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Åkesson M, Lehti L, Leander P, Sterner G, Wassélius J. Long-term safety of Gadofosveset in clinical practice. Magn Reson Imaging 2021; 86:70-73. [PMID: 34848324 DOI: 10.1016/j.mri.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to systematically search for long-term complications, including Nephrogenic Systemic Fibrosis (NSF), in patients who were previously administered the gadolinium-based contrast agent Gadofosveset at our institute. MATERIALS AND METHODS All patients who were administered Gadofosveset at our institute between 2006 and 2009 were identified in our Radiological Information System (RIS). Clinical data such as cause of death during follow-up, and dermatological or nephrological diseases were systematically searched for in electronic patient records (EPR). RESULTS During 2006-2009, Gadofosveset was administered a total of 67 times to 62 patients. One patient was unavailable for follow-up. The remaining 61 patients were followed up for up to 14 (median 12) years based on RIS and EPR data. There were 13 deaths among the 61 patients, all assessed as unrelated to Gadofosveset administration. No dermatological or renal disease suggestive of NSF, or potentially related to Gadofosveset administration, was found. At the time of examination, six patients were diagnosed with various stages of renal insufficiency, three of whom were on hemodialysis. Another three patients were diagnosed with renal insufficiency during the follow-up period, but none of these diagnoses were suspected to be related to the administration of Gadofosveset. CONCLUSIONS Based on the results of this retrospective safety analysis of up to 14 years following 1-2 exposures, we conclude that Gadofosveset in clinical practice is safe in the long-term.
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Affiliation(s)
- Michael Åkesson
- Department of Clinical Sciences Lund, Lund University, Sweden
| | - Leena Lehti
- Department of Clinical Sciences Lund, Lund University, Sweden; Vascular Center, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Peter Leander
- Department of Clinical Sciences Lund, Lund University, Sweden; Department of Radiology, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Gunnar Sterner
- Department of Clinical Sciences Lund, Lund University, Sweden; Department of Nephrology and Transplantation, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Johan Wassélius
- Department of Clinical Sciences Lund, Lund University, Sweden; Vascular Center, Skåne University Hospital Lund/Malmö, Lund, Sweden.
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Notohamiprodjo S, Varasteh Z, Beer AJ, Niu G, Chen X(S, Weber W, Schwaiger M. Tumor Vasculature. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Khairnar S, More N, Mounika C, Kapusetti G. Advances in Contrast Agents for Contrast-Enhanced Magnetic Resonance Imaging. J Med Imaging Radiat Sci 2019; 50:575-589. [PMID: 31727524 DOI: 10.1016/j.jmir.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/30/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is a well-established medical invention in modern medical technology diagnosis. It is a nondestructive, versatile, and sensitive technique with a high spatial resolution for medical diagnosis. However, MRI has some limitations in differentiating certain tissues, particularly tiny blood vessels, pathological to healthy tissues, specific tumors, and inflammatory conditions such as arthritis, atherosclerosis, and multiple sclerosis. The contrast agent (CA) assisted imaging is the best possible solution to resolve the limitations of MRI. METHOD The literature review was carried out using the keywords, "MRI, T1&T2 relaxation, MRI CAs, delivery and adverse effects, classification of CAs." The tools used for the literature search were PubMed, Scopus, and Google Scholar. RESULT AND DISCUSSION The literature findings focus on MRI technique, limitations, and possible solutions. Primarily, the review focuses on the mechanism of CAs in image formation with detailed explanations of T1 and T2 relaxations, the mechanism of the MRI-CA image formations. This review presents the adverse effects of CA as well as available marketed formulations and recent patents to extent complete information about the MRI-CA. CONCLUSION MRI generates detailed visual information of various tissues with high resolution and contrast. The proton present in the biological fluid plays a crucial role in MR image formation, and it is unable to distinguish pathological conditions in many cases. The CAs are the best solution to resolve the limitation by interacting with native protons. The present review discusses the mechanism of CAs in contrast enhancement and its broad classification with the latest literature. Furthermore, the article presents information about CA biodistribution and adverse effects. The review concludes with an appropriate solution for adverse effects and presents the future prospective for researchers to develop advanced formulations.
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Affiliation(s)
- Snehal Khairnar
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gujarat, India
| | - Namdev More
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gujarat, India
| | - Choppadandi Mounika
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gujarat, India
| | - Govinda Kapusetti
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gujarat, India.
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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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Kondo T, Kimura Y, Yamada H, Aoyama Y. Polymeric 1 H MRI Probes for Visualizing Tumor In Vivo. CHEM REC 2017; 17:555-568. [PMID: 28387472 DOI: 10.1002/tcr.201600144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Indexed: 11/09/2022]
Abstract
Magnetic resonance imaging (MRI) has become a prominent non- or low-invasive imaging technique, providing high-resolution, three-dimensional images as well as physiological information about tissues. Low-molecular-weight Gd-MRI contrast agents (CAs), such as Gd-DTPA (DTPA: diethylenetriaminepentaacetic acid), are commonly used in the clinical diagnosis, while macromolecular Gd-MRI CAs have several advantages over low-molecular-weight Gd-MRI CAs, which help minimize the dose of CAs and the risk of side effects. Accordingly, we developed chiral dendrimer Gd-MRI CAs, which showed high r1 values. The association constant values (Ka ) of S-isomeric dendrimer CAs to bovine serum albumin (BSA) were higher than those of R-isomeric dendrimer CAs. Besides, based on a totally new concept, we developed 13 C/15 N-enriched multiple-resonance NMR/MRI probes, which realized highly selective observation of the probes and analysis of metabolic reactions of interest. This account summarizes our recent study on developing both chiral dendrimer Gd-MRI CAs, and self-traceable 13 C/15 N-enriched phosphorylcholine polymer probes for early detection of tumors.
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Affiliation(s)
- Teruyuki Kondo
- Department of Energy and Hydrocarbon Chemistry, Graduate School of Engineering, Kyoto University, Katsura, Nishikyo-ku, Kyoto, 6158510, JAPAN
| | - Yu Kimura
- Research and Educational Unit of Leaders for Integrated Medical Systems, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Katsura, Nishikyo-ku, Kyoto, 6158510, JAPAN
| | - Hisatsugu Yamada
- Field of Bioresource Chemistry and Technology, Graduate School of Bioscience and Bioindustry, Tokushima University, 2-1, Minamijosanjima-cho, Tokushima, 7708506, JAPAN
| | - Yasuhiro Aoyama
- Professor emeritus, Kyoto University, Katsura, Nishikyo-ku, Kyoto, 6158510, JAPAN
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Oliveira IS, Hedgire SS, Li W, Ganguli S, Prabhakar AM. Blood pool contrast agents for venous magnetic resonance imaging. Cardiovasc Diagn Ther 2016; 6:508-518. [PMID: 28123972 DOI: 10.21037/cdt.2016.12.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Imaging of the venous system plays a vital role in the diagnosis and management of a wide range of clinically significant disorders. There have been great advances in venous imaging techniques, culminating in the use of magnetic resonance venography (MRV). Although MRV has distinct advantages in anatomic and quantitative cross sectional imaging without ionizing radiation, there are well-known challenges in acquisition timing and contrast administration in patients with renal impairment. The latest advancement involves the addition of new contrast media agents, which have emerged as valuable alternatives in these difficult scenarios. In this review, we will focus on a group of specific contrast agents called blood pool agents and discuss their salient features and clinical applications.
