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

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

Abstract

Purpose

Late 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 methods

Forty 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.

Results

Using 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).

Conclusion

We 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.

Keywords

Heart Magnetic resonance imaging Contrast agents Scar 

Abbreviations

CI

Confidence interval

CMR

Cardiac magnetic resonance

CNR

Contrast-to-noise ratio

ECV

Extracellular volume

GBCA

Gadolinium-based contrast agents

GFR

Glomerular filtration rate

ICC

Intraclass correlation coefficients

LGE

Late gadolinium enhancement

LV

Left ventricle

MOLLI

Modified Look-Locker inversion recovery

PSIR

Phase-sensitive inversion recovery

SI

Signal intensity

SNR

Signal-to-noise ratio

SSFP

Steady-state free precession

Notes

Acknowledgements

We would like to particularly thank all the patients who participated in our study.

Funding

This study has received funding by Geurbet, LLC.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Professor James C. Carr, MD.

Conflict of interest

Dr. James Carr and Dr. Jeremy Collins are members of the advisory board of Guerbet, LLC.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Prospective

• Diagnostic study

• Performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Amir Ali Rahsepar
    • 1
    • 2
    Email author
  • Ahmadreza Ghasemiesfe
    • 1
    • 2
  • Kenichiro Suwa
    • 1
  • Ryan S. Dolan
    • 1
  • Monda L. Shehata
    • 1
  • Monica J. Korell
    • 1
  • Nivedita K. Naresh
    • 1
  • Michael Markl
    • 1
  • Jeremy D. Collins
    • 1
    • 3
  • James C. Carr
    • 1
  1. 1.Department of Radiology, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Department of Radiology, Yale New Haven HealthBridgeport HospitalBridgeportUSA
  3. 3.Department of RadiologyMayo ClinicRochesterUSA

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