Prospective, randomized comparison of gadopentetate and gadobutrol to assess chronic myocardial infarction applying cardiovascular magnetic resonance

BMC Medical Imaging

Jeanette Schulz-Menger¹  Ralf Wassmuth¹  Johannes Schüler¹  Julius Traber¹  Florian von Knobelsdorff-Brenkenhoff¹  Daniel Messroghli²  Andre Rudolph¹ 

[1] Dept. of Cardiology and Nephrology, HELIOS-Kliniken Berlin Buch, Schwanebecker Chaussee 50, Berlin, 13125, Germany;Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany

关键词: Late gadolinium enhancement;    Chronic myocardial infarction;    Gd-DTPA;    Gadobutrol;    Contrast media;    Cardiovascular Magnetic Resonance;   

Others  :  1233369
DOI  :  10.1186/s12880-015-0099-3

 received in 2015-05-26, accepted in 2015-11-09,  发布年份 2015

【 摘 要 】

Background

We hypothesized that the contrast medium gadobutrol is not inferior compared to Gd-DTPA in identifying and quantifying ischemic late gadolinium enhancement (LGE), even by using a lower dose.

Methods

We prospectively enrolled 30 patients with chronic myocardial infarction as visualized by LGE during clinical routine scan at 1.5 T with 0.20 mmol/kg Gd-DTPA. Participants were randomized to either 0.15 mmol/kg gadobutrol (group A) or 0.10 mmol/kg gadobutrol (group B). CMR protocol was identical in both exams.

LGE was quantified using a semiautomatic approach. Signal intensities of scar, remote myocardium, blood and air were measured. Signal to noise (SNR) and contrast to noise ratios (CNR) were calculated.

Results

Signal intensities were not different between Gd-DTPA and gadobutrol in group A, whereas significant differences were detected in group B. SNR of injured myocardium (53.5+/−21.4 vs. 30.1+/−10.4, p = 0.0001) and CNR between injured and remote myocardium (50.3+/−20.3 vs. 27.3+/−9.3, p < 0.0001) were lower in gadobutrol. Infarct size was lower in both gadobutrol groups compared to Gd-DTPA (group A: 16.8+/−10.2 g vs. 12.8+/−6.8 g, p = 0.03; group B: 18.6+/−12.0 g vs. 14.0+/−9.9 g, p = 0.0016).

Conclusions

Taking application of 0.2 mmol/kg Gd-DTPA as the reference, the delineation of infarct scar was similar with 0.15 mmol/kg gadobutrol, whereas the use 0.10 mmol/kg gadobutrol led to reduced tissue contrast.

Trial registration

The study had been registered under EudraCT Number: 2010-020775-22. Registration date: 2010.08.10