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Affiliation(s)
- Irai S Oliveira
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandeep S Hedgire
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Weier Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Suvranu Ganguli
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand M Prabhakar
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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8
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Åkesson M, Lehti L, Höglund P, Åkeson P, Wassélius J. Thoracic magnetic resonance venography using Gadofosveset in patients with venous pathology-A comparative study of image quality and inter-rater variability. Phlebology 2016; 32:453-458. [PMID: 27388453 DOI: 10.1177/0268355516656316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background High-quality non-invasive imaging of the deep venous system in the thorax is challenging, but nevertheless required for diagnosis of vascular pathology as well as for patient selection and preoperative planning for endovascular procedures. Purpose To compare the diagnostic quality of Gadofosveset-enhanced thoracic magnetic resonance venography, seven consecutive patients with suspected or known disease affecting the central thoracic veins were compared to seven consecutive magnetic resonance venography using conventional gadolinium-based contrast agents. Materials and methods Diagnostic capability, defined as the ability to assess vessel patency and pathologic conditions, for the major thoracic deep venous segments was assessed by two-independent readers. Both reviewers rated the overall subjective image quality on a four-graded scale, and inter-rater variability was analyzed using unweighted and weighted Cohen's kappa values. Results Diagnostic capability was generally considerably higher in the Gadofosveset group for all examined vessel segments. The overall images quality rating was significantly higher for the Gadofosveset group with a mean rating of 2.9 and 2.7 for the two-independent readers, compared to 1.2 and 1.0 for the control croup. Inter-rater variability showed less variability for the Gadofosveset group with a quadratic-weighted Cohen's Kappa value of 0.58 compared to 0.36 for the control group. Conclusion Our results show that Gadofosveset-enhanced magnetic resonance venography of the central thoracic veins is a reliable technique in clinical routine practice that results in diagnostic images, superior to conventional gadolinium-based contrast medium.
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Affiliation(s)
- Michael Åkesson
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Leena Lehti
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,2 Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Peter Höglund
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,3 Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Per Åkeson
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,4 Department of Radiology, Skanevard Sund, Trelleborg Hospital, Trelleborg, Sweden
| | - Johan Wassélius
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,5 Department of Radiology, Skåne University Hospital, Lund, Sweden
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Part 2 - Coronary angiography with gadofosveset trisodium: a prospective intra-subject comparison for dose optimization for 100 % efficiency imaging. BMC Cardiovasc Disord 2016; 16:58. [PMID: 27004532 PMCID: PMC4804531 DOI: 10.1186/s12872-015-0152-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Three tesla (3T) coronary magnetic resonance angiography (MRA) may be optimized using gadolinium-based contrast agents (GBCA) such as gadofosveset trisodium. The goal of this study was to evaluate if there is a qualitative or quantitative improvement in the coronary arteries with variation in contrast dose. Methods Twenty-eight healthy volunteers were prospectively recruited for coronary MRA at 3T using a steady state injection technique for 3D radial whole-heart image acquisition with retrospective respiratory self-gating (ClinicalTrials.gov identifier: NCT01853592). Nineteen volunteers completed both single- and double-dose imaging instances (0.03 and 0.06 mmol/kg, respectively). Intra-individual comparison of image quality was assessed by measurement of apparent signal/contrast-to-noise ratio (aSNR/aCNR) and subjective evaluation of image quality by 2 independent reviewers. Results The average duration of coronary MRA acquisition was 7.2 ± 1.2 min. There was significantly higher (60 %, p < 0.001) aSNR of the aorta and right/left ventricle for the double dose compared to single dose injection scheme and aSNR of the coronary arteries increased by 70 % (p < 0.001) for the double dose injection. aCNR increased by +55 % and +60 % in the ventricles and coronary arteries, respectively (p < 0.001). Overall segmental artery visualization for single dose was possible 47 % of the time, which improved to 60 % with double dose (p = 0.019), predominantly driven by improvements in more distal segment visualization (+40 % improvement in mid arterial segments, p = 0.013). Conclusions Gadofosveset trisodium dose of 0.06 mmol/kg significantly quantitatively and qualitatively improves the coronary artery image quality compared to 0.03 mmol/kg at 3T for moderate duration (6–8 min) steady state contrast enhanced coronary MRA.
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Key J, Palange AL, Gentile F, Aryal S, Stigliano C, Di Mascolo D, De Rosa E, Cho M, Lee Y, Singh J, Decuzzi P. Soft Discoidal Polymeric Nanoconstructs Resist Macrophage Uptake and Enhance Vascular Targeting in Tumors. ACS NANO 2015; 9:11628-41. [PMID: 26488177 DOI: 10.1021/acsnano.5b04866] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Most nanoparticles for biomedical applications originate from the self-assembling of individual constituents through molecular interactions and possess limited geometry control and stability. Here, 1000 × 400 nm discoidal polymeric nanoconstructs (DPNs) are demonstrated by mixing hydrophobic and hydrophilic polymers with lipid chains and curing the resulting paste directly within silicon templates. By changing the paste composition, soft- and rigid-DPNs (s- and r-DPNs) are synthesized exhibiting the same geometry, a moderately negative surface electrostatic charge (-14 mV), and different mechanical stiffness (∼1.3 and 15 kPa, respectively). Upon injection in mice bearing nonorthotopic brain or skin cancers, s-DPNs exhibit ∼24 h circulation half-life and accumulate up to ∼20% of the injected dose per gram tumor, detecting malignant masses as small as ∼0.1% the animal weight via PET imaging. This unprecedented behavior is ascribed to the unique combination of geometry, surface properties, and mechanical stiffness which minimizes s-DPN sequestration by the mononuclear phagocyte system. Our results could boost the interest in using less conventional delivery systems for cancer theranosis.
