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Dendrimers, an Emerging Opportunity in Personalized Medicine? J Pers Med 2022; 12:jpm12081334. [PMID: 36013283 PMCID: PMC9409959 DOI: 10.3390/jpm12081334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 12/24/2022] Open
Abstract
Dendrimers are highly branched macromolecules tailorable at will to fulfil precise requirements. They have generated a great many expectations and a huge number of publications and patents in relation to medicine, including in relation to personalized medicine, but have resulted in very poor clinical translation up to now. As clinical trials are the first steps in view of developing new compounds for (a personalized) medicine, this review focusses on the clinical trials carried out with dendrimers. Many of these clinical trials have been recently posted (2020–2022); thus, only very few concern phase 3. The safety and efficiency of essentially two main types of dendrimers, based on polylysine and polyamidoamide scaffolds, have been assessed up to now. These dendrimers were tested with the aim of treating mainly bacterial vaginosis, cancers, and COVID-19.
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Caminade AM, Hameau A, Turrin CO, Laurent R, Majoral JP. Dendritic metal complexes for bioimaging. Recent advances. Coord Chem Rev 2021. [DOI: 10.1016/j.ccr.2020.213739] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Advocating the Development of Next-Generation High-Relaxivity Gadolinium Chelates for Clinical Magnetic Resonance. Invest Radiol 2019; 53:381-389. [PMID: 29462023 DOI: 10.1097/rli.0000000000000454] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The question of improved relaxivity, and potential efficacy therein, for a next-generation of magnetic resonance gadolinium chelates with extracellular distribution and renal excretion, which could also be viewed from the perspective of dose, is addressed on the basis of historical development, animal experimentation, and human trials. There was no systematic evaluation that preceded the choice of 0.1 mmol/kg as the standard dose for human imaging with the gadolinium chelates. In part, this dose was chosen owing to bloodwork abnormalities seen in phase I and phase II studies. Animal investigations and early clinical trials demonstrated improved lesion detectability at higher doses in the brain, liver, and heart. By designing an agent with substantially improved relaxivity, higher enhancement equivalent to that provided with the conventional gadolinium agents at high dose could be achieved, translating to improved diagnosis and, thus, clinical care. Implicit in the development of such high-relaxivity agents would be stability equivalent to or exceeding that of the currently approved macrocyclic agents, given current concern regarding dechelation and gadolinium deposition in the brain, skin, and bone with the linear agents that were initially approved. Development of such next-generation agents with a substantial improvement in relaxivity, in comparison with the current group of approved agents, with a 2-fold increase likely achievable, could lead to improved lesion enhancement, characterization, diagnosis, and, thus, clinical efficacy.
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Wahsner J, Gale EM, Rodríguez-Rodríguez A, Caravan P. Chemistry of MRI Contrast Agents: Current Challenges and New Frontiers. Chem Rev 2019; 119:957-1057. [PMID: 30350585 PMCID: PMC6516866 DOI: 10.1021/acs.chemrev.8b00363] [Citation(s) in RCA: 797] [Impact Index Per Article: 159.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tens of millions of contrast-enhanced magnetic resonance imaging (MRI) exams are performed annually around the world. The contrast agents, which improve diagnostic accuracy, are almost exclusively small, hydrophilic gadolinium(III) based chelates. In recent years concerns have arisen surrounding the long-term safety of these compounds, and this has spurred research into alternatives. There has also been a push to develop new molecularly targeted contrast agents or agents that can sense pathological changes in the local environment. This comprehensive review describes the state of the art of clinically approved contrast agents, their mechanism of action, and factors influencing their safety. From there we describe different mechanisms of generating MR image contrast such as relaxation, chemical exchange saturation transfer, and direct detection and the types of molecules that are effective for these purposes. Next we describe efforts to make safer contrast agents either by increasing relaxivity, increasing resistance to metal ion release, or by moving to gadolinium(III)-free alternatives. Finally we survey approaches to make contrast agents more specific for pathology either by direct biochemical targeting or by the design of responsive or activatable contrast agents.
