Pilot MR evaluation of pharmacokinetics and relaxivity of specific blood pool agents for MR angiography

How to compare the efficiency of albumin-bound and nonalbumin-bound contrast agents in vivo: the concept of dynamic relaxivity

RATIONALE AND OBJECTIVES

The objective of this study was to compare, in a rabbit experimental model that mimics a magnetic resonance (MR) angiographic protocol, the efficiency of the following types of compound on the MR signal: (1) a nonalbumin-bound blood pool contrast agent: P792; (2) a weak albumin-bound extracellular contrast agent: Gd-BOPTA; and (3) a strong albumin-bound blood pool contrast agent: MS325.

METHODS

The 2 main phases of early distribution after contrast agent injection, ie, the bolus phase (0-15 seconds postinjection) and the postbolus phase (1-5 minutes postinjection) were investigated by measuring Gd blood concentrations in the first 5 minutes postinjection. In the case of MS325 and Gd-BOPTA, the percentage of the free and bound forms were calculated throughout the pharmacokinetic profile. The dynamic relaxivity at 60 MHz in plasma of each contrast agent was determined in the 2 phases after contrast agent injection, ie, the bolus phase and the postbolus phase.

RESULTS

Injected under similar conditions, the 3 contrast agents had a comparable profile during the bolus phase (0-15 seconds postinjection). At 1 minute postinjection, only 38% of Gd-BOPTA remained in the blood, whereas 85% of P792 was still present in the blood. MS-325 had an intermediate position with 61% remaining in the blood. During the postbolus phase, the various compounds demonstrated similar behavior: the plasma concentration of P792 was higher than that of MS325 and Gd-BOPTA, ie, Ci/C0 (P792)>Ci/C0 (MS325)>Ci/C0 (Gd-BOPTA). At the peak of the bolus, 75% of MS325 and 93% of Gd-BOPTA was present in free form. This proportion decreased progressively during the postbolus phase, because 5 minutes postinjection, 23% of the free form remained for MS325 and 82% for Gd BOPTA. A significant decrease in dynamic r1 relaxivity was observed at 60 MHz for the products that bind to albumin (Gd-BOPTA and MS325) during the bolus phase. The dynamic relaxivity for MS325 at the bolus phase was 8.6 mMs and 5.2 mMs for Gd-BOPTA. At the postbolus phase, the dynamic relaxivity increased (17.3 mMs for MS325 and 6.7 mMs for Gd-BOPTA). The dynamic relaxivity of P792, which does not bind to albumin, was constantly equal to 26 mMs at each time point of the pharmacokinetic profile (bolus and postbolus phase).

CONCLUSIONS

The physicochemical measurements of relaxivity in plasma are made in vitro at a fixed concentration of gadolinium and the value of relaxivity is not necessarily an accurate reflection of the efficiency of the contrast agent in vivo, especially for contrast agents that bind to albumin. Indeed, in vivo, the proportion of free and bound forms of albumin-binding contrast agents varies according to the pharmacokinetic profile, and the relaxivities of albumin-bound and free contrast agents are different. Consequently, the concept of dynamic relaxivity was introduced to compare the efficiency of MS325, Gd-BOPTA, and P792 in vivo. The variation of the dynamic relaxivity of MS325 and Gd-BOPTA between the bolus and postbolus phase is significant (101% for MS325 and 29% for Gd-BOPTA) as a result of the variation in the quantity of bound and free forms during the pharmacokinetic profile. The blood pool agent P792 has different properties, which result from its intravascular retention and its lack of albumin binding. Indeed, contrary to Gd-BOPTA and MS325, the dynamic relaxivity of P792 is higher at the bolus phase (26 mMs) and does not vary during the pharmacokinetic profile. The impact of these different dynamic relaxivities should be integrated in the analysis of the performance of the different classes of contrast agents in clinical MRA protocols.

PEG-g-poly(GdDTPA-co-l-cystine): Effect of PEG Chain Length on in Vivo Contrast Enhancement in MRI