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Affiliation(s)
- Jaehong Key
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
- Department of Biomedical Engineering, Yonsei University , 1 Yonseidae-gil, Wonju, Gangwon-do 220-710, South Korea
| | - Anna Lisa Palange
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia (IIT) , via Morego 30, Genova I16163, Italy
| | - Francesco Gentile
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia (IIT) , via Morego 30, Genova I16163, Italy
| | - Santosh Aryal
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
- Department of Chemistry, Nanotechnology Innovation Center of Kansas State, Kansas State University , Manhattan, Kansas 66506, United States
| | - Cinzia Stigliano
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
| | - Daniele Di Mascolo
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia (IIT) , via Morego 30, Genova I16163, Italy
| | - Enrica De Rosa
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
| | - Minjung Cho
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
| | - Yeonju Lee
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
| | - Jaykrishna Singh
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
| | - Paolo Decuzzi
- Department of Translational Imaging and Department of Nanomedicine, Houston Methodist Research Institute , Houston, Texas 77030, United States
- Department of Experimental and Clinical Medicine, University of Magna Graecia , Catanzaro 88100, Italy
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia (IIT) , via Morego 30, Genova I16163, Italy
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Åkesson M, Lehti L, Höglund P, Åkeson P, Wassélius J. Gadofosveset-enhanced magnetic resonance venography in patients with venous pathology of the lower limbs - Comparison of diagnostic image quality and inter-rater variability with gadobutrol venography and computed tomography venography. Phlebology 2015; 31:737-743. [PMID: 26631538 DOI: 10.1177/0268355515619255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose This study was performed to compare the diagnostic quality of Gadofosveset-enhanced magnetic resonance venography with Gadobutrol-enhanced magnetic resonance venography and computed tomography venography for the deep veins of the lower extremities in patients with iliocaval venous pathology. Materials and methods Diagnostic capability and image quality were assessed by two independent readers. Inter-reader variability was analyzed by unweighted and quadratic weighted Cohen's kappa values. Results The diagnostic capability was equal to or higher in the Gadofosveset group for all examined vessel segments compared with both control groups. The image quality score was significantly higher for the Gadofosveset group compared to both control groups. Inter-reader variability expressed by quadratic weighted Cohen's kappa value (k) showed less variability in the Gadofosveset group compared to the control groups. Conclusion Our results show that Gadofosveset-enhanced magnetic resonance venography is a reliable technique in clinical routine practice, with image quality superior to both Gadobutrol-enhanced magnetic resonance venography and computed tomography venography.
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Affiliation(s)
- Michael Åkesson
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Leena Lehti
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,2 Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Peter Höglund
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Per Åkeson
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,3 Department of Radiology, Trelleborg Hospital, Trelleborg, Sweden
| | - Johan Wassélius
- 1 Department of Clinical Sciences, Lund University, Lund, Sweden.,4 Department of Neuroradiology, Skåne University Hospital, Lund, Sweden
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Abstract
This perspective outlines strategies towards the development of MR imaging probes that our lab has explored over the last 15 years. Namely, we discuss methods to enhance the signal generating capacity of MR probes and how to achieve tissue specificity through protein targeting or probe activation within the tissue microenvironment.
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Affiliation(s)
- Eszter Boros
- Athinoula A. Martinos Center for Biomedical 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, Department of Radiology Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
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Haneder S, Kucharczyk W, Schoenberg SO, Michaely HJ. Safety of magnetic resonance contrast media: a review with special focus on nephrogenic systemic fibrosis. Top Magn Reson Imaging 2015; 24:57-65. [PMID: 25654421 DOI: 10.1097/rmr.0b013e3182a14e79] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Stefan Haneder
- From the *Department of Radiology, University Hospital of Cologne, Cologne, Germany; University Medical Center Mannheim, Heidelberg University, Mannheim, Germany; and †University of Toronto, Toronto, Canada
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Farmakis SG, Khanna G. Extracardiac applications of MR blood pool contrast agent in children. Pediatr Radiol 2014; 44:1598-609; quiz 1595-7. [PMID: 25408135 DOI: 10.1007/s00247-014-3167-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/30/2014] [Accepted: 08/20/2014] [Indexed: 11/26/2022]
Abstract
Magnetic resonance (MR) angiography has significantly reduced the need for diagnostic conventional angiography and is preferred over CT angiography in children because of its lack of ionizing radiation. The availability of gadofosveset trisodium (the only clinically approved blood pool MR contrast agent) has led to an increase in applications of MR for vascular imaging and an improvement in diagnostic quality of MR angiography. Gadofosveset is a gadolinium-based contrast agent that binds reversibly to albumin, resulting in increased paramagnetic effect and longer intravascular residence. This allows for high-resolution arterial and venous MR angiography, assessment of flow characteristics of vascular malformations, dynamic vascular imaging, and multi-station imaging with a single low-dose gadolinium contrast injection. The purpose of this pictorial essay is to facilitate understanding of the kinetics and safety profile of gadofosveset trisodium, discuss technical aspects of imaging, and illustrate advantages and extracardiac applications in pediatric body imaging.
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Affiliation(s)
- Shannon G Farmakis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO, 63110, USA
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Knuttinen MG, Karow J, Mar W, Golden M, Xie KL. Blood Pool Contrast-enhanced Magnetic Resonance Angiography with Correlation to Digital Subtraction Angiography: A Pictorial Review. J Clin Imaging Sci 2014; 4:63. [PMID: 25558430 PMCID: PMC4278092 DOI: 10.4103/2156-7514.145860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/23/2014] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance angiography (MRA) provides noninvasive visualization of the vascular supply of soft tissue masses and vascular pathology, without harmful radiation. This is important for planning an endovascular intervention, and helps to evaluate the efficiency and effectiveness of the treatment. MRA with conventional extracellular contrast agents relies on accurate contrast bolus timing, limiting the imaging window to first-pass arterial phase. The recently introduced blood pool contrast agent (BPCA), gadofosveset trisodium, reversibly binds to human serum albumin, resulting in increased T1 relaxivity and prolonged intravascular retention time, permitting both first-pass and steady-state phase high-resolution imaging. In our practice, high-quality MRA serves as a detailed “roadmap” for the needed endovascular intervention. Cases of aortoiliac occlusive disease, inferior vena cava thrombus, pelvic congestion syndrome, and lower extremity arteriovenous malformation are discussed in this article. MRA was acquired at 1.5 T with an 8-channel phased array coil after intravenous administration of gadofosveset (0.03 mmol/kg body weight), at the first-pass phase. In the steady-state, serial T1-weighted 3D spoiled gradient echo images were obtained with high resolution. All patients underwent digital subtraction angiography (DSA) and endovascular treatment. MRA and DSA findings of vascular anatomy and pathology are discussed and correlated. BPCA-enhanced MRA provides high-quality first-pass and steady-state vascular imaging. This could increase the diagnostic accuracy and create a detailed map for pre-intervention planning. Understanding the pharmacokinetics of BPCA and being familiar with the indications and technique of MRA are important for diagnosis and endovascular intervention.
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Affiliation(s)
- Martha-Grace Knuttinen
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Jillian Karow
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Winnie Mar
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Margaret Golden
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Karen L Xie
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
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Comparison of blood pool and extracellular gadolinium chelate for functional MR evaluation of vascular thoracic outlet syndrome. Eur J Radiol 2014; 83:1209-1215. [DOI: 10.1016/j.ejrad.2014.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/12/2014] [Accepted: 04/15/2014] [Indexed: 11/22/2022]
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Alhadad A, Åkesson M, Lehti L, Leander P, Sterner G, Åkeson P, Wassélius J. Safety aspects of gadofosveset in clinical practice – analysis of acute and long-term complications. Magn Reson Imaging 2014; 32:570-3. [DOI: 10.1016/j.mri.2014.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 11/25/2022]
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Abstract
BACKGROUND In the general population, up to 10% of people younger than 70 years and 15% to 20% of people older than 70 years have peripheral arterial disease (PAD). Symptomatic and asymptomatic PAD has an estimated prevalence of 13% in the over 50 years age group. However, asymptomatic PAD can account for up to 75% of PAD patients and only 10% of PAD patients have typical intermittent claudication. People with PAD are at an increased risk of death, heart and cerebrovascular disease and are recommended to receive treatment to manage their cardiac risk. They suffer from significant functional limitations in their daily activities and the most severely affected are at risk of limb loss. Many people with PAD do not have any symptoms. Only some people have discomfort or pain in the lower legs when walking, so PAD often goes undetected. Given the high incidence of asymptomatic and undiagnosed PAD, it is important to determine the effectiveness of a screening intervention in preventing cardiovascular adverse outcomes, both fatal and non-fatal. OBJECTIVES To determine the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched November 2013) and CENTRAL (2013, Issue 10). SELECTION CRITERIA All published and unpublished randomised controlled trials (RCTs) of screening for PAD were sought without language restriction. DATA COLLECTION AND ANALYSIS Studies identified for potential inclusion in the review were independently assessed by both review authors. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions. MAIN RESULTS No RCTs were identified that met the inclusion criteria. AUTHORS' CONCLUSIONS Unfortunately, no randomised controlled trial data are available regarding screening for PAD. Therefore, we are unable to determine the effects of screening for PAD in order to guide decision making by healthcare providers and planners. High quality randomised controlled trials evaluating the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life are needed.
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Affiliation(s)
- Alina Andras
- Freeman HospitalNorthern Vascular CentreNewcastle upon TyneUKNE7 7DN
| | - Bart Ferket
- Erasmus MCDepts. of Epidemiology and RadiologyRoom Na 2523P.O.Box 2040RotterdamNetherlands3000 CA
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Boschewitz JM, Hadizadeh DR, Kukuk GM, Meyer C, Wilhelm K, Koscielny A, Verrel F, Gieseke J, Schild HH, Willinek WA. 0.125 mm(3) spatial resolution steady-state MR angiography of the thighs with a blood pool contrast agent using the quadrature body coil only at 1.5 Tesla. J Magn Reson Imaging 2014; 40:996-1001. [PMID: 24845363 DOI: 10.1002/jmri.24455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To implement and evaluate high spatial resolution three-dimensional MR contrast-enhanced angiography (3D-CEMRA) of the thighs using a blood pool contrast agent (BPCA) using the quadrature body coil only in patients with peripheral arterial occlusive disease (PAOD) in cases receiver coils cannot be used at 1.5 Tesla (T). MATERIALS AND METHODS Nineteen patients (mean age: 68.7 ± 11.2 years; range, 38-83 years) with known PAOD (Fontaine stages; III: 16, IV: 3) prospectively underwent 3D-CEMRA at 1.5T with a noninterpolated voxel size of 0.49 × 0.49 × 0.48 mm(3) . Digital subtraction angiography (DSA) was available for comparison in all patients. Two readers independently evaluated movement artifacts, overall image quality of 3D-CEMRA, and grade of stenosis as compared to DSA. SNR and CNR levels were quantified. RESULTS The 3D-CEMRA was successfully completed in all patients. Patient movement artifacts that affected stenosis grading occurred in 3/38 thighs. Overall image quality was rated excellent in 15/38, good in 12/38, and diagnostic in 8/38 thighs. Stenosis grading matched with that in DSA in 35/38 thighs. High SNR and CNR were measured in all vessels. CONCLUSION The 0.125 mm(3) spatial resolution 3D-CEMRA of the thighs with a BPCA is feasible using a quadrature body coil exclusively with excellent image quality despite long acquisition times. J. Magn. Reson. Imaging 2014;40:996-1001. © 2014 Wiley Periodicals, Inc.
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Abstract
OBJECTIVE The purpose of this review is to illustrate various applications of gadofosveset trisodium in evaluating abdominal and peripheral vascular disease. The basic properties, technical considerations, and clinical and potential future applications of gadofosveset are described. CONCLUSION Gadofosveset trisodium facilitates comprehensive high-resolution arterial and venous MR angiography. Because of its prolonged intravascular residence time, gadofosveset trisodium is particularly useful for evaluating venous, dynamic, and functional vascular disease with a single low-dose contrast injection.
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Wang J, Yan F, Liu J, Lu J, Li D, Luan J, Wang X, Li Y, Iezzi R, De Cobelli F. Multicenter, intra-individual comparison of single dose gadobenate dimeglumine and double dose gadopentetate dimeglumine for MR angiography of the peripheral arteries (the Peripheral VALUE Study). J Magn Reson Imaging 2013; 38:926-37. [PMID: 23371919 DOI: 10.1002/jmri.24040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/13/2012] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To prospectively compare single dose gadobenate dimeglumine with double dose gadopentetate dimeglumine for CE-MRA in patients with peripheral arterial occlusive disease (PAOD) using an intra-individual crossover study design in which all patients received both contrast agents in otherwise identical CE-MRA examinations. MATERIALS AND METHODS Institutional review board and regulatory approval were granted and all patients provided written informed consent. Sixty-eight patients (53M/15F; 62.4 ± 15.7 years) with mild-to-severe PAOD were enrolled for randomized 3-station CE-MRA with 0.1 mmol/kg gadobenate dimeglumine and 0.2 mmol/kg gadopentetate dimeglumine. Three blinded readers assessed images for vessel anatomical delineation, disease detection/exclusion, and global preference. Diagnostic performance for detection of ≥51% stenosis was determined for 53 patients who underwent DSA. Noninferiority was assessed using the Wilcoxon Signed Rank, McNemar, and Wald tests. Quantitative enhancement was compared. RESULTS No differences (P ≥ 0.25) were noted for any qualitative parameter at any station. Equivalence was reported in at least 62/64 patients (93.8% 3-reader agreement) for diagnostic preference. Superiority for gadobenate dimeglumine was reported by all readers for diagnostic performance (sensitivity: 80.4-88.0% versus 75.2-85.8%; specificity: 89.8-96.0% versus 88.7-94.8%; accuracy: 87.4-91.7% versus 84.9-90.6%; PPV: 84.0-92.8% versus 82.3-90.8%; NPV: 88.5-92.4% versus 85.7-91.1%). Quantitative enhancement was similar in the pelvis but significantly (P < 0.05) greater with gadobenate dimeglumine in the thigh for two readers. CONCLUSION Image quality and diagnostic performance on peripheral CE-MRA with 0.1 mmol/kg gadobenate dimeglumine is at least equivalent to that with 0.2 mmol/kg gadopentetate dimeglumine.
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Affiliation(s)
- Jian Wang
- Radiology Department, Shanghai Changhai Hospital, Shanghai, China
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Simultaneous MR Arteriography and Venography With Blood Pool Contrast Agent Detects Deep Venous Thrombosis in Suspected Arterial Disease. AJR Am J Roentgenol 2012; 198:1188-95. [DOI: 10.2214/ajr.11.7306] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Caravan P, Zhang Z. Structure-Relaxivity Relationships among Targeted MR Contrast Agents. Eur J Inorg Chem 2012; 2012:1916-1923. [DOI: 10.1002/ejic.201101364] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gaynor D, Griffith DM. The prevalence of metal-based drugs as therapeutic or diagnostic agents: beyond platinum. Dalton Trans 2012; 41:13239-57. [DOI: 10.1039/c2dt31601c] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Prospective Evaluation of High-Resolution MRI Using Gadofosveset for Stent-Graft Planning: Comparison With CT Angiography in 30 Patients. AJR Am J Roentgenol 2011; 197:1251-7. [DOI: 10.2214/ajr.10.6268] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Molecular MRI plays an important role in studying molecular and cellular processes associated with heart disease. Targeted probes that recognize important biomarkers of atherosclerosis, apoptosis, necrosis, angiogenesis, thrombosis and inflammation have been developed. This review discusses the properties of chemically different contrast agents including iron oxide nanoparticles, gadolinium-based nanoparticles or micelles, discrete peptide conjugates and activatable probes. Numerous examples of contrast agents based on these approaches have been used in preclinical MRI of cardiovascular diseases. Clinical applications are still under investigation for some selected agents with highly promising initial results. Molecular MRI shows great potential for the detection and characterization of a wide range of cardiovascular diseases, as well as for monitoring response to therapy.
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Tapping CR, Thackeray AT, Bartlett RJV, Rowland-Hill C, Maliakal P. Evaluation of spinal dural arteriovenous fistulae with gadofosveset trisodium at 3 T (TRICKS and LAVA). Clin Radiol 2011; 66:865-8. [PMID: 21546012 DOI: 10.1016/j.crad.2011.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 02/04/2011] [Accepted: 02/15/2011] [Indexed: 11/16/2022]
Affiliation(s)
- C R Tapping
- Department of Radiology, Hull Royal Infirmary, Hull, UK
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First-Pass and High-Resolution Steady-State Magnetic Resonance Angiography of the Peripheral Arteries With Gadobenate Dimeglumine. Invest Radiol 2011; 46:307-16. [DOI: 10.1097/rli.0b013e3182021879] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Plaza Martínez Á, Carrera Díaz S, Alonso Álvarez M, Escudero J, Vaquero Puerta C, Cairols Castellote M, Riambau V, Lojo Rocamonde I, Gutiérrez Alonso V. Tratamiento endovascular de la patología obstructiva aortoiliaca. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Kinner S, Zenge MO, Heilmaier C, de Greiff A, Vogt FM, Ladd ME, Barkhausen J, Quick HH. Peripheral MRA with k-space segmentation and blood-pool contrast agent. Acad Radiol 2011; 18:113-9. [PMID: 20947388 DOI: 10.1016/j.acra.2010.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/06/2010] [Accepted: 08/11/2010] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to perform high-resolution contrast-enhanced peripheral multistation magnetic resonance angiography using a new blood-pool contrast agent (gadofosveset trisodium; Vasovist) while suppressing venous signal by using an acquisition scheme with k-space segmentation. MATERIALS AND METHODS Multistation peripheral magnetic resonance angiography with Vasovist was performed in 20 patients with known peripheral arterial occlusive disease. The k-space of the three-dimensional data sets was segmented such that the central parts were acquired during the first pass of the blood-pool agent, while the peripheral parts were acquired in the steady state. A third magnetic resonance angiographic data set acquired using the conventional technique served as comparison for venous overlay. Two radiologists blindly compared vessel sharpness, conspicuity, and venous contamination. Furthermore, a semiautomatic program to compare edge sharpness was used. Results were compared by means of Wilcoxon's signed rank sum test. RESULTS Comparison of vessel sharpness revealed statistically significant differences in favor of the fused data sets in all three stations. Arteries were depicted more sharply in the fused images and over longer parts, while veins were almost completely suppressed. CONCLUSIONS Peripheral contrast-enhanced magnetic resonance angiography with first-pass and steady-state k-space segmentation using a blood-pool contrast agent proved feasible and provided high-resolution data with sharp delineation of the arteries while reducing venous contamination.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
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Laurent S, Vander Elst L, Henrotte V, Muller RN. Noncovalent Binding of Some New Lipophilic Gadolinium DTPA Complexes to Human Serum Albumin. A Structure-Affinity Relationship. Chem Biodivers 2010; 7:2846-55. [DOI: 10.1002/cbdv.201000194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Moriarty JM, Finn JP, Fonseca CG. Contrast agents used in cardiovascular magnetic resonance imaging: current issues and future directions. Am J Cardiovasc Drugs 2010; 10:227-37. [PMID: 20653329 DOI: 10.2165/11539370-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Cardiovascular MRI is being increasingly used in the evaluation of ischemic heart disease, cardiac masses, complex congenital heart disease, and morphologic evaluation of the vascular anatomy throughout the body. Many and varied contrast media may be used to increase the sensitivity and specificity of detecting and evaluating various pathologies, and a knowledge of the different mechanisms of action, distributions and safety profiles of these agents is required for safe and effective imaging. This article reviews the currently available magnetic resonance (MR) contrast media, discusses the risks and benefits, and gives illustrated examples of current clinical applications in cardiovascular disease. A literature search covered the period 1990 to the present with the use of multiple databases including MEDLINE, PUBMED, SciSearch and Google Medical. All identified studies containing information relevant to the topic of cardiovascular MRI and cardiovascular MR contrast agents and their uses and properties were evaluated. Evaluation was limited to studies in English. The conclusions were that the use of contrast agents vastly increases the diagnostic yield, sensitivity and specificity of cardiovascular MRI in the non-invasive diagnosis of the full breadth of cardiovascular pathology. The use of contrast MRI for investigating ischemic heart disease, cardiac masses, and congenital heart disease and in angiography is now well established, and the referring physician, cardiologist, or radiologist requires an in-depth knowledge of the safety profiles and correct dosing of commonly prescribed contrast agents. As the number of MR contrast agents on the market continues to increase, knowledge of the basic mechanism of action is vital for keeping abreast of how new and emerging agents will affect clinical practice in the future.
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Affiliation(s)
- John M Moriarty
- Diagnostic Cardiovascular Imaging, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Chiribiri A, Morton G, Nagel E. Gadofosveset injection for magnetic resonance angiography. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/iim.10.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gerretsen SC, le Maire TF, Miller S, Thurnher SA, Herborn CU, Michaely HJ, Kramer H, Vanzulli A, Vymazal J, Wasser MN, Ballarati CEM, Kirchin MA, Pirovano G, Leiner T. Multicenter, double-blind, randomized, intraindividual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine for MR angiography of peripheral arteries. Radiology 2010; 255:988-1000. [PMID: 20501735 DOI: 10.1148/radiol.10090357] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare the image quality and diagnostic performance achieved with doses of gadobenate dimeglumine and gadopentetate dimeglumine of 0.1 mmol per kilogram of body weight in patients undergoing contrast material-enhanced magnetic resonance (MR) angiography of the pelvis, thigh, and lower-leg (excluding foot) for suspected or known peripheral arterial occlusive disease. MATERIALS AND METHODS Institutional review board approval was granted from each center and informed written consent was obtained from all patients. Between November 2006 and January 2008, 96 patients (62 men, 34 women; mean age, 63.7 years +/- 10.4 [standard deviation]; range, 39-86 years) underwent two identical examinations at 1.5 T by using three-dimensional spoiled gradient-echo sequences and randomized 0.1-mmol/kg doses of each agent. Images were evaluated on-site for technical adequacy and quality of vessel visualization and offsite by three independent blinded readers for anatomic delineation and detection/exclusion of pathologic features. Comparative diagnostic performance was determined in 31 patients who underwent digital subtraction angiography. Data were analyzed by using the Wilcoxon signed-rank, McNemar, and Wald tests. Interreader agreement was determined by using generalized kappa statistics. Differences in quantitative contrast enhancement were assessed and a safety evaluation was performed. RESULTS Ninety-two patients received both agents. Significantly better performance (P < .0001; all evaluations) with gadobenate dimeglumine was noted on-site for technical adequacy and vessel visualization quality and offsite for anatomic delineation and detection/exclusion of pathologic features. Contrast enhancement (P < or = .0001) and detection of clinically relevant disease (P < or = .0028) were significantly improved with gadobenate dimeglumine. Interreader agreement for stenosis detection and grading was good to excellent (kappa = 0.749 and 0.805, respectively). Mild adverse events were reported for four (six events) and five (eight events) patients after gadobenate dimeglumine and gadopentetate dimeglumine, respectively. CONCLUSION Higher-quality vessel visualization, greater contrast enhancement, fewer technical failures, and improved diagnostic performance are obtained with gadobenate dimeglumine, relative to gadopentetate dimeglumine, when compared intraindividually at 0.1-mmol/kg doses in patients undergoing contrast-enhanced MR angiography for suspected peripheral arterial occlusive disease.
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Affiliation(s)
- Suzanne C Gerretsen
- Dept of Cardiovascular MR Research, Maastricht Univ Hosp, Peter Debijelaan 25, 6229HX Maastricht, the Netherlands
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Giesel FL, Mehndiratta A, Essig M. High-relaxivity contrast-enhanced magnetic resonance neuroimaging: a review. Eur Radiol 2010; 20:2461-74. [PMID: 20567832 DOI: 10.1007/s00330-010-1805-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 11/25/2022]
Abstract
Evaluation of brain lesions using magnetic resonance imaging (MRI) provides information that is critical for accurate diagnosis, prognosis, therapeutic intervention and monitoring response. Conventional contrast-enhanced MR neuroimaging using gadolinium (Gd) contrast agents primarily depicts disruption of the blood-brain barrier, demonstrating location and extent of disease, and also the morphological details at the lesion site. However, conventional imaging results do not always accurately predict tumour aggressiveness. Advanced functional MRI techniques such as dynamic contrast-enhanced perfusion-weighted imaging utilise contrast agents to convey physiological information regarding the haemodynamics and neoangiogenic status of the lesion that is often complementary to anatomical information obtained through conventional imaging. Most of the Gd contrast agents available have similar T1 and T2 relaxivities, and thus their contrast-enhancing capabilities are comparable. Exceptions are gadobenate-dimeglumine, Gd-EOB-DTPA, Gadobutrol and gadofosveset, which, owing to their transient-protein-binding capability, possess almost twice (and more) the T1 and T2 relaxivities as other agents at all magnetic field strengths. Numerous comparative studies have demonstrated the advantages of the increased relaxivity in terms of enhanced image contrast, image quality and diagnostic confidence. Here we summarise the benefits of higher relaxivity for the most common neuroimaging applications including MRI, perfusion-weighted imaging and MRA for evaluation of brain tumours, cerebrovascular disease and other CNS lesions.
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Affiliation(s)
- Frederik L Giesel
- Department of Radiology E010, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
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Villaraza AJL, Bumb A, Brechbiel MW. Macromolecules, dendrimers, and nanomaterials in magnetic resonance imaging: the interplay between size, function, and pharmacokinetics. Chem Rev 2010; 110:2921-59. [PMID: 20067234 PMCID: PMC2868950 DOI: 10.1021/cr900232t] [Citation(s) in RCA: 469] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Aaron Joseph L. Villaraza
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ambika Bumb
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Martin W. Brechbiel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Kau T, Gasser J, Celedin S, Rabitsch E, Eicher W, Uhl E, Hausegger KA. MR angiographic follow-up of intracranial aneurysms treated with detachable coils: evaluation of a blood-pool contrast medium. AJNR Am J Neuroradiol 2009; 30:1524-30. [PMID: 19439482 DOI: 10.3174/ajnr.a1622] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Blood-pool agents are promising in the imaging of small vessels with slow or complex flow. Our aim was to compare blood-pool contrast-enhanced MR angiography (BPCE-MRA) using gadofosveset trisodium (Vasovist) with 3D time-of-flight MRA (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular therapy. MATERIALS AND METHODS We included 32 patients with a total of 37 coiled aneurysms. MRAs in the early steady-state phase were performed on a 1.5T scanner within 8 days of digital subtraction angiography (DSA). Two radiologists independently analyzed TOF-MRA and BPCE-MRA images. Consensus was reached by review involving a third neuroradiologist. DSA images were interpreted separately by an interventional radiologist. Findings were assigned to 1 of 3 categories: 1) complete occlusion, 2) residual neck, and 3) residual aneurysm. RESULTS Follow-up DSA demonstrated 13 complete obliterations (class 1), 13 residual necks (class 2), and 11 residual aneurysms (class 3). Weighted kappa statistics showed substantial concordance of TOF-MRA and DSA (0.664) as well as BPCE-MRA and DSA (0.724) ratings. Comparison between TOF-MRA and BPCE-MRA found excellent agreement (0.818) with only 6 (16.2%) discrepancies. For detecting residual flow, the difference in accuracy of both MRA techniques (83.8% versus 91.9%) was not significant (McNemar, P = 1.000). BPCE-MRA showed a tendency towards higher sensitivity and specificity (91.7% and 92.3%, respectively) compared with TOF-MRA (87.5% and 76.9%). CONCLUSIONS In classifying the completeness of endovascular cerebral aneurysm therapy, we found that BPCE-MRA and 3D TOF-MRA showed very good agreement. The use of Vasovist did not lead to a significantly increased accuracy of MRA follow-up.
