Usage of the T1 effect of an iron oxide contrast agent in an animal model to quantify myocardial blood flow by MRI

[Cardiac magnetic resonance imaging: from imaging to diagnosis]

Cardiac magnetic resonance imaging (CMR) has evolved over the past 20 years from a research-based imaging modality to an indispensable routine procedure in cardiac diagnostics. In addition to the morphological representation of cardiac anatomy, whereby only noninvasive multidetector computed tomography (MDCT) is superior, another strength of CMR is the assessment of cardiac function and tissue differentiation. This requires that the radiologist performing the examination and analyzing the results has good knowledge of cardiac and thoracic anatomy and a detailed knowledge of the various cardiovascular diseases, hemodynamics, and pathophysiology. CMR reliably allows determination of a range of easy to determine quantitative parameters such as ventricular ejection fraction and also the valvular regurgitation fraction, which allows objective assessment of cardiac function. Especially the possibility to differentiate inflamed, viable, and ischemic tissue using adenosine stress MRI in the last 10 years has led to routine use of CMR. Even compared to competing nuclear medicine procedures, CMR is important for treatment decision-making and for prognosis estimation, thus, making it an indispensable component of cardiovascular diagnostics.

Optimized pharmacokinetic modeling for the detection of perfusion differences in skeletal muscle with DCE-MRI: effect of contrast agent size

PURPOSE

The goal of this study was to optimize dynamic contrast-enhanced (DCE)-MRI analysis for differently sized contrast agents and to evaluate the sensitivity for microvascular differences in skeletal muscle.

METHODS

In rabbits, pathophysiological perfusion differences between hind limbs were induced by unilateral femoral artery ligation. On days 14 and 21, DCE-MRI was performed using a medium-sized contrast agent (MCA) (Gadomer) or a small contrast agent (SCA) (Gd-DTPA). Acquisition protocols were adapted to the pharmacokinetic properties of the contrast agent. Model-based data analysis was optimized by selecting the optimal model, considering fit error, estimation uncertainty, and parameter interdependency from three two-compartment pharmacokinetic models (normal and extended generalized kinetic models and Patlak model). Model-based parameters were compared to the model-free parameter area-under-curve (AUC). Finally, the sensitivity of transfer constant Krans and AUC for physiological and pathophysiological microvascular differences was evaluated.

RESULTS

For the MCA, the optimal model included Ktrans and plasma fraction nu(p). For the SCA, Ktrans and interstitial fraction nu(e) should be incorporated. For the MCA, Ktrans were (4.8 +/- 0.2) x 10(-3) min(-1) (mean standard error) and (3.6 +/- 0.1) x 10(-3) min(-1) for the red soleus and white tibialis muscle, respectively, p < 0.01. With the SCA, Ktrans were (81 +/- 5) x 10(-3) min(-1) (soleus) and (66 +/- 5) x 10(-3) min(-1) (tibialis) p < 0.01. In the ischemic limb, Ktrans was significantly decreased relative to the control limb (soleus: 15%-20%; tibialis: 5%-10%). Similar differences in AUC were found for both contrast agents.

CONCLUSIONS

For optimal estimation of microvascular parameters, both model-based and model-free analysis should be adapted to the pharmacokinetic properties of the contrast agent. The detection of microvascular differences based on both Ktrans and AUC was most sensitive when the analysis strategy was tailored to the contrast agent used. The MCA was equally sensitive for microvascular differences as the SCA, with the advantage of improved spatial resolution.

Vessel growth and function: depiction with contrast-enhanced MR imaging

Magnetic resonance (MR) imaging is a versatile noninvasive diagnostic tool that can be applied to the entire human body to revealing morphologic, functional, and metabolic information. The authors review how MR imaging can depict both the established and the developing vasculature with techniques involving intravenously administered contrast agents. In addition to macrovascular morphology and flow, MR imaging is able to exploit microvascular properties, including vessel size distribution, hyperpermeability, flow heterogeneity, and possibly also upregulation of endothelial biomarkers. For each MR method, the basic principles, potential acquisition and interpretation pitfalls, solutions, and applications are described. Furthermore, discussion includes current shortcomings and the impact of future developments (eg, higher magnetic field strength systems, targeted macromolecular contrast agents) on the visualization of blood vessel growth and function with contrast-enhanced MR imaging.