Biodegradable macromolecular Gd(III) complexes, Gd-DTPA cystine copolymers (GDCP), were grafted with PEG of different sizes to modify the physicochemical properties and in vivo MRI contrast enhancement of the agents and to study the effect of PEG chain length on these properties. Three new PEG-grafted biodegradable macromolecular gadolinium(III) complexes were synthesized and characterized as blood pool MRI contrast agents. One of three different lengths of MPEG-NH(2) (MW = 550, 1000, and 2000) was grafted to the backbone of GDCP to yield PEG(n)()-g-poly(GdDTPA-co-l-cystine), PEG(n)()-GDCP. The PEG chain length did not dramatically alter the T(1) relaxivity, r(1), of the modified agents. The MRI enhancement profile of PEG(n)()-GDCP with different PEG sizes was significantly different in mice with respect to both signal intensity and clearance profiles. PEG(2000)-GDCP showed more prominent enhancement in the blood pool for a longer period of time than either PEG(1000)-GDCP or PEG(550)-GDCP. In the kidney, PEG(2000)-GDCP had less enhancement at 2 min than PEG(1000)-GDCP, but both PEG(550)-GDCP and PEG(1000)-GDCP showed a more pronounced signal decay thereafter. The three agents behaved similarly in the liver, as compared to that in the heart. All three agents showed little enhancement in the muscle. Chemical grafting with PEG of different chain lengths is an effective approach to modify the physiochemistry and in vivo contrast enhancement dynamics of the biodegradable macromolecular contrast agents. The novel agents are promising for further clinical development for cardiovascular and cancer MR imaging.

Standardized MR protocol for the evaluation of MRA sequences and/or contrast agents effects in high-degree arterial stenosis analysis

PURPOSE

To investigate the relative role of high resolution (spatial or temporal) magnetic resonance angiography (MRA) sequence and of contrast agent properties in the evaluation of high-degree arterial stenosis.

METHODS

We qualitatively and quantitatively studied both 50 and 95% (300 microm diameter) stenosis of a 6 mm arterial phantom with two contrast agents (CA), Gd-DOTA (r(1)=2.9 mM(-1) s(-1)) versus P760 (r(1)=25 mM(-1) s(-1)) at several CA concentrations, including arterial peak concentration after injection of either a single or double dose of CA, using either a high temporal (booster) or high spatial (HR) resolution 3D MRA sequences. Experimental data were then compared to theoretical data.

RESULTS

With the 3D HR sequence, both visual and quantitative analysis were significantly better compared to the 3D booster sequence, at each phantom diameter. Quantitative analysis was significantly improved by injection of a double versus a single dose of each CA (Gd-DOTA or P760), primarily in high degree stenosis.

CONCLUSION

Combined MRA spatial resolution and high CA efficiency are mandatory to correctly evaluate high degree stenosis.

Assessment of hepatic perfusion parameters with dynamic MRI

Quantification of hepatic perfusion parameters greatly contributes to the assessment of liver function. The purpose of this study was to describe and validate the use of dynamic MRI for the noninvasive assessment of hepatic perfusion parameters. The signal from a fast T(1)-weighted spoiled gradient-echo sequence preceded by a nonslice-selective 90 degrees pulse and a spoiler gradient was calibrated in vitro with tubes filled with various gadolinium concentrations. Dynamic images of the liver were obtained after intravenous bolus administration of 0.05 mmol/kg of Gd-DOTA in rabbits with normal liver function. Hepatic, aortic, and portal venous signal intensities were converted to Gd-DOTA concentrations according to the in vitro calibration curve and fitted with a dual-input one-compartmental model. With MRI, hepatic blood flow was 100 +/- 35 mL min(-1) 100 mL(-1), the arterial fraction 24 +/- 11%, the distribution volume 13.0 +/- 3.7%, and the mean transit time 8.9 +/- 4.1 sec. A linear relationship was observed between perfusion values obtained with MRI and with radiolabeled microspheres (r = 0.93 for hepatic blood flow [P < 0.001], r = 0.79 for arterial blood flow [P = 0.01], and r = 0.91 for portal blood flow [P < 0.001]). Our results indicate that hepatic perfusion parameters can be assessed with dynamic MRI and compartmental modeling.

Safety of magnetic resonance contrast media

Intravenous contrast media, specifically the gadolinium chelates, are well accepted for use in the clinical practice of magnetic resonance imaging. The gadolinium chelates are considered to be very safe and lack (in intravenous use) the nephrotoxicity found with iodinated contrast media. Minor adverse reactions, including nausea and hives, occur in a low percentage of cases. The four agents currently available in the United States cannot be differentiated on the basis of these adverse reactions. Severe anaphylactoid reactions are also known to occur with all agents, although these are uncommon. This review discusses the safety issues involved with intravenous administration of the gadolinium chelates and off-label use. The latter is common in clinical practice and permits broader application of these agents.

Physicochemical and biological evaluation of P792, a rapid-clearance blood-pool agent for magnetic resonance imaging

RATIONALE AND OBJECTIVES

To summarize the physicochemical characterization, pharmacokinetic behavior, and biological evaluation of P792, a new monogadolinated MRI blood-pool agent.