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Affiliation(s)
- T Kau
- Institute of Diagnostic and Interventional Radiology, St. Veiter Strasse 47, Klagenfurt, Austria.
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Albrecht T, Willinek WA. Peripheral vascular imaging with a blood pool contrast agent: imaging strategies and influence on patient management. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s10406-009-0243-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Essig M, Rohrer M, Giesel F, Tüttenberg J, Weber MA, Michaely H, Gerigk L, Voth M. Human brain tumor imaging with a protein-binding MR contrast agent: initial experience. Eur Radiol 2009; 20:218-26. [DOI: 10.1007/s00330-009-1530-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 06/09/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
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Iezzi R, Soulez G, Thurnher S, Schneider G, Kirchin MA, Shen N, Pirovano G, Spinazzi A. Contrast-enhanced MRA of the renal and aorto-iliac-femoral arteries: comparison of gadobenate dimeglumine and gadofosveset trisodium. Eur J Radiol 2009; 77:358-68. [PMID: 19679417 DOI: 10.1016/j.ejrad.2009.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/10/2009] [Accepted: 07/16/2009] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Dedicated contrast agents are now available for contrast-enhanced magnetic resonance angiography (CE-MRA). This study retrospectively compares the safety and diagnostic performance data from Phase III regulatory trials performed to evaluate gadobenate dimeglumine (MultiHance(®)) and gadofosveset trisodium (Vasovist®)) for renal and peripheral CE-MRA. MATERIALS AND METHODS Similar examination and blinded assessment methodology was utilized in all studies to determine the safety and diagnostic performance of the agents for detection of significant (>50%) steno-occlusive disease. Digital Subtraction Angiography (DSA) was used as the standard of truth. Diagnostic performance data (sensitivity, specificity, predictive values [PVs], and likelihood ratios [LRs]) were compared (Chi-square test). RESULTS CE-MRA with gadobenate dimeglumine was more specific (92.4% vs. 80.5%, p < 0.0001) and accurate (83.6% vs. 77.1%, p = 0.022) than CE-MRA with gadofosveset in the detection of significant renal artery stenosis. The average sensitivity was higher for gadofosveset (74.4% vs. 67.3%, p = 0.011) in peripheral vessels although gadobenate dimeglumine was more specific (93.0% vs. 88.2%, p < 0.0001) with no difference in accuracy (86.6% vs. 86.3%, p = 0.66). PPVs were higher (p < 0.0001) for gadobenate dimeglumine in both vascular territories. Pre- to post-test shifts in the probability of detecting significant disease were greater after gadobenate dimeglumine. Adverse events in the renal and peripheral studies were reported by 9.2% and 7.7% of patients after gadobenate dimeglumine compared with 30.3% and 22.1% of patients after gadofosveset. CONCLUSION The diagnostic performance of CE-MRA for the detection of significant steno-occlusive disease is similar with gadofosveset and gadobenate dimeglumine although the rate of adverse events appears higher with gadofosveset.
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Affiliation(s)
- Roberto Iezzi
- Department of Radiology, Università G D'Annunzio, Chieti, Italy
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Gadofosveset-enhanced MR angiography of the pedal arteries in patients with diabetes mellitus and comparison with selective intraarterial DSA. Eur Radiol 2009; 19:2993-3001. [DOI: 10.1007/s00330-009-1501-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 05/12/2009] [Accepted: 05/22/2009] [Indexed: 01/23/2023]
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Magnetic resonance angiography: current status in the planning and follow-up of endovascular treatment in lower-limb arterial disease. Cardiovasc Intervent Radiol 2009; 32:397-405. [PMID: 19130124 DOI: 10.1007/s00270-008-9467-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 10/13/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
Magnetic resonance angiography (MRA) has become an established imaging modality in the management of lower-limb arterial disease, with emerging roles in treatment planning and follow-up. Contrast-enhanced MRA is now the most widely used technique with clinically acceptable results in the majority of patients. Difficulties in imaging and image interpretation are recognised in certain subgroups, including patients with critical limb ischaemia as well as patients with stents. Although newer contrast agents and refined imaging protocols may offer some solutions to these problems, this optimism is balanced by concerns about the toxicity of certain gadolinium chelates. Further development of interventional MRA remains one of the most significant challenges in the development of magnetic resonance imaging-guided peripheral vascular intervention. The status of MRA in managing patients with lower-limb arterial disease in current clinical practice is reviewed.
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Ghaghada K, Hawley C, Kawaji K, Annapragada A, Mukundan S. T1 relaxivity of core-encapsulated gadolinium liposomal contrast agents--effect of liposome size and internal gadolinium concentration. Acad Radiol 2008; 15:1259-63. [PMID: 18790397 DOI: 10.1016/j.acra.2008.04.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 04/22/2008] [Accepted: 04/23/2008] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Long circulating core-encapsulated gadolinium (CE-Gd) liposomal nanoparticles that have surface conjugated polyethylene glycol are a promising platform technology for use as blood pool T1-based magnetic resonance (MR) contrast agents. The objective of this study was to investigate the effect of liposome size and internal (core) Gd concentration on the T1 relaxivity of CE-Gd liposomes. MATERIALS AND METHODS Twelve different liposomal formulations were synthesized and characterized, resulting in a size (50, 100, 200, and 400 nm) and core Gd-concentration (200, 350, and 500 mM) "matrix" of test samples. Subsequently, CE-Gd liposomes were diluted in deionized water (four diluted samples) and molar T1 relaxivity (r1) measurements were performed at 2- and 7-T MR field strengths. RESULTS The r1 of CE-Gd liposomes was inversely related to the liposome size. The largest change in r1 was observed between liposomes that were extruded through 50- and 100-nm filter membranes. At both field strengths, the variation in internal gadolinium concentration did not show any significant correlation (alpha < or = 0.05) with r1. CONCLUSIONS The size of CE-Gd liposomal nanoparticles significantly affects the T1 relaxivity. An inverse relation was observed between liposome size and T1 relaxivity. The T1 relaxivity did not change significantly with core Gd concentration over the measured concentration range.
