Magnetic resonance imaging of metastatic disease to the brain with gadobenate dimeglumine

Abstract

Seventy-four patients with one to eight proven intraaxial brain metastases received a total cumulative dose of 0.2 mmol/kg bodyweight gadobenate dimeglumine, administered as sequential injections of 0.05, 0.05 and 0.1 m mol/kg over a 20-min period. MR imaging was performed before the first administration (T2- and T1-weighted sequences) and after each injection of contrast agent (T1-weighted sequences only). Quantitative assessment of images revealed significant (P <0.01) dose-related increases in lesion-to-brain (L/B) ratio and percent enhancement of lesion signal intensity. Qualitative assessment by two independent, blinded assessors revealed additional lesions in 22%, 25% and 38% (assessor 1) and 29%, 32% and 34% (assessor 2) of patients after each cumulative dose when compared with combined T1- and T2-weighted pre-contrast images. Significantly more lesions (P < 0.01) were noted by both assessors after the first injection and by one assessor after each subsequent injection. For patients with just one lesion observed on unenhanced T1- and T2-weighted images, additional lesions were noted in 12%, 16% and 28% of patients by assessor 1 following each dose and in 24%, 27% and 30% of patients by assessor 2. Contemporaneously, diagnostic confidence was increased and lesion conspicuity improved over unenhanced MRI. For patients with one lesion observed after an initial dose of 0.05 mmol/kg, additional lesions were noted by assessors 1 and 2 in 9.1% and 11.8% of patients, respectively, after a cumulative dose of 0.1 mmol/kg and in a further 9.1% and 5.9% of patients, respectively, after a cumulative dose of 0.2 mmol/kg. No safety concerns were apparent.

Contrast Enhancement of Central Nervous System Lesions: Multicenter Intraindividual Crossover Comparative Study of Two MR Contrast Agents

“…In other words, a mean increase in quantitative lesion enhancement of approximately 30% was noted between a dose of 0.1 mmol/kg and a dose of 0.2 mmol/kg of gadoteridol. Similar findings have been noted previously in studies that involved a comparison of cumulative doses of gadobenate for the detection of cerebral metastases (56,57). In our study, similar mean increments of approximately 30% for gadobenate compared with gadopentetate were noted by all three blinded readers for both lesion-to-brain or lesion-to-spine CNR and percentage of lesion enhancement.…”

High-relaxivity contrast-enhanced magnetic resonance neuroimaging: a review

“…Early dosing studies demonstrated that, as expected, double doses of gadobenate dimeglumine (MultiHance®) are potentially beneficial with increased sensitivity in brain lesion detection, but, unlike other contrast agents, no further benefit is derived from triple doses [15,19]. However, the more significant evidence of improved diagnostic performance with the higher relaxivity agent derives from a series of intraindividual crossover studies directly comparing gadobenate dimeglumine (MultiHance®) with gadopentetate dimeglumine (Magnevist®, Bayer Schering Pharma AG, Berlin, Germany) [20][21][22][23][24][25], gadoterate meglumine (Dotarem®, Guerbet Aulnay s/ Bois, France) [20,22], gadodiamide (Omniscan™, GE Healthcare AS, Oslo, Norway) [20,26] and gadofosveset trisodium (Vasovist®) [6].…”

Diagnostic imaging of intracranial metastasis

“…Dosage of MRI contrast can impact detection of metastatic disease. Studies have shown increasing detection of metastases with increasing doses of MRI contrast and increased detection of brain metastases with double or triple contrast doses compared to single contrast dose MRIs [10,[21][22][23][24]. More recent studies have demonstrated a significant improvement in effects of T1 shortening and lesion detection even using half the dose of contrast agent if the examination if performed using higher field strength magnet of 3 Tesla compared to 1.5 Tesla [25].…”