METHODS

The molecular modeling of P792 was described. The r1 relaxivity properties of P792 were measured in water and 4% human serum albumin at different magnetic fields (20, 40, 60 MHz). The stability of the gadolinium complex was assessed. The pharmacokinetic and biodistribution profiles were studied in rabbits. Renal tolerance in dehydrated rats undergoing selective intrarenal injection was evaluated. Hemodynamic safety in rats and in vitro histamine and leukotriene B4 release were also tested.

RESULTS

The mean diameter of P792 is 50.5 A and the r1 relaxivity of this monogadolinium contrast agent is 29 L x mmol(-1) x s(-1) at 60 MHz. The stability of the gadolinium complex in transmetallation is excellent. The pharmacokinetic and biodistribution profiles are consistent with that of a rapid-clearance blood-pool agent: P792 is mainly excreted by glomerular filtration, and its diffusion across normal endothelium is limited. Renal and hemodynamic safety is comparable to that of the nonspecific agent gadolinium-tetraazacyclododecane tetraacetic acid. No histamine or leukotriene B4 release was found in RBL-2H3 isolated mastocytes.

CONCLUSIONS

The relaxivity of P792 at clinical field is very high for a monogadolinium complex without protein binding. The pharmacokinetic and biodistribution profiles are consistent with those of a rapid-clearance blood-pool agent. Its initial safety profile is satisfactory. Experimental and clinical studies are underway to confirm the potential of P792 in MRI.

P792: a rapid clearance blood pool agent for magnetic resonance imaging: preliminary results

An original MRI contrast agent, called P792, is described. P792 is a gadolinium macrocyclic compound based on a Gd-DOTA structure substituted by hydrophilic arms. The chemical structure of P792 has been optimized in order to provide (1) a high r(1) relaxivity in the clinical field for MRI: 29 mM(-1)xs(-1) at 60 MHz, (2) a high biocompatibility profile and (3) a high molecular volume: the apparent hydrodynamic volume of P792 is 125 times greater than that of Gd-DOTA. As a result of this high molecular volume, P792 presents an unusual pharmacokinetic profile, as it is a Rapid Clearance Blood Pool Agent (RCBPA) characterized by limited diffusion across the normal endothelium. The original pharmacokinetic properties of this RCBPA are expected to be well suited to MR coronary angiography, angiography, perfusion imaging (stress and rest), and permeability imaging (detection of ischemia and tumor grading). Further experimental imaging studies are ongoing to define the clinical value of this compound.

Radiologic anatomy of the rabbit liver on hepatic venography, arteriography, portography, and cholangiography

Seo TS, Oh JH, Lee DH, et al. Radiologic anatomy of the rabbit liver on hepatic venography, arteriography, portography, and cholangiography. Invest Radiol 2001;36:186-192.

RATIONALE AND OBJECTIVES

The radiologic anatomy of rabbit liver has received little study but is important in many experimental investigations.

METHODS

Twenty-four rabbits were studied by using hepatic venograms, aortograms, hepatic arteriograms, cholangiograms, and portograms.

RESULTS

In all cases, the right, middle, and left hepatic veins drained into the inferior vena cava just below the diaphragm, and the caudate lobe hepatic vein drained more inferiorly. The proper hepatic artery was a branch of the common hepatic artery in 96%. The first branch of the proper hepatic artery was the caudate lobe artery. The remaining main hepatic artery was divided into the right and left hepatic arteries. The left hepatic artery was further divided into the medial and lateral segmental branches in 95%. The anatomy of the portal vein or bile duct was the same as the hepatic artery in 100% of cases.

CONCLUSIONS

Knowledge of the normal patterns and variations of the vessels and bile duct will be helpful for experiments of the rabbit liver in future studies.

