Motives
To compare pulmonary blood flow (PBF) measurements acquired with three previously published models (low dose "single bolus", "dual bolus", and a "non-linear correction" algorithm) for addressing the non-linear relationship between contrast agent concentration and MR signal in the arterial input function (AIF), and to compare both lung signal and PBF measurements obtained using Gd-DTPA (Magnevist) with those obtained using the high-relaxivity agent Gd-BOPTA (Multihance).
Materials and Methods
Ten out of twelve healthy humans were successfully scanned on two consecutive days at 1.5T. Contrast-enhanced pulmonary perfusion scans were acquired with a 3D spoiled gradient echo pulse sequence and interleaved variable density k-space sampling with a 1s frame rate and 4×4×4 mm3 resolution. Each day, two perfusion scans were acquired with either Gd-DTPA or Gd-BOPTA; the order of the administered contrast agent was randomized. ROI analysis was used to determine PBF based on indicator dilution theory. Linear Mixed Effects Modeling was used to compare the AIF models and contrast agents.
Results
With Gd-DTPA, no significant differences were observed between the mean PBF calculated for the "single bolus" (323 ± 110 ml/100ml/min), "dual bolus" (315 ± 177 ml/100ml/min), and "non-linear correction" (298 ± 100 ml/100ml/min) approach. With Gd-BOPTA, the mean PBF using the "dual bolus" approach (245 ± 103 ml/100ml/min) was lower than with the "single bolus" (345 ± 130 ml/100ml/min, p < 0.01) and "non-linear correction" (321 ± 115 ml/100ml/min, p = 0.02). Peak lung enhancement was significantly higher in all regions with Gd-BOPTA than with Gd-DTPA (p << 0.01).
Conclusion
The “dual bolus” approach with Gd-BOPTA resulted in a significantly lower PBF than the other combinations of contrast agent and AIF model. No other statistically significant differences were found. Given the much higher signal in the lung parenchyma using Gd-BOPTA, the use of Gd-BOPTA with either single bolus or the non-linear correction method appears most promising for voxel-wise perfusion quantification using 3D dynamic contrast enhanced pulmonary perfusion MRI.