Image quality of late gadolinium enhancement in cardiac magnetic resonance with different doses of contrast material in patients with chronic myocardial infarction

Abstract

Background Contrast-enhanced cardiac magnetic resonance (CMR) is pivotal for evaluating chronic myocardial infarction (CMI). Concerns about safety of gadolinium-based contrast agents favour dose reduction. We assessed image quality of scar tissue in CMRs performed with different doses of gadobutrol in CMI patients. Methods Informed consent was waived for this Ethics Committee-approved single-centre retrospective study. Consecutive contrast-enhanced CMRs from CMI patients were retrospectively analysed according to the administered gadobutrol dose (group A, 0.10 mmol/kg; group B, 0.15 mmol/kg; group C, 0.20 mmol/kg). We calculated the signal-to-noise ratio for scar tissue (SNRscar) and contrast-to-noise ratio between scar and either remote myocardium (CNRscar-rem) or blood (CNRscar-blood). Results Of 79 CMRs from 79 patients, 22 belonged to group A, 26 to group B, and 31 to group C. The groups were homogeneous for age, sex, left ventricular morpho-functional parameters, and percentage of scar tissue over whole myocardium (p ≥ 0.300). SNRscar was lower in group A (46.4; 40.3–65.1) than in group B (70.1; 52.2–111.5) (p = 0.013) and group C (72.1; 59.4–100.0) (p = 0.002), CNRscar-rem was lower in group A (62.9; 52.2–87.4) than in group B (96.5; 73.1–152.8) (p = 0.008) and in group C (103.9; 83.9–132.0) (p = 0.001). No other significant differences were found (p ≥ 0.335). Conclusions Gadobutrol at 0.10 mmol/kg provides inferior scar image quality of CMI than 0.15 and 0.20 mmol/kg; the last two dosages seem to provide similar LGE. Thus, for CMR of CMI, 0.15 mmol/kg of gadobutrol can be suggested instead of 0.20 mmol/kg, with no hindrance to scar visualisation. Dose reduction would not impact on diagnostic utility of CMR examinations.

Imaging tools for assessment of myocardial fibrosis in humans: the need for greater detail

“…However, more recent studies suggest that this concern is overestimated. These studies propose decreasing the dose of gadobutrol (Monti et al 2020) or using macrocyclic GBCA e.g., gadoteric acid which appears to be safe even in patients receiving hemodialysis, with no significant reduction in the image quality (Alfano et al 2020;Woolen et al 2020;Costelloe 2020). Further safety concerns are related to the identification of gadolinium deposit in the brain of patients receiving multiple doses of GBCA.…”

The predictive role of right ventricular late gadolinium enhancement in patients with tetralogy of Fallot undergoing pulmonary valve replacement

“…Lastly, while patients did receive different doses of contrast agents as imaging protocols changed through the years, we may expect this issue to have a limited effect on LGE assessment. Indeed, previous studies showed that different contrast doses still yield similar image quality, therefore suggesting that LGE segmentation with manual corrections would still be viable [ 32 ].…”

Ablation Lesion Assessment with MRI

“…While there has been no head-to-head-comparison of the different agents in the context of cardiac LGE imaging, recent data showed that Gadovist (Bayer) at 0.10 mmol/kg provides inferior LGE image quality than 0.15 and 0.20 mmol/kg with respect to ventricular scar assessment (image acquisition at a median of 9 minutes post gadolinium injection). [ 36 ] Interestingly, there is evidence suggesting that scans with 3T provide a signal-to-noise ratio that allows for better delineation of scarred myocardium than 1.5 T scans, even with lower contrast concentration (0.10 versus 0.20 mmol/kg Dotarem [Guerbet]), but again, systematic comparative data are lacking. [ 37 ]…”