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Endrikat J, Gutberlet M, Barkhausen J, Schöckel L, Bhatti A, Harz C, Hoffmann KT. Clinical Efficacy of Gadobutrol: Review of Over 25 Years of Use Exceeding 100 Million Administrations. Invest Radiol 2024; 59:345-358. [PMID: 37972293 DOI: 10.1097/rli.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Gadobutrol has been administered more than 100 million times worldwide, since February 1998, that is, over the last 25 years. Numerous clinical studies in a broad range of indications document the long-term experience with gadobutrol. OBJECTIVE The aim of this study was to provide a literature-based overview on gadobutrol's efficacy in 9 approved indications and use in children. MATERIALS AND METHODS Efficacy results in patients of all age groups including sensitivity, specificity, accuracy, and positive/negative predictive values were identified by a systematic literature search on Embase until December 31, 2022. Nine approved indications were considered: central nervous system (CNS), magnetic resonance angiography (MRA), breast, heart, prostate, kidney, liver, musculoskeletal, whole body, and various indications in children. RESULTS Sixty-five publications (10 phase III, 2 phase IV, 53 investigator-initiated studies) reported diagnostic efficacy results obtained from 7806 patients including 271 children, at 369 centers worldwide. Indication-specific sensitivity ranges were 59%-98% (CNS), 53%-100% (MRA), 80%-100% (breast), 64%-90% (heart), 64%-96% (prostate), 71-85 (kidney), 79%-100% (liver), 53%-98% (musculoskeletal), and 78%-100% (children). Indication-specific specificity ranges were 75%-100% (CNS), 64%-99% (MRA), 58%-98% (breast), and 47%-100% (heart). CONCLUSIONS The evaluated body of evidence, consisting of 65 studies with 7806 patients, including 271 children and 7535 adults, showed that gadobutrol is an efficacious magnetic resonance imaging contrast agent for all age groups in various approved indications throughout the whole body.
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Affiliation(s)
- Jan Endrikat
- From the Radiology, Bayer AG, Berlin, Germany (J.E., L.S., C.H.); Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany (J.E.); Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany (M.G.); Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein-Campus Luebeck, Luebeck, Germany (J.B.); Bayer US LLC, Benefit-Risk Management Pharmacovigilance, Whippany, NJ (A.B.); and Department of Neuroradiology, University of Leipzig, Leipzig, Germany (K.-T.H.)
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Cerne JW, Pathrose A, Singer AM, Moore JE, Serhal A, Aouad P, Umair M, Ragin A, Allen BD, Avery R, Markl M, Carr JC. MRA of the Supraaortic Vasculature: Comparison of Gadobutrol and Gadoterate Meglumine at 1.5 T. J Magn Reson Imaging 2021; 56:440-449. [PMID: 34953154 DOI: 10.1002/jmri.28044] [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: 10/13/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Gadobutrol (GB) and gadoterate meglumine (GM) are contrast agents used for contrast-enhanced magnetic resonance angiography (CEMRA). Supraaortic vasculature (SAV) CEMRAs are used to evaluate stroke risk and neurologic symptoms. There is a need to compare the SAV CEMRA image quality obtained with GB and GM. PURPOSE To intra-individually compare MRA images obtained with equimolar GB and GM at 1.5 T in the SAV. STUDY TYPE Prospective, crossover. POPULATION Twenty-eight subjects (54 ± 13 years; 17 female). FIELD STRENGTH/SEQUENCE 1.5 T; three-dimensional (3D) gradient recalled echo. ASSESSMENT Quantitative image quality was measured by normalized signal intensity (SIn ) [SIn = SI blood/SD blood] and contrast ratio (CR) [CR = SI blood/SI muscle], determined by an observer (JWC) with 1 year of vascular imaging experience. Three radiologists (AS, PA, and MU) with (5, 5, and 6 years of) vascular imaging experience evaluated image quality by Likert-scale ratings (of image impression, wall conspicuity, and artifact absence). STATISTICAL TESTS SIn and CR were compared with paired t-tests or Wilcoxon signed-rank tests and Bland-Altman plots. Qualitative ratings were compared with Wilcoxon signed-rank test. RESULTS No significant difference in SIn was found between GB and GM. CRs with GB were significantly higher than GM at the right common carotid (6.9 ± 2.5 vs. 4.8 ± 1), left internal carotid (7.3 ± 2 vs. 4.4 ± 1.2), right internal carotid (7.7 ± 2.2 vs. 5 ± 1.1), and left vertebral (6.6 ± 2.2 vs. 4.5 ± 1.1) arteries. Bland-Altman plots showed relatively greater differences between GB and GM at higher CRs and SIn s. GM showed significantly higher artifact than GB (3.56 ± 0.52 vs. 3.36 ± 0.46) and significantly lower overall image quality (10.73 ± 1.45 vs. 11.26 ± 1.58) at the left vertebral artery. DATA CONCLUSION At 1.5 T and equimolar demonstration, GB (0.1 mL/kg, i.e., 0.1 mmol/kg) showed higher CRs in the SAV compared to GM (0.2 mL/kg, i.e., 0.1 mmol/kg) at most vessels. Subjective image quality was not significantly different between the two agents for most vessels. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- John W Cerne