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Affiliation(s)
- Jessica Wahsner
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Eric M. Gale
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Aurora Rodríguez-Rodríguez
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
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Teresa Albelda M, Garcia-España E, Frias JC. Visualizing the atherosclerotic plaque: a chemical perspective. Chem Soc Rev 2014; 43:2858-76. [PMID: 24526041 DOI: 10.1039/c3cs60410a] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis is the major underlying pathologic cause of coronary artery disease. An early detection of the disease can prevent clinical sequellae such as angina, myocardial infarction, and stroke. The different imaging techniques employed to visualize the atherosclerotic plaque provide information of diagnostic and prognostic value. Furthermore, the use of contrast agents helps to improve signal-to-noise ratio providing better images. For nuclear imaging techniques and optical imaging these agents are absolutely necessary. We report on the different contrast agents that have been used, are used or may be used in future in animals, humans, or excised tissues for the distinct imaging modalities for atherosclerotic plaque imaging.
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Affiliation(s)
- Ma Teresa Albelda
- Universidad de Valencia, Instituto de Ciencia Molecular, Edificio de Institutos de Paterna, c/ Catedrático José Beltrán 2, 46071 Valencia, Spain
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Restrepo CS, Tavakoli S, Marmol-Velez A. Contrast-enhanced cardiac magnetic resonance imaging. Magn Reson Imaging Clin N Am 2012; 20:739-60. [PMID: 23088948 DOI: 10.1016/j.mric.2012.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac magnetic resonance (CMR) imaging has significantly evolved in the past decade and is well established in the evaluation of coronary artery disease (CAD). The evaluation of cardiac anatomy and contractility by high-resolution CMR can be improved by using intravenous administration of gadolinium-based contrast agents. Delayed enhancement CMR imaging has become the gold standard for quantification of myocardial viability in CAD. Contrast-enhanced CMR imaging may circumvent the need for endomyocardial biopsy or localize the involved regions, thereby improving the diagnostic yield of this invasive procedure. The application of contrast-enhanced CMR as an advanced imaging technique for ischemic and nonischemic diseases is reviewed.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center, San Antonio, TX 78229, USA.
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Wagner M, Wagner S, Schnorr J, Schellenberger E, Kivelitz D, Krug L, Dewey M, Laule M, Hamm B, Taupitz M. Coronary MR angiography using citrate-coated very small superparamagnetic iron oxide particles as blood-pool contrast agent: initial experience in humans. J Magn Reson Imaging 2011; 34:816-23. [PMID: 21769977 DOI: 10.1002/jmri.22683] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 05/23/2011] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate very small superparamagnetic iron oxide particles (VSOP-C184) as blood-pool contrast agent for coronary MR angiography (CMRA) in humans. MATERIALS AND METHODS Six healthy volunteers and 14 patients with suspected coronary artery disease underwent CMRA after administration of VSOP-C184 at the following doses: 20 μmol Fe/kg (4 patients), 40 μmol Fe/kg (5 patients), 45 μmol Fe/kg (6 healthy volunteers), and 60 μmol Fe/kg (5 patients). In healthy volunteers, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and vessel edge definition (VED) of contrast-enhanced CMRA were compared with non-contrast-enhanced CMRA. In patients, a per-segment intention-to-diagnose evaluation of contrast-enhanced CMRA for detection of significant coronary stenosis (≥50%) was performed. RESULTS Three healthy volunteers (45 μmol Fe/kg VSOP-C184) and two patients (60 μmol Fe/kg VSOP-C184) had adverse events of mild or moderate intensity. VSOP-C184 significantly increased CNR (15.1 ± 4.6 versus 6.9 ± 1.9; P = 0.010), SNR (21.7 ± 5.3 versus 15.4 ± 1.6; P = 0.048), and VED (2.3 ± 0.6 versus 1.2 ± 0.2; P < 0.001) compared with non-contrast-enhanced CMRA. In patients, contrast-enhanced CMRA yielded sensitivity, specificity, and diagnostic accuracy for detection of significant coronary stenosis of 86.7%, 71.0%, 73.1%, respectively. CONCLUSION CMRA using VSOP-C184 was feasible and yielded moderate diagnostic accuracy for detection of significant coronary stenosis within this proof-of-concept setting.
