Comprehensive evaluation of macroscopic and microscopic myocardial fibrosis by cardiac MR: intra-individual comparison of gadobutrol versus gadoterate meglumine View Full Text


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Article Info

DATE

2019-01-07

AUTHORS

Amir Ali Rahsepar, Ahmadreza Ghasemiesfe, Kenichiro Suwa, Ryan S. Dolan, Monda L. Shehata, Monica J. Korell, Nivedita K. Naresh, Michael Markl, Jeremy D. Collins, James C. Carr

ABSTRACT

PurposeLate gadolinium enhancement cardiac MR (LGE-CMR) and extracellular volume fraction (ECV-CMR) are widely used to evaluate macroscopic and microscopic myocardial fibrosis. Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the superior safety profile of these agents. We aimed to assess the performance of two macrocyclic contrast agents, gadoterate meglumine and gadobutrol, for the evaluation of myocardial scar.Material and methodsForty subjects (61 ± 11 years, 67.5% men) who underwent LGE-CMR using gadobutrol were prospectively recruited for a research CMR scan using same-dose gadoterate meglumine (0.2 mmol/kg) at 1.5 T. Myocardial scar quantification was performed using a short-axis phase-sensitive inversion recovery (PSIR) Turbo-FLASH and steady-state free precession (SSFP) images. Pre- and post-contrast T1-mapping was employed to assess myocardial ECV. An intraclass correlation coefficient (ICC) was used to check for reliability between the two contrast agents.ResultsUsing manual thresholding on PSIR Turbo-FLASH images, mean LGE scar percentage (LGE%) was 9.9 ± 9.7% and 9.4 ± 9.7% for gadobutrol and gadoterate meglumine, respectively (p > 0.05) (ICC: 0.99, 95% CI: 0.97–0.99). Using the PSIR SSFP technique and manual thresholding, LGE% averaged 7.5 ± 9.0% and 7.1 ± 8.6% for gadobutrol and gadoterate meglumine, respectively (p > 0.05) (ICC: 0.99, 95% CI: 0.98–0.99). Average ECV with gadobutrol and gadoterate meglumine were similar at 28.40 ± 4.88 and 28.46 ± 4.73 (p > 0.05) with a strong correlation (ICC: 0.98, 95% CI: 0.94–0.99).ConclusionWe found LGE- and ECV-CMR values derived from gadoterate meglumine comparable to values derived from gadobutrol. Gadoterate meglumine has a comparable performance to gadobutrol in identifying LGE-derived myocardial scar both qualitatively and quantitatively.Key Points• Late gadolinium-enhancement cardiac MR (LGE-MR) and extracellular volume (ECV) fraction are widely used to evaluate macroscopic and microscopic myocardial fibrosis.• Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the presumed superior safety profile of these agents.• LGE- and ECV-CMR values derived from gadoterate meglumine are comparable to values derived from gadobutrol. More... »

PAGES

4357-4367

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00330-018-5956-3

DOI

http://dx.doi.org/10.1007/s00330-018-5956-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111252633

