Part 2 - Coronary angiography with gadofosveset trisodium: a prospective intra-subject comparison for dose optimization for 100 % efficiency imaging

Mark A Ahlman, Fabio S Raman, Jianing Pang, Filip Zemrak, Veit Sandfort, Scott R Penzak, Zhaoyang Fan, Songtao Liu, Debiao Li, David A Bluemke, Mark A Ahlman, Fabio S Raman, Jianing Pang, Filip Zemrak, Veit Sandfort, Scott R Penzak, Zhaoyang Fan, Songtao Liu, Debiao Li, David A Bluemke

Abstract

Background: Three tesla (3T) coronary magnetic resonance angiography (MRA) may be optimized using gadolinium-based contrast agents (GBCA) such as gadofosveset trisodium. The goal of this study was to evaluate if there is a qualitative or quantitative improvement in the coronary arteries with variation in contrast dose.

Methods: Twenty-eight healthy volunteers were prospectively recruited for coronary MRA at 3T using a steady state injection technique for 3D radial whole-heart image acquisition with retrospective respiratory self-gating (ClinicalTrials.gov identifier: NCT01853592). Nineteen volunteers completed both single- and double-dose imaging instances (0.03 and 0.06 mmol/kg, respectively). Intra-individual comparison of image quality was assessed by measurement of apparent signal/contrast-to-noise ratio (aSNR/aCNR) and subjective evaluation of image quality by 2 independent reviewers.

Results: The average duration of coronary MRA acquisition was 7.2 ± 1.2 min. There was significantly higher (60 %, p < 0.001) aSNR of the aorta and right/left ventricle for the double dose compared to single dose injection scheme and aSNR of the coronary arteries increased by 70 % (p < 0.001) for the double dose injection. aCNR increased by +55 % and +60 % in the ventricles and coronary arteries, respectively (p < 0.001). Overall segmental artery visualization for single dose was possible 47 % of the time, which improved to 60 % with double dose (p = 0.019), predominantly driven by improvements in more distal segment visualization (+40 % improvement in mid arterial segments, p = 0.013).

Conclusions: Gadofosveset trisodium dose of 0.06 mmol/kg significantly quantitatively and qualitatively improves the coronary artery image quality compared to 0.03 mmol/kg at 3T for moderate duration (6-8 min) steady state contrast enhanced coronary MRA.

Keywords: 3.0 Tesla; Gadofosveset trisodium; Gadolinium-based intravascular contrast agent; Image quality; MS-325; Navigator-based angiography; Respiratory motion correction; Whole-heart coronary magnetic resonance angiography.

Figures

Fig. 1
Fig. 1
Visual comparison of image quality with double dose. Double dose (left column) and single dose (right column) maximum intensity projection MRA images of the heart for two subjects (top and bottom rows). Visually compared to single dose images (b and d), double dose images (a and c) show appreciably higher image quality of the LAD (white arrow), RCA (white arrowhead), and LCX arteries (black arrow). Window and level is fixed for representative image comparisons per subject
Fig. 2
Fig. 2
Curved multiplanar reconstruction of the LAD (white arrowheads) using an image acquired with the double dose steady state injection protocol. The LAD can be followed from the proximal (right) to the distal segment (left), and is seen wrapping around the apex of the left ventricle (far left)
Fig. 3
Fig. 3
Example of a 3-dimensional projection of a coronary angiogram using a double dose injection protocol. The LAD can be followed to its most distal segment, wrapping around the apex of the heart