【 授权许可】

   
2015 Rudolph et al.

【 图 表 】

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【 参考文献 】

• [1]Boye P, Abdel-Aty H, Zacharzowsky U, Bohl S, Schwenke C, van der Geest RJ, Dietz R, Schirdewan A, Schulz-Menger J. Prediction of life-threatening arrhythmic events in patients with chronic myocardial infarction by contrast-enhanced CMR. JACC Cardiovasc Imaging. 2011; 4(8):871-879.
• [2]de Haan S, Meijers TA, Knaapen P, Beek AM, van Rossum AC, Allaart CP. Scar size and characteristics assessed by CMR predict ventricular arrhythmias in ischaemic cardiomyopathy: comparison of previously validated models. Heart. 2011; 97(23):1951-1956.
• [3]Kim RJ, Chen EL, Lima JA, Judd RM. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation. 1996; 94(12):3318-3326.
• [4]von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Cardiovascular magnetic resonance imaging in ischemic heart disease. J Magn Reson Imaging. 2012; 36(1):20-38.
• [5]von Knobelsdorff-Brenkenhoff F, Bublak A, El-Mahmoud S, Wassmuth R, Opitz C, Schulz-Menger J. Single-centre survey of the application of cardiovascular magnetic resonance in clinical routine. Eur Heart J Cardiovasc Imaging. 2013; 14(1):62-68.
• [6]Yang L, Krefting I, Gorovets A, Marzella L, Kaiser J, Boucher R, Rieves D. Nephrogenic systemic fibrosis and class labeling of gadolinium-based contrast agents by the Food and Drug Administration. Radiology. 2012; 265(1):248-253.
• [7]Wadas TJ, Sherman CD, Miner JH, Duncan JR, Anderson CJ. The biodistribution of [153Gd]Gd-labeled magnetic resonance contrast agents in a transgenic mouse model of renal failure differs greatly from control mice. Magn Reson Med. 2010; 64(5):1274-1280.
• [8]Pintaske J, Martirosian P, Graf H, Erb G, Lodemann KP, Claussen CD, Schick F. Relaxivity of Gadopentetate Dimeglumine (Magnevist), Gadobutrol (Gadovist), and Gadobenate Dimeglumine (MultiHance) in human blood plasma at 0.2, 1.5, and 3 Tesla. Invest Radiol. 2006; 41(3):213-221.
• [9]Wollanka H, Weidenmaier W, Giersig C. NSF after Gadovist exposure: a case report and hypothesis of NSF development. Nephrol Dial Transplant. 2009; 24(12):3882-3884.
• [10]Elmholdt TR, Bettina J, Mette R, Pedersen M, Olesen AB. Two cases of nephrogenic systemic fibrosis after exposure to the macrocyclic compound gadobutrol. NDT Plus. 2010; 3:285-287.
• [11]Messroghli DR, Radjenovic A, Kozerke S, Higgins DM, Sivananthan MU, Ridgway JP. Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart. Magn Reson Med. 2004; 52(1):141-146.
• [12]Flett AS, Hasleton J, Cook C, Hausenloy D, Quarta G, Ariti C, Muthurangu V, Moon JC. Evaluation of techniques for the quantification of myocardial scar of differing etiology using cardiac magnetic resonance. Jacc. 2011; 4(2):150-156.
• [13]Dietrich O, Raya JG, Reeder SB, Reiser MF, Schoenberg SO. Measurement of signal-to-noise ratios in MR images: influence of multichannel coils, parallel imaging, and reconstruction filters. J Magn Reson Imaging. 2007; 26(2):375-385.
• [14]Messroghli DR, Rudolph A, Abdel-Aty H, Wassmuth R, Kuhne T, Dietz R, Schulz-Menger J. An open-source software tool for the generation of relaxation time maps in magnetic resonance imaging. BMC Med Imaging. 2010; 10:16. BioMed Central Full Text
• [15]Messroghli DR, Walters K, Plein S, Sparrow P, Friedrich MG, Ridgway JP, Sivananthan MU. Myocardial T1 mapping: application to patients with acute and chronic myocardial infarction. Magn Reson Med. 2007; 58(1):34-40.
• [16]Durmus T, Schilling R, Doeblin P, Huppertz A, Hamm B, Taupitz M, Wagner M. Gadobutrol for magnetic resonance imaging of chronic myocardial infarction: intraindividual comparison with gadopentetate dimeglumine. Invest Radiol. 2012; 47(3):183-188.
