An Investigation of Transient Severe Motion Related to Gadoxetic Acid–enhanced MR Imaging

Abstract

Purpose To investigate the cause of imaging artifacts observed during gadoxetic acid–enhanced arterial phase imaging of the liver. Materials and Methods This HIPAA-compliant study was approved by the institutional review board. Data were collected prospectively at two sites (site A, United States; site B, Japan) from patients undergoing contrast material–enhanced MR imaging with gadoxetic acid (site A, n = 154, dose = 0.05 mmol/kg; site B, n = 130, 0.025 mmol/kg) or gadobenate dimeglumine (only site A, n = 1666) from January 2014 to September 2014 at site A and from November 2014 to January 2015 at site B. Detailed comparisons between the two agents were made in the patients with dynamic liver acquisitions (n = 372) and age-, sex-, and baseline oxygen saturation (Spo2)-matched pairs (n = 130) at site A. Acquired data included self-reported dyspnea after contrast agent injection, Spo2, and breath-hold fidelity monitored with respiratory bellows. Results Self-reported dyspnea was more frequent with gadoxetic acid than with gadobenate dimeglumine (site A, 6.5% [10 of 154] vs 0.1% [two of 1666], P < .001; site B, 1.5% [two of 130]). In the matched-pair comparison, gadoxetic acid, as compared with gadobenate dimeglumine, had higher breath-hold failure rates (site A, 34.6% [45 of 130] vs 11.7% [15 of 130], P < .0001; site B, 16.2% [21 of 130]) and more severe artifacts during arterial phase imaging (site A, 7.7% [10 of 130] vs 0% [none of 130], P < .001; site B, 2.3% [three of 130]). Severe imaging artifacts in patients who received gadoxetic acid were significantly associated with male sex (P = .023), body mass index (P = .021), and breath-hold failure (P < .001) but not with dyspnea or Spo2 decrease. Conclusion Severe motion-related artifacts in the arterial phase of gadoxetic acid–enhanced liver MR imaging are associated with breath-hold failure but not with subjective feelings of dyspnea or a substantial decrease in blood Spo2. Subjective feelings of dyspnea are not necessarily associated with imaging artifacts. The phenomenon, albeit at a lower rate, was confirmed at a second site in Japan.

Transient Severe Respiratory Motion Artifacts After Application of Gadoxetate Disodium: What We Currently Know

“…Interestingly, the results from different investigators show a wide range of frequencies of TSM after injection of gadoxetate disodium. The highest frequency (22 %) was observed by Motosugi et al in the USA [13]. Hayashi et al from Japan observed the lowest frequency of TSM (5 %) [11].…”

“…This assumption might explain the differences in observed frequencies of TSM. Indeed, the study sites addressing TSM used different doses of gadoxetate disodium: weight-adapted doses of 0.025 or 0.05 mmol/kg [11,13] fixed doses of 10 ml (package size) or 20 ml [6,8,10] (▶ Table 2). …”

“…Some institutions administer gadoxetate disodium with a high injection rate of 2 ml/s to achieve a concentrated bolus for improved arterial phase contrast [6,8,9,12,13]. Other institutions administer it with a slower injection rate of 1 ml/s to spread the contrast bolus, thereby reducing the risk of a poorly timed arterial phase [6,10,11,13,25].…”

“…Other institutions administer it with a slower injection rate of 1 ml/s to spread the contrast bolus, thereby reducing the risk of a poorly timed arterial phase [6,10,11,13,25]. Dilution of gadoxetate disodium with saline is an alternative approach to spread the contrast bolus [9].…”

“…Both Hayashi et al and Motosugi et al applied the same amount of weight-adapted gadoxetate disodium at a slow rate of 1 ml/s but observed different frequencies of TSM (5 % vs. 13 %) [11,13]. Studies with faster injection rates of 2 ml/s also showed varying, but higher frequencies of TSM, ranging from 10 % to 22 % with either weight-adjusted dosing or fixed doses of 10 ml gadoxetate disodium (▶ Table 2) [6,8,13].…”