Comparison of Gadofosveset Trisodium and Gadobenate Dimeglumine During Time-Resolved Thoracic MR Angiography at 3T

Rationale and Objectives

Gadofosveset trisodium is a blood-pool contrast agent (BPA) that shows a less pronounced r1 relaxivity advantage over gadobenate dimeglumine at 3T than at 1.5T. However, there are few data on image quality during first-pass imaging of the thoracic vasculature with gadofosveset trisodium at 3 T. Therefore, it was the aim of this study to compare first-pass imaging characteristics of gadofosveset trisodium to gadobenate dimeglumine during time-resolved contrast-enhanced three-dimensional magnetic resonance angiography (CE MRA) at 3 T.

Materials and Methods

Twenty volunteers underwent time-resolved CE MRA on a 3 T magnetic resonance (MR) system with a standard eight-channel phased-array surface coil, receiving either gadofosveset trisodium (blood pool agent [BPA], n = 10) or gadobenate dimeglumine (standard contrast agent, [SCA], n = 10). Image quality was assessed by two independent readers using a Likert scale ranging from 0 = poor quality to 3 = excellent quality, and relative signal-to-noise and contrast-to-noise ratios were calculated.

Results

Equally good to excellent first-pass image quality was confirmed for time-resolved CE MRA using BPA and SCA (arteries, 2.8 ± 0.2 and 2.6 ± 0.4; veins, 2.5 ± 0.3 and 2.2 ± 0.4; artifacts, 2.4 ± 0.2 and 2.3 ± 0.1). Signal-to-noise and contrast-to-noise ratios showed nonsignificant differences, except for left subclavian artery values. There was an overall nonsignificant superiority in signal-to-noise and contrast-to-noise ratios for standard contrast agent in arterial values and BPA regarding venous values.

Conclusions

Despite a markedly decreased r 1/ r 2 relaxivity ratio, first-pass imaging characteristics of gadofosveset trisodium and gadobenate dimeglumine are equally well suited for first pass time-resolved CE MRA at 3 T.

The most widely used gadolinium-based agents for contrast-enhanced magnetic resonance angiography (CE-MRA) have small molecular sizes, resulting in short blood-pool residence times. Gadofosveset trisodium is a gadolinium-based blood-pool contrast agent (BPA) based on a higher albumin-binding capacity and thus a considerably prolonged intravascular residence time. In addition, the multiple paramagnetic ions attached to each macromolecule result in a relatively high T1 relaxivity, as shown by Rohrer et al (at 1.5 T, gadofosveset trisodium r 1 = 19 vs gadobenate dimeglumine r 1 = 6.3 in plasma at 37°C). However, at 3 T, contrast agents show individual field-strength dependencies that result in a less pronounced differences between relaxivities (at 3 T, gadofosveset trisodium r 1 = 9.9 vs gadobenate dimeglumine r 1 = 5.5 in plasma at 37°C) and hence altered r 1/ r 2 ratios .

Previous studies have focused on the benefits of the longer acquisition window of BPAs that can be exploited for time-intensive high-resolution assessment of arteries and veins at low concentrations at 1.5 T . Preclinical tests of gadofosveset trisodium were presented as early as 1996 . Phase II and III studies were performed for peripheral arteries in which the prolonged decrease of the blood T1 was used for improved image quality . Early applications reported in the literature included evaluations of aortoiliac occlusive disease and the carotid arteries . Such early clinical reports demonstrated the feasibility of steady-state and dynamic (ie, time-resolved) three-dimensional CE MRA compared to two-dimensional time-of-flight MRA as a reference standard. A recently reported study showed significantly increased image quality with gadofosveset trisodium compared to the low-albumin-binding contrast agent gadopentetate dimeglumine for nondynamic CE MRA at 1.5 T as part of a whole-body imaging approach .

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Materials and methods

MR Imaging

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Qualitative Data Analysis

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Quantitative Data Analysis

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SNR=mean(ROIavg)SD(ROIsub), SNR

=

mean

(

ROI

avg

)

SD

(

ROI

sub

)

,

where mean denotes the average signal intensity and SD the standard deviation of all pixels within the ROI. The relative CNR (CNR rel ) was calculated for all vascular ROIs referenced to the surrounding fatty and muscular tissue as

CNRrel=SNRvasc−SNRrefSNRref, CNR

rel

=

SNR

vasc

−

SNR

ref

SNR

ref

,

where SNR vasc is the SNR of the vessel of interest, and SNR ref is calculated for either fat or muscle.

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Statistical Analysis

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Results

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Qualitative Data Analysis

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Table 1

Summary of Qualitative Image Grading

Arteries Aorta First branch Second branch Total SCA 2.7 ± 0.3 (2.5) 3.0 ± 0.0 (3.0) 2.8 ± 0.3 (2.8) 2.8 ± 0.3 (2.8) BPA 2.6 ± 0.4 (2.5) 2.6 ± 0.4 (3.0) 2.5 ± 0.5 (2.5) 2.6 ± 0.4 (2.7) Veins Vena cava First branch Second branch Total SCA 2.9 ± 0.2 (2.5) 2.9 ± 0.2 (3.0) 2.2 ± 0.5 (2.0) 2.6 ± 0.4 (2.5) BPA 2.4 ± 0.5 (2.3) 2.4 ± 0.5 (2.5) 2.1 ± 0.5 (2.0) 2.2 ± 0.5 (2.3) Artifacts Blurring Ghosting Fold-over Total SCA 2.1 ± 0.2 (3.0) 2.9 ± 0.2 (3.0) 2.2 ± 0.4 (2.0) 2.4 ± 0.2 (2.3) BPA 2.0 ± 0.2 (3.0) 3.0 ± 0.0 (3.0) 2.1 ± 0.2 (2.0) 2.3 ± 0.1 (2.3)

BPA, blood-pool contrast agent (gadofosveset trisodium); SCA, standard contrast agent (gadobenate dimeglumine).

Data are expressed as mean ± standard deviation (median). No significant differences in image quality between SCA and BPA were observed.

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Quantitative Data Analysis

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Discussion

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Conclusions

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