium.
- Qualitatively assess the preference, or lack thereof, of radiologists regarding the images generated by abbreviated protocol liver MR with HBP using gadobenate dimeglumine versus abbreviated protocol liver MR with HBP using gadoxetate disodium.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 4
Contacts and Locations
Study Contact
Study Contact
- Name: Samuel Chang, MD
- Phone Number: 720-848-0000
- Email: Samuel.Chang@cuanschutz.edu
Study Contact Backup
- Name: Tracey MacDermott
- Phone Number: (303)724-2757
- Email: TRACEY.MACDERMOTT@CUANSCHUTZ.EDU
Study Locations
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Colorado
-
Aurora, Colorado, United States, 80045
- University of Colorado Hospital
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Colorectal cancer patients
- Age 18-80 years
- No prior treatment including surgery
- Prior imaging with suspected liver metastasis
Exclusion Criteria:
- Age < 18 years or > 80 years
- eGFR < 30 ml/min/1.73 m2
- Previous reaction to gadolinium contrast agents
- History of claustrophobia or movement disorders likely to impact image quality
- Non-MR safe implants or metallic foreign bodies
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Gadoxetate disodium exam first, Gadobenate Dimeglumine exam second
The subjects will be randomized into two groups.
Both groups will undergo two complete protocol liver magnetic resonance imaging (MRI) for known or suspected colorectal cancer (CRC) metastasis, one exam with gadoxetate disodium and the other exam with gadobenate dimeglumine, within an interval of 3-10 days, but in opposite order, determined randomly.
|
The most commonly used MR contrast agent in abdominal imaging is gadobenate dimeglumine, which has mainly the characteristics of an extracellular agent used for most indications of MR examinations.
Other Names:
Gadoxetate disodium MR contrast is now mainly used for the purpose of HBP liver MR imaging to save MR scanner time and total examination time.
Other Names:
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Experimental: Gadobenate Dimeglumine exam first, Gadoxetate disodium exam second
The subjects will be randomized into two groups.
Both groups will undergo two complete protocol liver MRI for known or suspected CRC metastasis, one exam with gadoxetate disodium and the other exam with gadobenate dimeglumine, within an interval of 3-10 days, but in opposite order, determined randomly.
|
The most commonly used MR contrast agent in abdominal imaging is gadobenate dimeglumine, which has mainly the characteristics of an extracellular agent used for most indications of MR examinations.
Other Names:
Gadoxetate disodium MR contrast is now mainly used for the purpose of HBP liver MR imaging to save MR scanner time and total examination time.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Diagnostic Performance of gadobenate dimeglumine
Time Frame: 1 month
|
The primary performance diagnostic will be sensitivity, similar to the recently published retrospective study by Canellas et al. (2019).
In addition to other diagnostic performance metrics of interest (e.g., specificity, AUROC), lesions will be analyzed descriptively in terms of number of metastases detected and lesion size.
|
1 month
|
|
Quantitative Measures of hepatobiliary phase images
Time Frame: 1 month
|
Mixed effects regression models will again be used to compare the three outcomes between methods, accounting for correlated data.
The specific link function of the regression models will depend on the distributional characteristics of each outcome (e.g., logit link for dichotomous outcomes; linear regression for continuously measured outcomes).
|
1 month
|
|
Preference of radiologists for the images generated by amHBP versus aeHBP
Time Frame: 1 month
|
The quality of amHBP and aeHBP images will be assessed with ordinal response mixed effect models that include right/left image as a covariate.
We will assess if there was any reader specific and/or general bias to prefer an image on the left or the right of a screen, regardless of the amHBP or aeHBP, and consider this when modeling the probability of preference of amHBP over aeHBP.
We will estimate the relative probabilities of no-preference, amHBP preference, or aeHBP preference.
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1 month
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Compare Sensitivity and Specificity,
Time Frame: 1 month
|
The primary analysis will use pathology as the gold standard, if available, but will revert to long term imaging in the absence of pathology.