References

    1. Gerber TC, Carr JJ, Arai AE, Dixon RL, Ferrari VA, Gomes AS, et al. Ionizing radiation in cardiac imaging. Circulation. 2009;119:1056–65. doi: 10.1161/CIRCULATIONAHA.108.191650.
    1. Namasivayam S, Kalra MK, Torres WE, Small WC. Adverse reactions to intravenous iodinated contrast media: a primer for radiologists. Emerg Radiol. 2006;12(5):210–5. doi: 10.1007/s10140-006-0488-6.
    1. Nikolaou K, Alkadhi H, Bamberg F, Leschka S, Wintersperger BJ. MRI and CT in the diagnosis of coronary artery disease: indications and applications. Insights into imaging. 2011;2(1):9–24. doi: 10.1007/s13244-010-0049-0.
    1. Goyen M, Edelman M, Perreault P, O’Riordan E, Bertoni H, Taylor J, et al. MR angiography of aortoiliac occlusive disease: a phase III study of the safety and effectiveness of the blood-pool contrast agent MS-325. Radiology. 2005;236:825–33. doi: 10.1148/radiol.2363040577.
    1. Yang Q, Li K, Liu X, Bi X, Liu Z, An J, et al. Contrast-enhanced whole-heart coronary magnetic resonance angiography at 3.0-T: a comparative study with X-ray angiography in a single center. J Am Coll Cardiol. 2009;54(1):69–76. doi: 10.1016/j.jacc.2009.03.016.
    1. Frydrychowicz A, Russe MF, Bock J, Stalder AF, Bley TA, Harloff A, et al. Comparison of gadofosveset trisodium and gadobenate dimeglumine during time-resolved thoracic MR angiography at 3T. Acad Radiol. 2010;17:1394. doi: 10.1016/j.acra.2010.05.022.
    1. Perreault P, Edelman MA, Baum RA, Yucel EK, Weisskoff RM, Shamsi K, et al. MR angiography with gadofosveset trisodium for peripheral vascular disease: phase II trial1. Radiology. 2003;229:811–20. doi: 10.1148/radiol.2293021180.
    1. Hayashi H, Yuasa Y, Amano Y, Tanimoto A, Saito Y, Yoshioka K, et al. Arterial visualization by contrast-enhanced moving-table MR angiography: crossover comparison of 0.1 and 0.2 mmol/kg doses of meglumine gadopentetate in normal volunteers. J Magn Reson Imaging. 2008;28(3):783–90. doi: 10.1002/jmri.21488.
    1. Heverhagen JT, Wright CL, Schmalbrock P, Knopp MV. Dose comparison of single versus double dose in contrast-enhanced magnetic resonance angiography of the renal arteries: intra-individual cross-over blinded trial using Gd-DTPA. Eur Radiol. 2009;19(1):67–72. doi: 10.1007/s00330-008-1120-9.
    1. Nacif MS, Arai AE, Lima J, Bluemke DA. Gadolinium-enhanced cardiovascular magnetic resonance: administered dose in relationship to United States Food and Drug Administration (FDA) guidelines. J Cardiovasc Magn Reson. 2012;14:18.
    1. Pang J, Bhat H, Sharif B, Fan Z, Thomson LE, LaBounty T, et al. Whole-heart coronary MRA with 100 % respiratory gating efficiency: Self-navigated three-dimensional retrospective image-based motion correction (TRIM) Magn Reson Med. 2014;71(1):67–74. doi: 10.1002/mrm.24628.
    1. Pang J, Sharif B, Arsanjani R, Bi X, Fan Z, Yang Q, et al. Accelerated whole-heart coronary MRA using motion-corrected sensitivity encoding with three-dimensional projection reconstruction. Magn Reson Med. 2014.
    1. Ahlman MA, Raman FS, Penzak SR, Pang J, Li D, Bluemke D. Optimization of gadofosveset intravenous injection scheme for coronary MRA: the pharmacokinetics approach. J Cardiovasc Magn Reson. 2014;16(Suppl 1):160. doi: 10.1186/1532-429X-16-S1-P160.
    1. Maki JH, Wang M, Wilson GJ, Shutske MG, Leiner T. Highly accelerated first-pass contrast-enhanced magnetic resonance angiography of the peripheral vasculature: comparison of gadofosveset trisodium with gadopentetate dimeglumine contrast agents. J Magn Reson Imaging. 2009;30(5):1085–92. doi: 10.1002/jmri.21961.
    1. Raman FS, Nacif MS, Cater G, Gai N, Jones J, Li D, et al. 3.0-T whole-heart coronary magnetic resonance angiography: comparison of gadobenate dimeglumine and gadofosveset trisodium. Int J Cardiovasc Imaging. 2013;29(5):1085–94. doi: 10.1007/s10554-013-0192-z.
    1. Kelle S, Thouet T, Tangcharoen T, Nassenstein K, Chiribiri A, Paetsch I, et al. Whole-heart coronary magnetic resonance angiography with MS-325 (Gadofosveset) Med Sci Monit. 2007;13:CR469–74.
    1. Prompona M, Cyran C, Nikolaou K, Bauner K, Reiser M, Huber A. Contrast-enhanced whole-heart coronary MRA using Gadofosveset 3.0 T versus 1.5 T. Acad Radiol. 2010;17:862–70. doi: 10.1016/j.acra.2010.02.009.
    1. Malayeri AA, Macedo R, Li D, Chen S, Bahrami H, Lai S, et al. Coronary vessel wall evaluation by magnetic resonance imaging in the multi-ethnic study of atherosclerosis: determinants of image quality. J Comput Assist Tomogr. 2009;33(1):1. doi: 10.1097/RCT.0b013e3181648606.
    1. Pang J, Sharif B, Fan Z, Bi X, Arsanjani R, Berman DS, et al. ECG and navigator-free four-dimensional whole-heart coronary MRA for simultaneous visualization of cardiac anatomy and function. Magn Reson Med. 2014;72(5):1208–17. doi: 10.1002/mrm.25450.
    1. Jahnke C, Paetsch I, Achenbach S, Schnackenburg B, Gebker R, Fleck E, et al. Coronary MR imaging: breath-hold capability and patterns, coronary artery rest periods, and beta-blocker use. Radiology. 2006;239(1):71–8. doi: 10.1148/radiol.2383042019.
    1. Reiter T, Ritter O, Prince MR, Nordbeck P, Wanner C, Nagel E, et al. Minimizing risk of nephrogenic systemic fibrosis in cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:31. doi: 10.1186/1532-429X-14-31.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi