Impact on gadolinium anomaly in river waters in Tokyo related to the increased number of MRI devices in use

The Gd-based contrast agents utilized in magnetic resonance imaging are difficult to remove by usual sewage treatment technology, and they enter rivers in the discharges from waste water treatment plants. Gd anomaly in rivers has been considered depends on used amount of Gd-based contrast agents. In this study, variation of Gd anomaly in rivers of Tokyo was determined by comparisons to previously reported values. The range of anthropogenic Gd was 0.1-138.8 ppt with an average value of 35.5 ppt (n = 40); in particular, the anthropogenic Gd was significantly changed depending on the location of the waste water treatment plants, and the measurement revealed significant increases in the Gd anomaly in the range of 5.0-6.6 times compared to data obtained 22 years ago. This study highlights the necessary of continuous research in setting new public policies for medical practices.

Prospective intraindividual comparison of gadoterate and gadobutrol for cervical and intracranial contrast-enhanced magnetic resonance angiography

PURPOSE

Gadobutrol (GB) is reported to provide improved relaxivity and concentration compared to gadoterate (GT). This study was designed to intraindividually compare quantitative and qualitative enhancement characteristics of GB to GT in cervicocranial magnetic resonance angiography (MRA) of patients with cerebrovascular disease (CVD).

METHODS

Patients (n = 54) with CVD underwent two identical contrast-enhanced magnetic resonance angiography (CE-MRA) examinations of the cervical and intracranial vasculature in randomized order, using GB and GT in equimolar dose. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were obtained by two independent neuroradiologists, blinded to the applied contrast agents. Qualitative assessment was performed using a three-point scale with a focus on M1/M2 segments.

RESULTS

One thousand and twenty-six vessel segments were analyzed. GB revealed a significantly higher SNR (p = 0.032) and CNR (p = 0.031) in all vessel segments. GB featured a significantly higher SNR and CNR in thoracic (p = 0.022; p = 0.016) and cervical vessels (p = 0.03; p = 0.038), as well as in the posterior circulation (p = 0.012; p = 0.005). In blinded qualitative assessment, overall preference was given to GB (p = 0.02), showing a significant better delineation of the M1/M2 segments (p = 0.041).

CONCLUSION

Compared to GT, the use of GB results in a significantly higher SNR and CNR in cervical and cerebral CE-MRA, leading to a better delineation of the intracranial vasculature. Present results underline the potential of GB for improved CE-MRA assessment of vasculature in CVD patients.

Diagnostic value of gadobutrol versus gadopentetate dimeglumine in enhanced MRI of brain metastases

PURPOSE

To compare gadobutrol and gadopentetate dimeglumine (Gd-DTPA) contrast-enhanced magnetic resonance imaging (MRI) at 3T for visualizing brain metastases.

MATERIALS AND METHODS

The present randomized study included 60 consecutive patients with known or suspected brain metastases from systemic malignancies. Two enhanced cerebral MR scans were performed in each patient within an interval of 2-5 days using different contrast agents (gadobutrol or Gd-DTPA) at 3T. The dose of the contrast agents (0.1 mmol/kg Gd) was also identical. The axial T₁ FLAIR images at 3, 7, and 10 minutes after the injection of the contrast agent were obtained for evaluation. Two experienced radiologists performed subjective evaluation of the image quality, made the choice of the optimal images, and performed an objective evaluation including: signal-to-noise ratio (SNR) of the brain metastases, contrast-to-noise ratio (CNR), contrast enhancement (CE), contrast-to-brain ratio (CBR), and contrast enhancement ratio (CER) of the brain metastases.

RESULTS

Subjective evaluation showed that at 3, 7, and 10 minutes gadobutrol elicited higher scores (margin score: 3.56 ± 0.74 vs. 3.33 ± 0.93, 3.68 ± 0.57 vs. 3.45 ± 0.81, 3.58 ± 0.71 vs. 3.43 ± 0.76; interior score: 2.83 ± 0.42 vs. 2.63 ± 0.61, 2.86 ± 0.38 vs. 2.73 ± 0.52, 2.80 ± 0.42 vs. 2.69 ± 0.53; and overall score: 4.42 ± 0.98 vs. 4.09 ± 1.19, 4.57 ± 0.75 vs. 4.26 ± 1.05, 4.48 ± 0.83 vs. 4.21 ± 1.03, respectively) in displaying the details and overall lesions than Gd-DTPA (repeated measures analysis of variance [ANOVA], margin score: P = 0.001, < 0.0001, 0.006; interior score: P < 0.0001, 0.004, 0.009; and overall score: P = 0.001, < 0.0001, < 0.0001, respectively). Subjective optimal image evaluation showed that the percentage of image assessed as "gadobutrol was better than Gd-DTPA (41.2-44.1%)" was greater than that assessed as "Gd-DTPA was better than gadobutrol (5.9-26.5%)." Objective evaluation showed that at 3, 7, and 10 minutes the SNR (214.17 ± 85.70 vs. 199.57 ± 85.08, 214.80 ± 86.03 vs. 199.19 ± 84.74, and 213.83 ± 82.46 vs. 193.68 ± 79.59, respectively), CNR (68.64 ± 50.18 vs. 57.88 ± 51.06, 75.42 ± 53.19 vs. 63.74 ± 53.91, and 77.13 ± 51.86 vs. 63.21 ± 51.71, respectively), CE (101.76 ± 63.31 vs. 87.61 ± 64.85, 99.85 ± 61.56 vs. 85.08 ± 64.98, and 100.33 ± 58.63 vs. 82.73 ± 61.73, respectively), CBR (0.48 ± 0.32 vs. 0.40 ± 0.33, 0.54 ± 0.34 vs. 0.46 ± 0.35, and 0.56 ± 0.34 vs. 0.47 ± 0.34, respectively), and CER (0.99 ± 0.69 vs. 0.88 ± 0.81, 0.97 ± 0.68 vs. 0.86 ± 0.84, and 0.98 ± 0.65 vs. 0.85 ± 0.80, respectively) were all higher when using gadobutrol compared with Gd-DTPA in the enhanced MR (repeated measures ANOVA, all P < 0.0001). On Gd-DTPA enhanced images, 289, 292, and 292 lesions at 3, 7, and 10 minutes were detected by the two radiologists, while 295, 301, and 301 lesions were detected on gadobutrol-enhanced images, respectively.

CONCLUSION

Using a 3T T₁ FLAIR sequence, gadobutrol (0.1 mmol/kg body weight)-enhanced MR resulted in more conspicuous brain metastases, and more metastases compared with the same dose of Gd-DTPA. A delay time of 7 minutes for postcontrast MRI in patients with brain metastases is suggested in clinical practice.

LEVEL OF EVIDENCE

2 J. MAGN. RESON. IMAGING 2017;45:1827-1834.

Diverse patterns of perilymphatic space enhancement in the rat inner ear after intratympanic injection of two different types of gadolinium: a 9.4-tesla magnetic resonance study

OBJECTIVE

To compare the quality of perilymphatic enhancement in the rat inner ear after intratympanic injection of two types of gadolinium with a 9.4-tesla micro-MRI.

MATERIALS AND METHODS

Gadolinium was injected into the middle ear in 6 Sprague-Dawley rats via the transtympanic route. The left ear was injected with Gd-DO3A-butrol first, and then the right ear was injected with Gd-DOTA. MR images of the inner ear were acquired 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4 h after intratympanic (IT) injection using an Agilent MRI system 9.4T/160/AS. The normalized signal intensity was quantitatively analyzed at the scala vestibuli (SV), scala media, and scala tympani (ST) using a Marosis M-view system. Then the normalized signal intensities (SIs) were compared between the two contrast agents.

RESULTS

For Gd-DO3A-butrol, the SI was as low as 1.0-1.5 throughout 1-4 h at the SV and ST of the basal turn. The maximum SI was 1.5 ± 0.5 at the SV (2 h) and 1.3 ± 0.5 at the ST (2 h). For Gd-DOTA, the 1-hour postinjection SI at the basal turn was 2.5 ± 0.5 at the SV, 1.6 ± 0.3 at the ST, and 1.2 ± 0.3 at the scala media. In the apical turn, the maximum SI was reached after 2.5 h. The maximum SI in the apical turn was 1.8 ± 0.4 at the SV (3.5 h), 1.8 ± 0.4 at the ST (4 h), and 1.4 ± 0.3 at the scala media (4 h).

CONCLUSIONS

We were able to clearly visualize and separate the ST and SV using IT Gd and 9.4-tesla micro-MRI. We recommend using Gd-DO3A-butrol over Gd-DOTA and to perform the MRI 2.5 h after using IT Gd in the rat inner ear.

Effect of imaging time in the magnetic resonance detection of intracerebral metastases using single dose gadobutrol

OBJECTIVE

To compare the effect of imaging time delay on the MR detection of intracerebral metastases using single dose gadobutrol.

MATERIALS AND METHODS

Twenty-one patients with intracerebral metastases underwent contrast-enhanced MR with three-dimensional T1-weighted sequence at 1 minute, 5 minutes and 10 minutes after a single dose injection of gadobutrol. One hundred index metastatic lesions (1 to 30 mm; median, 7 mm) were chosen for the analysis. For the qualitative analysis, lesion conspicuity were assessed on a 1 (worst) to 5 (best) scale of the index lesions by an expert reader. For the quantitative analysis, signal intensity (SI) of enhancing lesions and normal parenchyma was measured to determine the contrast rate (CR, %) ([postcontrast SI lesion - postcontrast SI white matter] × 100 / postcontrast SI white matter) and the enhancement rate (ER, %) ([postcontrast SI lesion - baseline SI gray matter] × 100 / baseline SI gray matter). Statistical comparisons were made between three different time delays.

RESULTS

Lesion conspicuity did not differ significantly among the three time delays (p = 0.097). Although the SI, CR and ER of lesions did not reveal any significant difference between 1 minute and 5 minutes delayed images, both the 1 minute and 5 minutes delayed images showed significantly higher CRs of lesions compared with the 10 minutes delayed images (p = 0.004 and p = 0.001, respectively).

CONCLUSION

With single dose gadobutrol, imaging time delay did not have an effect on lesion conspicuity. Both 1-minute and 5-minute-delayed imaging after gadobutrol injection appears to be effective for the detection of intracerebral metastases.

Dynamic and static magnetic resonance angiography of the supra-aortic vessels at 3.0 T: intraindividual comparison of gadobutrol, gadobenate dimeglumine, and gadoterate meglumine at equimolar dose

PURPOSE

The purpose of this study was the intraindividual comparison of a 1.0 M and two 0.5 M gadolinium-based contrast agents (GBCA) using equimolar dosing in dynamic and static magnetic resonance angiography (MRA) of the supra-aortic vessels.

MATERIALS AND METHODS

In this institutional review board-approved study, a total of 20 healthy volunteers (mean ± SD age, 29 ± 6 years) underwent 3 consecutive supra-aortic MRA examinations on a 3.0 T magnetic resonance system. The order of GBCA (Gadobutrol, Gadobenate dimeglumine, and Gadoterate meglumine) was randomized with a minimum interval of 48 hours between the examinations. Before each examination and 45 minutes after each examination, circulatory parameters were recorded. Total GBCA dose per MRA examination was 0.1 mmol/kg with a 0.03 mmol/kg and 0.07 mmol/kg split for dynamic and static MRA, respectively, injected at a rate of 2 mL/s. Two blinded readers qualitatively assessed static MRA data sets independently using pairwise rankings (superior, inferior, and equal). In addition, quantitative analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) evaluation as well as vessel sharpness analysis of static MRA using an in-house-developed semiautomated tool. Dynamic MRA was evaluated for maximal SNR. Statistical analysis was performed using the Cohen κ, the Wilcoxon rank sum tests, and mixed effects models.