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30617490


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    "description": "PurposeLate gadolinium enhancement cardiac MR (LGE-CMR) and extracellular volume fraction (ECV-CMR) are widely used to evaluate macroscopic and microscopic myocardial fibrosis. Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the superior safety profile of these agents. We aimed to assess the performance of two macrocyclic contrast agents, gadoterate meglumine and gadobutrol, for the evaluation of myocardial scar.Material and methodsForty subjects (61\u2009\u00b1\u200911\u00a0years, 67.5% men) who underwent LGE-CMR using gadobutrol were prospectively recruited for a research CMR scan using same-dose gadoterate meglumine (0.2\u00a0mmol/kg) at 1.5\u00a0T. Myocardial scar quantification was performed using a short-axis phase-sensitive inversion recovery (PSIR) Turbo-FLASH and steady-state free precession (SSFP) images. Pre- and post-contrast T1-mapping was employed to assess myocardial ECV. An intraclass correlation coefficient (ICC) was used to check for reliability between the two contrast agents.ResultsUsing manual thresholding on PSIR Turbo-FLASH images, mean LGE scar percentage (LGE%) was 9.9\u2009\u00b1\u20099.7% and 9.4\u2009\u00b1\u20099.7% for gadobutrol and gadoterate meglumine, respectively (p\u2009>\u20090.05) (ICC: 0.99, 95% CI: 0.97\u20130.99). Using the PSIR SSFP technique and manual thresholding, LGE% averaged 7.5\u2009\u00b1\u20099.0% and 7.1\u2009\u00b1\u20098.6% for gadobutrol and gadoterate meglumine, respectively (p\u2009>\u20090.05) (ICC: 0.99, 95% CI: 0.98\u20130.99). Average ECV with gadobutrol and gadoterate meglumine were similar at 28.40\u2009\u00b1\u20094.88 and 28.46\u2009\u00b1\u20094.73 (p\u2009>\u20090.05) with a strong correlation (ICC: 0.98, 95% CI: 0.94\u20130.99).ConclusionWe found LGE- and ECV-CMR values derived from gadoterate meglumine comparable to values derived from gadobutrol. Gadoterate meglumine has a comparable performance to gadobutrol in identifying LGE-derived myocardial scar both qualitatively and quantitatively.Key Points\u2022 Late gadolinium-enhancement cardiac MR (LGE-MR) and extracellular volume (ECV) fraction are widely used to evaluate macroscopic and microscopic myocardial fibrosis.\u2022 Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the presumed superior safety profile of these agents.\u2022 LGE- and ECV-CMR values derived from gadoterate meglumine are comparable to values derived from gadobutrol.", 
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34 schema:description PurposeLate gadolinium enhancement cardiac MR (LGE-CMR) and extracellular volume fraction (ECV-CMR) are widely used to evaluate macroscopic and microscopic myocardial fibrosis. Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the superior safety profile of these agents. We aimed to assess the performance of two macrocyclic contrast agents, gadoterate meglumine and gadobutrol, for the evaluation of myocardial scar.Material and methodsForty subjects (61 ± 11 years, 67.5% men) who underwent LGE-CMR using gadobutrol were prospectively recruited for a research CMR scan using same-dose gadoterate meglumine (0.2 mmol/kg) at 1.5 T. Myocardial scar quantification was performed using a short-axis phase-sensitive inversion recovery (PSIR) Turbo-FLASH and steady-state free precession (SSFP) images. Pre- and post-contrast T1-mapping was employed to assess myocardial ECV. An intraclass correlation coefficient (ICC) was used to check for reliability between the two contrast agents.ResultsUsing manual thresholding on PSIR Turbo-FLASH images, mean LGE scar percentage (LGE%) was 9.9 ± 9.7% and 9.4 ± 9.7% for gadobutrol and gadoterate meglumine, respectively (p > 0.05) (ICC: 0.99, 95% CI: 0.97–0.99). Using the PSIR SSFP technique and manual thresholding, LGE% averaged 7.5 ± 9.0% and 7.1 ± 8.6% for gadobutrol and gadoterate meglumine, respectively (p > 0.05) (ICC: 0.99, 95% CI: 0.98–0.99). Average ECV with gadobutrol and gadoterate meglumine were similar at 28.40 ± 4.88 and 28.46 ± 4.73 (p > 0.05) with a strong correlation (ICC: 0.98, 95% CI: 0.94–0.99).ConclusionWe found LGE- and ECV-CMR values derived from gadoterate meglumine comparable to values derived from gadobutrol. Gadoterate meglumine has a comparable performance to gadobutrol in identifying LGE-derived myocardial scar both qualitatively and quantitatively.Key Points• Late gadolinium-enhancement cardiac MR (LGE-MR) and extracellular volume (ECV) fraction are widely used to evaluate macroscopic and microscopic myocardial fibrosis.• Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the presumed superior safety profile of these agents.• LGE- and ECV-CMR values derived from gadoterate meglumine are comparable to values derived from gadobutrol.
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42 ConclusionWe
43 ECV
44 LGE
45 LGE-CMR
46 MR
47 MethodsForty subjects
48 SSFP technique
49 Turbo-FLASH
50 agents
51 assessment
52 cardiac MR
53 coefficient
54 comparable performance
55 comparison
56 comprehensive evaluation
57 contrast agents
58 contrast medium
59 correlation
60 correlation coefficient
61 evaluation
62 extracellular volume fraction
63 fibrosis
64 fraction
65 gadobutrol
66 gadoterate meglumine
67 images
68 intra-individual comparison
69 intraclass correlation coefficient
70 macrocyclic contrast agents
71 manual thresholding
72 materials
73 medium
74 meglumine
75 myocardial ECV
76 myocardial fibrosis
77 myocardial scar
78 myocardial scar assessment
79 myocardial scar quantification
80 percentage
81 performance
82 profile
83 quantification
84 reliability
85 safety profile
86 scans
87 scar
88 scar assessment
89 scar percentage
90 scar quantification
91 steady-state free precession images
92 strong correlation
93 subjects
94 superior safety profile
95 technique
96 thresholding
97 values
98 volume fraction
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