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Abstract
Gadofosveset (Vasovist®, Bayer Schering Pharma AG, Berlin/Germany) is the first intravascular contrast agent approved for use with magnetic resonance angiography in the European Union, Switzerland, Turkey, Canada, and Australia. Gadofosveset reversibly binds to albumin providing extended intravascular enhancement compared wth existing extracellular magnetic resonance contrast agents. Prior to approval, gadofosveset underwent extensive testing to evaluate the safety and efficacy of the drug; the clinical trials show that gadofosveset-enhanced magnetic resonance angiography (MRA) is safe and well tolerated in patients with vascular disease and effective for the detection of vascular stenosis and aneurysms gadofosveset has the potential to open new horizons in diagnostic MRA by increasing the spatial resolution and the robustness of MRA examinations and facilitating the examination of multiple vascular beds.
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Affiliation(s)
- Mathias Goyen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Hadizadeh DR, Gieseke J, Lohmaier SH, Wilhelm K, Boschewitz J, Verrel F, Schild HH, Willinek WA. Peripheral MR angiography with blood pool contrast agent: prospective intraindividual comparative study of high-spatial-resolution steady-state MR angiography versus standard-resolution first-pass MR angiography and DSA. Radiology 2008; 249:701-11. [PMID: 18769017 DOI: 10.1148/radiol.2492072033] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare the accuracy of high-spatial-resolution steady-state magnetic resonance (MR) angiography with standard-resolution first-pass MR angiography in the lower extremities, with digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS Institutional ethics committee approval and written informed consent were obtained. Twenty-seven patients (16 men, 11 women; mean age, 64.4 years +/- 14.8 [standard deviation]; range, 26-87 years) suspected of having or known to have peripheral arterial disease underwent first-pass and steady-state MR angiography and DSA. First-pass and steady-state MR angiography were performed in the same patient in the same session and with the same dose of blood pool contrast agent. The most severe stenosis grade of each evaluated segment was measured; sensitivity, specificity, and positive and negative predictive values were calculated at first-pass and steady-state MR angiography, with DSA as the reference standard. The kappa coefficient was used to measure the agreement between first-pass MR angiography, steady-state MR angiography, and DSA. RESULTS A total of 334 arterial segments were available for intraindividual comparison of first-pass MR angiography, steady-state MR angiography, and DSA in 27 patients. In 20 (74%) of 27 patients, the stenosis grade of at least one of the evaluated vessels differed at steady-state MR angiography from that at first-pass MR angiography. In total, stenosis grade was judged as higher at first-pass MR angiography than at DSA (overestimation) in 28 of 334 segments and as lower (underestimation) in 15 of 334 segments. The stenosis grade as judged at steady-state MR angiography matched with that at DSA in 334 of 334 vessel segments. CONCLUSION High-spatial-resolution steady-state MR angiography allowed for better agreement with DSA regarding stenosis grade in patients with arterial disease compared with standard-resolution arterial-phase first-pass MR angiography.
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Abstract
OBJECTIVE Current MRI technology and postprocessing tools have enabled 3D contrast-enhanced MR angiography (MRA) to evolve into a first-line noninvasive diagnostic tool to evaluate vascular disorders. CONCLUSION In this article, 3D MRA techniques, bolus timing issues, new IV contrast agents allowing a steady-state acquisition, principals of postprocessing, and unenhanced MRA techniques are reviewed and how to effectively use 3D gadolinium-enhanced MRA for peripheral arterial imaging is described.
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Perini R, Choe R, Yodh AG, Sehgal C, Divgi CR, Rosen MA. Non-invasive assessment of tumor neovasculature: techniques and clinical applications. Cancer Metastasis Rev 2008; 27:615-30. [DOI: 10.1007/s10555-008-9147-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Soulez G, Pasowicz M, Benea G, Grazioli L, Niedmann JP, Konopka M, Douek PC, Morana G, Schaefer FKW, Vanzulli A, Bluemke DA, Maki JH, Prince MR, Schneider G, Ballarati C, Coulden R, Wasser MN, McCauley TR, Kirchin MA, Pirovano G. Renal Artery Stenosis Evaluation: Diagnostic Performance of Gadobenate Dimeglumine–enhanced MR Angiography—Comparison with DSA. Radiology 2008; 247:273-85. [DOI: 10.1148/radiol.2471070711] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McGregor R, Vymazal J, Martinez-Lopez M, Neuwirth J, Salgado P, Beregi JP, Peduto A, de la Pena-Almaguer E, Slater GJ, Shamsi K, Parsons EC. A multi-center, comparative, phase 3 study to determine the efficacy of gadofosveset-enhanced magnetic resonance angiography for evaluation of renal artery disease. Eur J Radiol 2008; 65:316-25. [PMID: 17499952 DOI: 10.1016/j.ejrad.2007.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 01/26/2007] [Accepted: 03/20/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine prospectively the safety and efficacy of the blood-pool contrast agent gadofosveset trisodium in renal artery magnetic resonance angiography (MRA). MATERIALS AND METHODS Gadofosveset (0.03 mmol/kg) was administered to adult patients with known or suspected renal arterial disease in a multi-center phase 3 single dose study. The drug binds reversibly to albumin, prolonging the blood residence time, and allowing collection of images in the first-pass and steady-state phases. The combination of these images was compared to non-contrast MRA, using catheter X-ray angiography (XRA) as the standard of reference (SOR). All MRA images were collected at 1.5 T in one imaging session for direct comparison, and XRA within 30 days. Sensitivity, specificity, and accuracy for diagnosing significant disease (stenosis > or =50%) were calculated for MRA using three independent blinded readers. Patient safety was monitored for 72-96 h. RESULTS A total of 145 patients at 18 centers were enrolled and received gadofosveset; the 127 with complete efficacy data entered the primary efficacy analysis. Gadofosveset-enhanced MRA led to significant improvement (p<0.01) in sensitivity (+25%, +26%, +42%), specificity (+23%, +25%, +29%), and accuracy (+23%, +28%, +29%) over non-enhanced MRA for the three readers. The rate of uninterpretable examinations decreased from 30% to less than 2%. There were no serious adverse events, and the most common adverse events were nausea, pruritus, and headache (8% each). No significant trends in clinical chemistry parameters, nor significant changes in serum creatinine, were found following administration of gadofosveset. CONCLUSION In patients with known or suspected renal arterial disease, multi-phase gadofosveset-enhanced MRA significantly improves sensitivity, specificity, and accuracy versus non-enhanced MRA. Gadofosveset was safe and well tolerated in this patient population.
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