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Affiliation(s)
- Moritz Wagner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
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MR angiography of collateral arteries in a hind limb ischemia model: comparison between blood pool agent Gadomer and small contrast agent Gd-DTPA. PLoS One 2011; 6:e16159. [PMID: 21298092 PMCID: PMC3027628 DOI: 10.1371/journal.pone.0016159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/07/2010] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to compare the blood pool agent Gadomer with a small contrast agent for the visualization of ultra-small, collateral arteries (diameter<1 mm) with high resolution steady-state MR angiography (SS-MRA) in a rabbit hind limb ischemia model. Ten rabbits underwent unilateral femoral artery ligation. On days 14 and 21, high resolution SS-MRA (voxel size 0.49×0.49×0.50 mm3) was performed on a 3 Tesla clinical system after administration of either Gadomer (dose: 0.10 mmol/kg) or a small contrast agent (gadopentetate dimeglumine (Gd-DTPA), dose: 0.20 mmol/kg). All animals received both contrast agents on separate days. Selective intra-arterial x-ray angiograms (XRAs) were obtained in the ligated limb as a reference. The number of collaterals was counted by two independent observers. Image quality was evaluated with the contrast-to-noise ratio (CNR) in the femoral artery and collateral arteries. CNR for Gadomer was higher in both the femoral artery (Gadomer: 73±5 (mean ± SE); Gd-DTPA: 40±3; p<0.01) and collateral arteries (Gadomer: 18±4; Gd-DTPA: 9±1; p = 0.04). Neither day of acquisition nor contrast agent used influenced the number of identified collateral arteries (p = 0.30 and p = 0.14, respectively). An average of 4.5±1.0 (day 14, mean ± SD) and 5.3±1.2 (day 21) collaterals was found, which was comparable to XRA (5.6±1.7, averaged over days 14 and 21; p>0.10). Inter-observer variation was 24% and 18% for Gadomer and Gd-DTPA, respectively. In conclusion, blood pool agent Gadomer improved vessel conspicuity compared to Gd-DTPA. Steady-state MRA can be considered as an excellent non-invasive alternative to intra-arterial XRA for the visualization of ultra-small collateral arteries.
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Abstract
Coronary MR imaging is a promising noninvasive technique for the combined assessment of coronary artery anatomy and function. Anomalous coronary arteries and aneurysms can reliably be assessed in clinical practice using coronary MR imaging and the presence of significant left main or proximal multivessel coronary artery disease detected. Technical challenges that need to be addressed are further improvements in motion suppression and abbreviated scanning times aimed at improving spatial resolution and patient comfort. The development of new and specific contrast agents, high-field MR imaging with improved spatial resolution, and continued progress in MR imaging methods development will undoubtedly lead to further progress toward the noninvasive and comprehensive assessment of coronary atherosclerotic disease.
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Affiliation(s)
- Sebastian Kelle
- Division of Cardiology, Department of Medicine, German Heart Institute, Berlin, Germany; Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kantor B, Nagel E, Schoenhagen P, Barkhausen J, Gerber TC. Coronary computed tomography and magnetic resonance imaging. Curr Probl Cardiol 2009; 34:145-217. [PMID: 19269527 DOI: 10.1016/j.cpcardiol.2008.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cardiac computed tomography and magnetic resonance are relatively new imaging modalities that can exceed the ability of established imaging modalities to detect present pathology or predict patient outcomes. Coronary calcium scoring may be useful in asymptomatic patients at intermediate risk. Computed tomographic coronary angiography is a first-line indication to evaluate congenitally abnormal coronary arteries and, along with stress magnetic resonance myocardial perfusion imaging, is useful in symptomatic patients with nondiagnostic conventional stress tests. Cardiac magnetic resonance is indicated for visualizing cardiac structure and function, and delayed enhancement magnetic resonance is a first-line indication for assessing myocardial viability. Imaging plaque and molecular mechanisms related to plaque rupture holds great promise for the presymptomatic detection of patients at risk for coronary events but is not yet suitable for routine clinical use.
