Abstract
PurposeTo compare enhancement characteristics and image quality of two macrocyclic gadolinium chelates, gadoterate meglumine and gadobutrol, in low-dose, time-resolved MRA of the calf station.Materials and Methods100 consecutive patients with peripheral arterial disease (stages II-IV) were retrospectively analysed. Fifty patients were included in each group - 32 men and 18 women for gadobutrol (mean age 67 years) and 34 men, 16 women for gadoterate meglumine (mean age 64 years). 0.03 mmol/kg bw of either gadobutrol or gadoterate meglumine was injected. Gadobutrol was diluted 1∶1 with normal saline (0.9% NaCl) to provide similar injection volume and bolus geometry compared to the undiluted 0.5 M dose of gadoterate meglumine. Signal-to-noise-ratio (SNR), contrast-to-noise-ratio (CNR) and image quality were analysed and compared between the two groups.ResultsMean SNR ranged from 83.0±46.7 (peroneal artery) to 96.4±64.5 (anterior tibial artery) for gadobutrol, and from 37.6±13.8 (peroneal artery) to 45.3±16.4 (anterior tibial artery) for the gadoterate meglumine group (p<0.0001). CNR values ranged from 30.1±20.1 (peroneal artery) to 37.6±26.0 (anterior tibial artery) for gadobutrol and from 14.9±8.0 (peroneal artery) to 18.6±16.4 (anterior tibial artery) for gadoterate meglumine (p<0.0001). No significant difference in image quality was found except for the peroneal arteries (p = 0.006 and p = 0.04). Interreader agreement was excellent (kappa 0.87–0.93)ConclusionThe significantly better enhancement as assessed by SNR and CNR provided by gadobutrol compared to gadoterate meglumine does not translate into substantial differences in image quality in an equimolar, low-dose, time-resolved MRA protocol of the calves.
Highlights
The diagnostic value of contrast-enhanced MR-angiography (CE MRA) for the evaluation of the lower extremity vasculature at 3 Tesla (3 T) is well-established in the literature [1,2]
The significantly better enhancement as assessed by SNR and CNR provided by gadobutrol compared to gadoterate meglumine does not translate into substantial differences in image quality in an equimolar, low-dose, timeresolved MRA protocol of the calves
CE MRA enables accurate gradation of disease stage in patients suffering from peripheral artery disease (PAD): comparisons with conventional angiography, the clinical gold standard, have demonstrated a high degree of overall diagnostic accuracy with CE MRA, with values of 80% for stenosis detection and 93.5% for the detection of high grade vessel stenosis [5]
Summary
The diagnostic value of contrast-enhanced MR-angiography (CE MRA) for the evaluation of the lower extremity vasculature at 3 Tesla (3 T) is well-established in the literature [1,2]. Available high field MR systems operating at 3 T allow markedly shortened acquisition times without a corresponding loss in spatial resolution [1]. This is in part due to intrinsically higher SNR at these field strengths combined with the development of other innovations such as parallel imaging and multi-element coils [3,4]. CE MRA enables accurate gradation of disease stage in patients suffering from peripheral artery disease (PAD): comparisons with conventional angiography, the clinical gold standard, have demonstrated a high degree of overall diagnostic accuracy with CE MRA, with values of 80% for stenosis detection and 93.5% for the detection of high grade vessel stenosis [5]
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