To address the potential impact of this limitation, we will also conduct an exploratory analysis to compare the sensitivity and specificity of the imaging methods by each gold standard.
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1 month
|
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Test Validity of Imaging Methods
Time Frame: 1 month
|
We will also conduct an exploratory analysis to test the validity of long term imaging as a gold standard against available pathology reports.
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1 month
|
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Compare Patient Time Associated with Imaging Method
Time Frame: 1 month
|
In addition to analyses for the primary aims, additional analyses will be conducted to examine patient time associated with each imaging method; time metrics can be compared between imaging methods in absolute terms, but also proportionally to sensitivity.
|
1 month
|
|
Compare Cost Associated with Imaging Method
Time Frame: 1 month
|
In addition to analyses for the primary aims, additional analyses will be conducted to examine cost associated with each imaging method; cost metrics can be compared between imaging methods in absolute terms, but also proportionally to sensitivity.
|
1 month
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Nikhil Madhuripan, MD, University of Colorado, Denver
Publications and helpful links
General Publications
- Canellas R, Patel MJ, Agarwal S, Sahani DV. Lesion detection performance of an abbreviated gadoxetic acid-enhanced MRI protocol for colorectal liver metastasis surveillance. Eur Radiol. 2019 Nov;29(11):5852-5860. doi: 10.1007/s00330-019-06113-y. Epub 2019 Mar 19.
- Brismar TB, Dahlstrom N, Edsborg N, Persson A, Smedby O, Albiin N. Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA: a comparison in healthy volunteers. Acta Radiol. 2009 Sep;50(7):709-15. doi: 10.1080/02841850903055603.
- Baek SE, Park MS, Hong HS, Choi JY, Chung YE, Lim JS, Kim MJ, Kim KW. Characterisation of small hypoattenuating hepatic lesions in multi-detector CT (MDCT) in patients with underlying extrahepatic malignancy: added value of contrast-enhanced MR images. Eur Radiol. 2010 Dec;20(12):2853-61. doi: 10.1007/s00330-010-1872-x. Epub 2010 Jul 9.
- Schulz A, Viktil E, Godt JC, Johansen CK, Dormagen JB, Holtedahl JE, Labori KJ, Bach-Gansmo T, Klow NE. Diagnostic performance of CT, MRI and PET/CT in patients with suspected colorectal liver metastases: the superiority of MRI. Acta Radiol. 2016 Sep;57(9):1040-8. doi: 10.1177/0284185115617349. Epub 2015 Nov 29.
- Zhang L, Yu X, Huo L, Lu L, Pan X, Jia N, Fan X, Morana G, Grazioli L, Schneider G. Detection of liver metastases on gadobenate dimeglumine-enhanced MRI: systematic review, meta-analysis, and similarities with gadoxetate-enhanced MRI. Eur Radiol. 2019 Oct;29(10):5205-5216. doi: 10.1007/s00330-019-06110-1. Epub 2019 Mar 26.
- Hardie AD, Naik M, Hecht EM, Chandarana H, Mannelli L, Babb JS, Taouli B. Diagnosis of liver metastases: value of diffusion-weighted MRI compared with gadolinium-enhanced MRI. Eur Radiol. 2010 Jun;20(6):1431-41. doi: 10.1007/s00330-009-1695-9. Epub 2010 Feb 11.
- Kenis C, Deckers F, De Foer B, Van Mieghem F, Van Laere S, Pouillon M. Diagnosis of liver metastases: can diffusion-weighted imaging (DWI) be used as a stand alone sequence? Eur J Radiol. 2012 May;81(5):1016-23. doi: 10.1016/j.ejrad.2011.02.019. Epub 2011 Mar 4.
- Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO. MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci. 2007;6(1):43-52. doi: 10.2463/mrms.6.43.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 19-1045.cc
- P30CA046934 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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