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Bremerich J, Bilecen D, Reimer P. MR angiography with blood pool contrast agents. Eur Radiol 2007; 17:3017-24. [PMID: 17639407 DOI: 10.1007/s00330-007-0712-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/21/2007] [Accepted: 06/05/2007] [Indexed: 01/09/2023]
Abstract
Contrast-enhanced magnetic resonance angiography (CE-MRA) with standard extracellular contrast material is well established for vascular imaging. Recently, the first blood pool contrast agent (BPA) has become clinically available. This paper reviews characteristics and classification of BPA as well as first clinical experience in various vascular territories. BPAs comprise gadolinium-based compounds, synthetic compounds, and ultrasmall superparamagnetic iron-oxide (USPIO) particles. Such BPAs are retained in blood with a prolonged time-window of enhancement as compared to extracellular gadolinium chelates. Promising results from USPIO at first-pass and steady-state angiography have been published, but no USPIO is approved yet. Gadofosveset is the first clinically approved BPA. After bolus injection, gadofosveset binds noncovalently to serum-albumine, thus enhancing relaxivity. First published results from carotid, coronary, renal, and peripheral angiography are encouraging; particularly helpful is prolonged enhancement during steady state. More BPAs have been clinically evaluated, but no approval has been granted. Bolus-injectable BPAs allow for first-pass CE-MRA similar to standard extracellular contrast media, but with higher relaxivity, allowing lower doses and reduced injection rates. An additional feature of BPA is the steady-state phase with a broad time window enabling high-resolution angiography or double-gated angiography of coronary arteries to compensate for the complex motion pattern.
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Affiliation(s)
- Jens Bremerich
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Bansmann PM, Priest AN, Muellerleile K, Stork A, Lund GK, Kaul MG, Adam G. MRI of the coronary vessel wall at 3 T: comparison of radial and cartesian k-space sampling. AJR Am J Roentgenol 2007; 188:70-4. [PMID: 17179347 DOI: 10.2214/ajr.06.0266] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to compare the quality of 3D gradient-echo images obtained using radial versus cartesian k-space sampling at 3 T. CONCLUSION This study shows that the quality of coronary vessel wall imaging of the right coronary artery with radial k-space sampling in 3D turbo field-echo sequences is superior to cartesian k-space sampling at 3 T. Radial k-space sampling at 3 T makes it possible to combine low motion artifact susceptibility with high signal-to-noise ratio.
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Affiliation(s)
- Paul M Bansmann
- Department of Diagnostic and Interventional Radiology, Center of Diagnostic Imaging and Intervention, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
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Magnetic Resonance Angiography and Evaluation of Vulnerable Plaque. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Yang CW, Carr JC, Francois CJ, Shea SM, Deshpande VS, Meyers SN, Beohar N, Finn JP, Li D. Coronary magnetic resonance angiography using magnetization-prepared contrast-enhanced breath-hold volume-targeted imaging (MPCE-VCATS). Invest Radiol 2006; 41:639-44. [PMID: 16829747 DOI: 10.1097/01.rli.0000226030.12061.b1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Coronary artery x-ray angiography (XRA) is currently the gold standard for the assessment of coronary artery disease. A substantial minority of patients referred for coronary angiography have no significant coronary artery disease. The purpose of this study is to evaluate magnetization-prepared contrast-enhanced breath-hold volume-targeted imaging (MPCE-VCATS), a new 3-dimensional breath-hold coronary magnetic resonance angiography (MRA) technique, in detecting hemodynamically significant coronary artery stenoses in a patient population, with XRA correlation. MATERIALS AND METHODS A total of 19 subjects who were referred for conventional coronary angiography were enrolled in the study. ECG-triggered MPCE-VCATS coronary artery scans were acquired for the left main coronary artery (LCA), left anterior descending (LAD), and right coronary artery (RCA). Coronary MRA and XRA results were compared. RESULTS The overall sensitivity, accuracy, and negative predictive value for diagnosing any hemodynamically significant coronary artery disease (> or =50% diameter reduction) was 91%, 80%, and 90%, respectively. The sensitivity of the technique in the LCA, LAD, and RCA was 100%, 100% and 78%, respectively. The negative predictive value of the technique was 100%, 100%, and 71%, respectively. DISCUSSION MPCE-VCATS is a promising technique for coronary artery imaging. It has a relatively high sensitivity as well as a high NPV. The results of the study may indicate a future role for the technique in obviating the need for some patients to undergo XRA.
