Improved Quality and Diagnostic Confidence Achieved by Use of Dose-Reduced Gadolinium Blood-Pool Agents for Time-Resolved Intracranial MR Angiography

• Type of Material: Article
• Authors: Seena Dehkharghani, Emory University; J Kang, Emory University; Amit Saindane, Emory University
• Language: English
• Date: 2014-03-01
• Publisher: AMER SOC NEURORADIOLOGY
• Publication Version: Final Published Version
• Copyright Statement: © 2014 by American Journal of Neuroradiology
• Final Published Version (URL): http://dx.doi.org/10.3174/ajnr.A3693
• Title of Journal or Parent Work: AMERICAN JOURNAL OF NEURORADIOLOGY
• Volume: 35
• Issue: 3
• Start Page: 450
• End Page: 456
• Keywords: Science & Technology; RELAXIVITY; Clinical Neurology; CONTRAST AGENT; GADOPENTETATE DIMEGLUMINE; GADOBENATE DIMEGLUMINE; 3 TESLA; Life Sciences & Biomedicine; Radiology, Nuclear Medicine & Medical Imaging; 1ST-PASS; MS-325; Neuroimaging; Neurosciences & Neurology; GADOFOSVESET TRISODIUM; MAGNETIC-RESONANCE ANGIOGRAPHY; EFFICACY
• Research Categories: Biology, Biostatistics; Health Sciences, Radiology

Abstract

BACKGROUND AND PURPOSE: Time-resolved MRA with the use of bolus injection of paramagnetic agents has proved valuable in neurovascular imaging. Standard contrast agents have limited blood-pool residence times, motivating the development of highly protein-bound blood-pool agents with greater relaxivity and longer intravascular residence, affording improved image quality at lesser doses. This study represents the first comparison of blood-pool agents to standard agents in time-resolved cerebral MRA. MATERIALS AND METHODS: One hundred datasets were acquired at 1.5T by use of a standardized, time-resolved MRA protocol. Patients received either unit dosing of a standard extracellular agent at 0.1 mmol/kg or a blood-pool agent at 0.03 mmol/kg. Peak arterial and venous enhancement phases were identified and subsequently scored qualitatively by use of a 4-point Likert scale, with attention to 6 vascular segments: 1) intracranial ICA; 2) MCA M1; 3) MCA M2; 4) MCA M3; 5) deep cerebral veins; and 6) dural venous sinuses. RESULTS: Fifty MR angiographies were acquired with each agent. No significant differences were found between agents in generation of uncontaminated arteriograms. Blood-pool agents, at 67% dose reduction, were of significantly greater quality across most vascular segments, including ICA (P = .019), M2 (P = .003), and M3 (P < .01). Superiority in the M1 segment approached significance (P = .059). Significantly better venographic quality was noted for deep venous structures (P = .016) with the use of blood-pool agents. CONCLUSIONS: Blood-pool agents provide superior demonstration of most intracranial vessels in time-resolved MRA compared with standard agents, at reduced doses. The greater relaxation enhancement and more favorable dosing profile make blood-pool agents superior to standard agents for use in cerebral time-resolved MRA.