Abstract
Objective:The aim of the current study was to determine the effects of gadolinium contrast agent on right (RV) and left ventricular (LV) volumetric, aortic flow and pulse wave velocity (PWV) quantification using manual, semi-automatic and fully automatic analysis techniques.Methods:61 participants free from known cardiovascular disease were recruited. Cardiac MR was performed on a 3 T scanner. A balanced steady-state free precession stack was acquired of the ventricles with phase contrast imaging of the aorta performed pre- and post-administration of 10 ml 0.5 mmol ml−1 gadoterate meglumine. The images were analysed manually, and using a semi-automated and a fully automated technique.Results:54 completed the study. Gadolinium-based contrast administration significantly increase the signal-to-noise ratio (pre: 830 ± 398 vs post: 1028 ± 540, p = 0.003) with no significant change in contrast-to-noise ratio (pre: 583 ± 302 vs post: 559 ± 346, p = 0.54). On LV analysis, post-contrast analysis yielded significantly higher end systolic volume (54 ± 20 vs 57 ± 18 ml, p = 0.04), and lower ejection fraction (59 ± 9 vs 57 ± 8%, p = 0.023). On RV analysis, gadolinium contrast resulted in no significant differences. Similar results were seen using the semi-automated and fully-automated techniques but with a larger magnitude of difference. Conversely, using both manual and software analysis aortic flow and PWV quantification proved robust to the effects of contrast agent producing only small non-significant differences.Conclusion:Gadolinium contrast administration significantly alters LV endocardial contour detection with this effect amplified when using semi-automated analysis techniques. In comparison, RV and PWV analysis is robust to these effects.Advances in knowledge:Contrast administration alters LV quantification but not flow analysis. However, these differences are small.
Highlights
Left ventricular analysis Administration of gadolinium contrast agent led to an increased signal-to-noise ratio (SNR) with no significant change in the contrast-to-noise ratio (CNR) calculations
The results from Manual analysis (MA) found LVESV was significantly higher (54 ± 20 vs 57 ± 18 ml, p = 0.039) and LVEF significantly lower (59 ± 9 vs 57 ± 8%, p = 0.023) following the administration of gadolinium contrast agent (Table 1 for comparison of ventricular volumes pre- and post-administration of contrast)
Similar results were observed in semi-automated analysis (SA), showing a post gadolinium-contrast increase in LVESV (48 ± 20 vs 53 ± 21 ml, p = 0.000) and a reduction in LVEF (62 ± 10 vs 60 ± 9%, p < 0.001)
Summary
The use of gadolinium-based contrast agents in cardiac MR (CMR) has become a common place due to its use in the detection, characterization and quantification of myocardial scarring.[13,14,15] Due to the need to wait 10 min after contrast administration to acquire late gadolinium enhancement sequences, acquisition of short axis cine images and aortic flow sequences are frequently obtained after the initial injection of gadolinium contrast to maximize the utilization of the scanner time and minimize downtime. A literature search on the effects of contrast agents yielded conflicting results with some studies showing no changes in ventricular parameters before and after contrast administration while others reported a significant impact up on left ventricular (LV) quantification.[17,18,19] In light of the small cohorts and the lack of right ventricular (RV) analysis within said studies, the validity of comparing values obtained after the administration of gadolinium-based contrast agents with non-contrast sequences is potentially questionable
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