Gadobenate dimeglumine‐enhanced MR angiography: Diagnostic performance of four doses for detection and grading of carotid, renal, and aorto‐iliac stenoses compared to digital subtraction angiography

Abstract

Purpose:To determine the diagnostic performance of contrast-enhanced MR angiography (CE-MRA) with four doses of gadobenate dimeglumine for detection of significant steno-occlusive disease of the carotid, renal, and pelvic vasculature. Materials and Methods:Eighty-four patients with suspected disease of the renal (n ϭ 16), pelvic (n ϭ 41), or carotid (n ϭ 27) arteries underwent CE-MRA (3D-spoiled gradient-echo sequences) at 1.5T. CE-MRA was performed with gadobenate dimeglumine at 0.025, 0.05, 0.1, or 0.2 mmol/kg (23,24,19, and 18 patients, respectively) administered at 2 mL/sec. Accuracy, sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) for detection of significant disease (Ͼ50% stenosis or occlusion for renal/pelvic arteries; Ͼ70% stenosis or occlusion for carotid arteries) was determined by three fully blinded, independent radiologists using conventional digital subtraction angiography (DSA) as reference standard. All comparisons were tested statistically (ANOVA, chi-square, and Mantel-Haenszel tests as appropriate) and reader agreement (kappa) was assessed.Results: Values for accuracy, sensitivity, specificity, PPV, and NPV on CE-MRA were consistently higher for 0.1 mmol/kg gadobenate dimeglumine (accuracy ϭ 95.2-97.3%, sensitivity ϭ 84.2% (all readers), specificity ϭ 96.9 -99.2%, PPV ϭ 80.0 -94.1%, NPV ϭ 97.6 -97.7%). The greater accuracy of the 0.1 mmol/kg dose was significant (P Ͻ 0.01, all readers) compared to all other dose groups. Agreement between the three readers was good for all dose groups (kappa Ն0.58), with the highest percent agreement (85.7%) noted for the 0.1 mmol/kg dose. Conclusion:Significantly better diagnostic performance on CE-MRA of the renal, pelvic, and carotid arteries is achieved with a gadobenate dimeglumine dose of 0.1 mmol/kg bodyweight.

Mathematical optimization of contrast concentration for t1‐weighted spoiled gradient echo imaging

“…However, the concentrations of gadobenate dimeglumine needed to achieve the maximum signal were much lower than for gadoteridol. This behavior may explain the clinical observations of Schneider et al who demonstrated that increasing the dose of gadobenate dimeglumine to 0.2 mmol/kg had no SNR advantage over 0.1 mmol/kg for MRA of multiple vascular territories (12). Finally, it should be noted that despite the high longitudinal relaxivity of ferumoxytol (r 1 ¼ 15 s À1 mM À1 ), its high transverse relaxivity (r 2 *¼ 89 s À1 mM…”

Multicenter, Double-Blind, Randomized, Intraindividual Crossover Comparison of Gadobenate Dimeglumine and Gadopentetate Dimeglumine for MR Angiography of Peripheral Arteries

“…mine have been shown as deleterious in terms of image quality and diagnostic performance ( 9,47,48 ). Notably, a 0.1-mmol/kg dose of gadobenate dimeglumine provides similar image quality and contrast enhancement to that achieved with a double 0.2-mmol/kg dose of gadopentetate dimeglumine for contrastenhanced MR angiography of the renal arteries and abdominal aorta ( 26 ) and carotid arteries ( 27 ).…”

“…However, a drawback of contrast-enhanced MR angiography is insuffi cient contrast enhancement for accurate visualization and diagnosis if the contrast agent dose is too low (6)(7)(8)(9). This is particularly relevant in the peripheral runoff vasculature where vessels are smaller and highly susceptible to fl ow alterations in heavily diseased patients; it is also relevant if parallel imaging techniques are used because these techniques decrease the signal-to-noise ratio (SNR) ( 10 ).…”

Assessment of the kidneys: magnetic resonance angiography, perfusion and diffusion

“…Traditionally, renal MRA has been performed with both single (0.1 mmol/kg) and double (0.2 mmol/kg) dose ECCM. However, most studies have found a single dose to be sufficient [20,21] and to reveal less degradation from background parenchymal enhancement [22]. Despite this, double doses were still widely used clinically prior to the advent of nephrogenic systemic fibrosis (NSF), which has dramatically changed dosing of Gd-based ECCM in clinical MRA [23].…”