• [17]De Cobelli F, Esposito A, Perseghin G, Sallemi C, Belloni E, Ravelli S, Lanzani C, Del Maschio A. Intraindividual comparison of gadobutrol and gadopentetate dimeglumine for detection of myocardial late enhancement in cardiac MRI. AJR Am J Roentgenol. 2012; 198(4):809-816.
• [18]Rudolph A, Abdel-Aty H, Bohl S, Boye P, Zagrosek A, Dietz R, Schulz-Menger J. Noninvasive detection of fibrosis applying contrast-enhanced cardiac magnetic resonance in different forms of left ventricular hypertrophy relation to remodeling. J Am Coll Cardiol. 2009; 53(3):284-291.
• [19]Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M, Sheppard MN, Poole-Wilson PA, Pennell DJ. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol. 2006; 48(10):1977-1985.
• [20]Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ et al.. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson. 2013; 15:35. BioMed Central Full Text
• [21]Knowles BR, Batchelor PG, Parish V, Ginks M, Plein S, Razavi R, Schaeffter T. Pharmacokinetic modeling of delayed gadolinium enhancement in the myocardium. Magn Reson Med. 2008; 60(6):1524-1530.
• [22]Heiberg E, Sjogren J, Ugander M, Carlsson M, Engblom H, Arheden H. Design and validation of Segment--freely available software for cardiovascular image analysis. BMC Med Imaging. 2010; 10:1. BioMed Central Full Text
• [23]Ugander M, Oki AJ, Hsu LY, Kellman P, Greiser A, Aletras AH, Sibley CT, Chen MY, Bandettini WP, Arai AE. Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J. 2012; 33(10):1268-1278.
• [24]Mongeon FP, Jerosch-Herold M, Coelho-Filho OR, Blankstein R, Falk RH, Kwong RY. Quantification of extracellular matrix expansion by CMR in infiltrative heart disease. JACC Cardiovasc Imaging. 2012; 5(9):897-907.
• [25]Tao Q, Milles J, Zeppenfeld K, Lamb HJ, Bax JJ, Reiber JH, van der Geest RJ. Automated segmentation of myocardial scar in late enhancement MRI using combined intensity and spatial information. Magn Reson Med. 2010; 64(2):586-594.
• [26]Bauner KU, Reiser MF, Huber AM. Low dose gadobenate dimeglumine for imaging of chronic myocardial infarction in comparison with standard dose gadopentetate dimeglumine. Invest Radiol. 2009; 44(2):95-104.
• [27]Tumkosit M, Puntawangkoon C, Morgan TM, Clark HP, Hamilton CA, Ntim WO, Clark PB, Hundley WG. Left ventricular infarct size assessed with 0.1 mmol/kg of gadobenate dimeglumine correlates with that assessed with 0.2 mmol/kg of gadopentetate dimeglumine. J Comput Assist Tomogr. 2009; 33(3):328-333.
• [28]Balci NC, Inan N, Anik Y, Erturk MS, Ural D, Demirci A. Low-dose gadobenate dimeglumine versus standard-dose gadopentate dimeglumine for delayed contrast-enhanced cardiac magnetic resonance imaging. Acad Radiol. 2006; 13(7):833-839.
• [29]Schlosser T, Hunold P, Herborn CU, Lehmkuhl H, Lind A, Massing S, Barkhausen J. Myocardial infarct: depiction with contrast-enhanced MR imaging--comparison of gadopentetate and gadobenate. Radiology. 2005; 236(3):1041-1046.
• [30]Bandettini WP, Kellman P, Mancini C, Booker OJ, Vasu S, Leung SW, Wilson JR, Shanbhag SM, Chen MY, Arai AE. MultiContrast Delayed Enhancement (MCODE) improves detection of subendocardial myocardial infarction by late gadolinium enhancement cardiovascular magnetic resonance: a clinical validation study. J Cardiovasc Magn Reson. 2012; 14(1):83. BioMed Central Full Text
• [31]Klem I, Weinsaft JW, Bahnson TD, Hegland D, Kim HW, Hayes B, Parker MA, Judd RM, Kim RJ. Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation. J Am Coll Cardiol. 2012; 60(5):408-420.
• [32]Fluechter S, Kuschyk J, Wolpert C, Doesch C, Veltmann C, Haghi D, Schoenberg SO, Sueselbeck T, Germans T, Streitner F et al.. Extent of late gadolinium enhancement detected by cardiovascular magnetic resonance correlates with the inducibility of ventricular tachyarrhythmia in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson. 2010; 12:30. BioMed Central Full Text