RESULTS

No significant differences of hemodynamic parameters were observed. In static MRA, Gadobutrol was rated superior to Gadoterate meglumine (P < 0.05) and equal to Gadobenate dimeglumine (P = 0.06) with good to excellent reader agreement (κ, 0.66-0.83). In static MRA, SNR was significantly higher using 1.0 M Gadobutrol as compared with either 0.5 M agent (P < 0.05 and P < 0.05) and CNR was significantly higher as compared with Gadoterate meglumine (P < 0.05), whereas CNR values of Gadobutrol data sets were not significantly different as compared with Gadobenate dimeglumine (P = 0.13). Differences in CNR between Gadobenate dimeglumine and Gadoterate meglumine were not significant (P = 0.78). Differences in vessel sharpness between the different GBCAs were also not significant (P > 0.05). Maximal SNR in dynamic MRA using Gadobutrol was significantly higher than both comparators at the level of the proximal and distal internal carotid artery (P < 0.05 and P < 0.05; P < 0.05 and P < 0.05).

CONCLUSIONS

At equimolar doses, 1.0 M Gadobutrol demonstrates higher SNR/CNR than do Gadobenate dimeglumine and Gadoterate meglumine, with superior image quality as compared with Gadoterate meglumine for dynamic and static carotid MRA. Despite the shortened bolus with Gadobutrol, no blurring of vessel edges was observed.

Contrast-enhanced MR imaging in neuroimaging

MR imaging without and with gadolinium-based contrast agents (GBCAs) is an important imaging tool for defining normal anatomy and characteristics of lesions. GBCAs have been used in contrast-enhanced MR imaging in defining and characterizing lesions of the central nervous system for more than 20 years. The combination of unenhanced and GBCA-enhanced MR imaging is the clinical gold standard for the noninvasive detection and delineation of most intracranial and spinal lesions. MR imaging has a high predictive value that rules out neoplasm and most inflammatory and demyelinating processes of the central nervous system.

Cerebral neoplastic enhancing lesions: multicenter, randomized, crossover intraindividual comparison between gadobutrol (1.0M) and gadoterate meglumine (0.5M) at 0.1 mmol Gd/kg body weight in a clinical setting

OBJECTIVE

Two macrocyclic extracellular contrast agents, one-molar neutral gadobutrol and ionic gadoterate meglumine, were compared to determine the overall preference for one or the other in a clinical setting.

MATERIALS AND METHODS

Multicenter, randomized, single-blind, intra-individually controlled, comparison study with a corresponding blinded read. Efficacy analysis was based on 136 patients who underwent identical MRI examinations: group A first received 1.0M gadobutrol followed by 0.5M gadoterate meglumine 48 h to 7 days later; group B had a reversed administration order. Three independent blinded readers assessed off-site their overall diagnostic preference (primary efficacy parameter) based on a matched pairs approach.

RESULTS

Superiority of gadobutrol over gadoterate meglumine was demonstrated for the qualitative assessment of overall preference across all readers by a statistically significant difference between both contrast agents for this primary endpoint. Preferences in lesion enhancement (secondary endpoint) were also found significantly in favor of gadobutrol. For preference in lesion delineation from surrounding tissue/edema and for internal structure only a trend towards a higher proportion for gadobutrol was found (except for internal structure reported by one reader, which showed a result of statistical significance). Lesion contrast and relative lesion enhancement (quantitative parameters) were statistically significantly higher for gadobutrol compared to gadoterate meglumine.

CONCLUSION

Contrast-enhanced MRI of neoplastic brain lesions at a dose of 0.1 mmol Gd/kg body weight, assessed in a standardized off-site blinded reading, results in a significantly higher qualitative and quantitative preference for gadobutrol compared to gadoterate meglumine.