A review of contrast media research in 1999-2000

Contrast media research published during the years 1999 and 2000 is reviewed in this article, in terms of relevance to developments within the field of diagnostic radiology. The primary focus is on publications from the journal Investigative Radiology, which publishes much of the clinical and laboratory research performed in this field. The journals Radiology and the American Journal of Roentgenology are dominant in the field of diagnostic radiology and together publish more than 10 times the number of articles as appear each year in Investigative Radiology. However, in 1999 for example, these two journals together published fewer articles than did Investigative Radiology alone that concerned basic (animal) research with contrast media. Thirty-six percent of the articles in Investigative Radiology in 1999 had a primary focus on contrast media and 18% on basic (animal) research with contrast media. To make this review more complete, articles from other major journals are cited and discussed, as needed, to provide supplemental information in the few areas not well covered by articles in Investigative Radiology. The safety of contrast media is always an important topic and research continues to be performed in this area, both to explore fundamental issues regarding iodinated contrast media and also to establish the overall safety profile of new magnetic resonance (MR) and ultrasound agents. In regard to preclinical investigations, most of the work performed in the last 2 years has been with MR and ultrasound. In MR, research efforts continue to be focused on the development of targeted agents. In ultrasound, research efforts are split between studies looking at new imaging methods and early studies of targeted agents. In regard to the clinical application of contrast media, the published literature continues to be dominated by MR. Investigations include the study of disease in clinical trials and in animal models. A large number of studies continue to be published in regard to new techniques and applications within the field of contrast-enhanced magnetic resonance angiography. This field represents the single, largest new clinical application of contrast media in MR to emerge in the last decade. New clinical research continues to be published regarding the use of contrast media in computed tomography (CT), ultrasound, and x-ray angiography. The introduction of spiral CT (together with the multidetector scanners) has led to greater utilization of this modality, as well as intravenous iodinated contrast media. The number of publications regarding clinical applications of intravenously injected ultrasound contrast agents remains low, with the high expectations in regard to growth (in terms of number of exams using contrast) of the last decade yet to be fulfilled.

MRI contrast enhancement of necrosis by MP-2269 and gadophrin-2 in a rat model of liver infarction

RATIONALE AND OBJECTIVES

The mechanisms of action leading to specific localization of necrosis-avid contrast agents (NACAs) such as gadophrin-2 are not well defined. It has been suggested recently that agents with a high degree of serum albumin binding may also serve as NACAs by virtue of nonspecific hydrophobic interactions. The present MRI-histomorphology correlation study was conducted to verify the likelihood of the proposed albumin-binding mechanism by comparing an albumin-binding blood pool agent, MP-2269, with gadophrin-2 in a rat model of reperfused liver infarction.

METHODS

Reperfused infarction in the right liver lobe was surgically induced in six rats. Serial T1-weighted MRI was performed before and after intravenous injection of MP-2269 at 0.05 mmol/kg and repeated in the same rats 24 hours later after intravenous injection of gadophrin-2 at the same dosage (0.05 mmol/kg). The MR images were matched with corresponding histomorphological findings. The signal intensity and contrast ratio of infarcted and normal hepatic lobes were quantified and compared between the two agents during the postcontrast course.

RESULTS

Before contrast, the infarcted lobe was indiscernible from normal liver on T1-weighted MRI. Shortly after injection of both MP-2269 and gadophrin-2, a negative contrast occurred between infarcted and normal liver because of a strong liver signal intensity enhancement and an inferior uptake in the necrotic liver. On delayed phase (>60 minutes), a necrosis-specific contrast enhancement (contrast ratio 1.6) developed with gadophrin-2 but not with MP-2269. The MR images matched well with corresponding histomorphological findings.

CONCLUSIONS

Although both MP-2269 and gadophrin-2 feature an albumin-binding capacity, only gadophrin-2 displayed a persistent necrosis-specific contrast enhancement in the rat model of reperfused liver infarction. Therefore, the role of albumin binding in the mechanisms of NACAs should be reevaluated.

Gd3+ complexes with slowly exchanging bound-water molecules may offer advantages in the design of responsive MR agents

RATIONALE AND OBJECTIVES

Slow water exchange in Gd3+ complexes is generally considered detrimental to their use as MR contrast agents. The objective of this work was to demonstrate how this feature may serve as a useful template for the design of responsive MR agents.

METHODS

Lanthanide (Ln) complexes of two 1,4,7,10-tetraazacyclododecane-N,N',N",N'"-tetraacetic acid (DOTA)-tetraamide phosphonate (1) and phosphonate ester (2) ligands were studied by multinuclear (1H, 13C, 31P, and 17O) nuclear MR spectroscopy.

RESULTS

The inner-sphere water lifetime in the Ln(2) complexes was much longer (tauM298 = 0.8-1.3 ms) than in the corresponding Ln(1) complexes. This allowed direct detection of the bound-water molecule in europium(2) in water at 40 degrees C by 1H nuclear MR. The water relaxivity of gadolinium(2) was independent of pH between 8.5 and 6.0, whereas the relaxivity of gadolinium(1) increased more than twofold in this pH range.

CONCLUSIONS

T1-weighted images of phantoms containing gadolinium(1) at different pH values demonstrate the efficacy of this complex as a pH-sensitive MR contrast agent.