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Affiliation(s)
- Carina W Yang
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Nguyen TD, Spincemaille P, Vaidya A, Prince MR, Lu ZR, Wang Y. Contrast-Enhanced Magnetic Resonance Angiography with Biodegradable (Gd-DTPA)-Cystamine Copolymers: Comparison with MS-325 in a Swine Model. Mol Pharm 2006; 3:558-65. [PMID: 17009855 DOI: 10.1021/mp060051o] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to evaluate the use of (Gd-DTPA)-cystamine copolymers (GDCC), a novel biodegradable intravascular polydisulfide-based macromolecular gadolinium(III) contrast agent, for first-pass and steady-state contrast-enhanced magnetic resonance angiography (MRA) in a swine model. A breath-hold background-suppressed 3D MRA of the thorax was performed for first-pass imaging and repeated every 10 min after GDCC injection to monitor the tissue enhancement time course. A navigator-gated 3D MRA of the coronary arteries was performed during steady state following the first-pass imaging. Imaging with intravascular agent MS-325 approximately 1 h after GDCC injection was also included for comparison. Experimental results indicated that GDCC provided significant blood signal-to-noise ratio (SNR) improvement, approximately 1633% for first-pass and 33% for steady-state contrast-enhanced MRA. Compared to MS-325, GDCC provided similar blood enhancement for first-pass and steady-state imaging but with a different tissue enhancement time course. The blood SNR enhancement half-time was 10 +/- 6 min for GDCC and 46 +/- 33 min for MS-325. GDCC provided less enhancement in the liver, bone growth plates, and muscle than MS-325.
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Affiliation(s)
- Thanh D Nguyen
- Department of Radiology, Weill Medical College of Cornell University, New York, New York 10022, USA
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Cheng L, Gao Y, Guaricci AI, Mulukutla S, Sun W, Sheng F, Foo TK, Prince MR, Wang Y. Breath-hold 3D steady-state free precession coronary MRA compared with conventional X-ray coronary angiography. J Magn Reson Imaging 2006; 23:669-73. [PMID: 16568438 DOI: 10.1002/jmri.20567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the use of breath-hold three-dimensional (3D) steady-state free precession (SSFP) coronary magnetic resonance angiography (MRA) in patients with coronary artery disease (CAD) in comparison with conventional coronary x-ray angiography (XRA). MATERIALS AND METHODS Twenty-eight patients with suspected CAD were examined with the use of a breath-hold 3D-SSFP-MRA sequence and conventional XRA. To assess the accuracy of MRA, two clinicians who were blinded to patient information independently reviewed the MRA and XRA data, which were presented in a randomized order. To identify discrepancies between MRA and XRA, and assess features of coronary lesions on MRA, two additional clinicians examined MRA and XRA data that were presented side by side, divided into proximal, mid, and distal segments, and compared them segment by segment. RESULTS The sensitivity and specificity for diagnosing significant coronary stenoses (> 50% diameter narrowing) were 64% and 94%, respectively. At sites of coronary lesions identified on XRA, bright signals and enlarged vessel profiles, in addition to the characteristic narrow lumen, were frequently observed on MRA. CONCLUSION Breath-hold SSFP coronary MRA has good specificity but inconclusive sensitivity in diagnosing significant coronary stenoses, and provides important image features for depicting coronary lesions.
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Affiliation(s)
- Liuquan Cheng
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
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Abstract
Over the past decade, coronary magnetic resonance imaging has been transformed from a scientific curiosity to a clinically useful imaging tool for patients with known or suspected anomalous coronary arteries or coronary artery aneurysms and for assessment of coronary artery bypass graft patency. Coronary magnetic resonance imaging also appears to be of clinical value for assessment of native vessel integrity in selected patients, especially those patients with suspected left main/multivessel disease. Among patients referred for X-ray angiography, a normal coronary magnetic resonance imaging strongly suggests the absence of severe multivessel disease. Technical and methodological advances in motion suppression, along with increasing clinical experience will no doubt facilitate improved visualization of the distal and branch vessel.
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Affiliation(s)
- Evan Appelbaum
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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Abstract
With cardiovascular magnetic resonance imaging (CMR), the necessity of invasive coronary angiography may be increasingly avoided. CMR provides information about the anatomy of the coronaries themselves (e.g. anomalies, aneurysm), functional information on myocardial blood flow (dobutamine-stress-MR, perfusion measurement) and detailed information on cell-mediated alterations (e.g. fibrosis, necrosis). However, visualization of distal coronary vessels and the small side branches is not yet adequate, so that complete replacement of invasive coronary angiography by CMR is not possible.
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Affiliation(s)
- S Kelle
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin
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Goyen M, Herborn CU, Kröger K, Ruehm SG, Debatin JF. Total-body 3D magnetic resonance angiography influences the management of patients with peripheral arterial occlusive disease. Eur Radiol 2005; 16:685-91. [PMID: 16175353 DOI: 10.1007/s00330-005-0001-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 07/06/2005] [Accepted: 08/18/2005] [Indexed: 10/25/2022]
Abstract
High-resolution total-body 3D MR angiography (MRA) has recently become available, revealing additional clinically relevant disease in patients with peripheral arterial occlusive disease (PAOD). However, the actual impact of total-body MRA on patient management in patients with PAOD has not been investigated so far. Two hundred forty-nine consecutive patients with angiographically proven PAOD were prospectively examined by means of contrast-enhanced total-body 3D MRA on a 1.5-T MR scanner. All correlative imaging studies performed within 60 days of total-body MRA were included in the efficacy analysis. Additional clinically relevant disease (luminal narrowing >50%, aneurysmal changes or dissections) was found in 73 segments (52 patients), including the renal arteries (36 segments), carotid arteries (28 segments), subclavian arteries (four segments) and abdominal aortic aneurysms (AAA) (five segments). Of the 73 segments, 36 were deemed necessary for further investigation by means of focused MRA examinations; the diagnosis was confirmed in all cases. Within the 60-day follow-up period, interventional or surgical therapy outside the peripheral arterial tree was performed in nine patients (11 segments), including carotid endatherectomy and renal artery angioplasty. The outlined total-body 3D MRA approach permits a comprehensive evaluation of the arterial system in patients with atherosclerosis and does indeed have an impact on patient management in patients with PAOD.
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Affiliation(s)
- Mathias Goyen
- University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Spuentrup E, Botnar RM. Coronary magnetic resonance imaging: visualization of the vessel lumen and the vessel wall and molecular imaging of arteriothrombosis. Eur Radiol 2005; 16:1-14. [PMID: 16132919 DOI: 10.1007/s00330-005-2886-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 06/22/2005] [Accepted: 07/08/2005] [Indexed: 01/21/2023]
Abstract
Coronary magnetic resonance (MR) imaging has dramatically emerged over the last decade. Technical improvements have enabled reliable visualization of the proximal and midportion of the coronary artery tree for exclusion of significant coronary artery disease. However, current technical developments focus also on direct visualization of the diseased coronary vessel wall and imaging of coronary plaque because plaques without stenoses are typically more vulnerable with higher risk of plaque rupture. Plaque rupture with subsequent thrombosis and vessel occlusion is the main cause of myocardial infarction. Very recently, the first success of molecular imaging in the coronary arteries has been demonstrated using a fibrin-specific contrast agent for selective visualization of coronary thrombosis. This demonstrates in general the high potential of molecular MR imaging in the field of coronary artery disease. In this review, we will address recent technical advances in coronary MR imaging, including visualization of the lumen and the vessel wall and molecular imaging of coronary arteriothrombosis. First results of these new approaches will be discussed.
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Affiliation(s)
- Elmar Spuentrup
- Department of Diagnostic Radiology, University Hospital, Aachen Technical University, Pauwelsstrasse 30, 52057, Aachen, Germany.
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