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alyssa M Singer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jackson E Moore
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - Ali Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pascale Aouad
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muhammad Umair
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Liu X, Zhang W, Li Z, Fu Y, Ren J, Shen W, Wang J, Xu Y, Song B. Improved display of abdominal contrast-enhanced MRA using gadobutrol: comparison with Gd-DTPA. Clin Radiol 2019; 74:978.e1-978.e7. [PMID: 31551147 DOI: 10.1016/j.crad.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023]
Abstract
AIM To qualitatively and quantitatively compare gadobutrol with gadopentetate dimeglumine (Gd-DTPA) in abdominal contrast-enhanced magnetic resonance angiography (CE-MRA) and contrast-enhanced magnetic resonance imaging (CE-MRI) during one-stop imaging. MATERIALS AND METHODS This prospective, blinded, multicentre, intra-individual comparison study was approved by the institutional review board. All patients underwent gadobutrol- and Gd-DTPA-enhanced MRA and MRI. Qualitative analysis for vessels was performed using a three-point scale while quantity analysis was performed by signal-to-noise ratio (SNR). Visceral organs enhancements were also analysed. A Wilcoxon matched-pair signed-rank test was used to evaluate the quality and quantity results. RESULTS One hundred and twelve patients were enrolled. Quality analyses results for large vessels and small vessels of gadobutrol and Gd-DTPA were 18.38±1.51 and 6.76±1.58 and 17.87±1.84 and 6.09±1.55, respectively. Wilcoxon signed-rank tests revealed gadobutrol was significantly superior to Gd-DTPA (p=0.036) for small vessels. For large vessel quantity analysis, gadobutrol demonstrated significantly higher signal-to-noise ratios (SNR; p=0.041) than Gd-DTPA, with mean values of 948.156±349.731 and 838.925±248.197. There was no statistically significant in enhancement of liver, spleen, and renal tissue during gadobutrol- and Gd-DTPA-enhanced imaging (p>0.05). One patient reported an adverse event. Dizziness and vomiting occurred after injection of Gd-DTPA. CONCLUSIONS The present study demonstrates gadobutrol-enhanced MRA was superior to that of Gd-DTPA without statistical significance in visceral organ enhancement. It indicates gadobutrol may be more suitable for abdominal one-stop imaging for CE-MRA and CE-MRI by improving depiction of vessels in MRA images.
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Affiliation(s)
- X Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - W Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Z Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Y Fu
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - J Ren
- Department of Radiology, Sichuan Cancer Hospital, Chengdu, Sichuan Province, China
| | - W Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin, Tianjin Province, China
| | - J Wang
- Department of Radiology, The Third Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong Province, China
| | - Y Xu
- Department of Radiology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - B Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Lee CH, Vellayappan B, Taupitz M, Hamm B, Asbach P. Dynamic contrast-enhanced MR imaging of the prostate: intraindividual comparison of gadoterate meglumine and gadobutrol. Eur Radiol 2019; 29:6982-6990. [PMID: 31264013 DOI: 10.1007/s00330-019-06321-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To intraindividually compare the signal-enhancing effect of 0.5 M gadoterate meglumine and 1.0 M gadobutrol in dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging of the prostate. METHODS Fifty patients who underwent two 3-T MR examinations of the prostate were included in this IRB-approved retrospective uncontrolled, unrandomized study. All received two scans (mean time interval, 20.5 months) including T1-weighted DCE-MR imaging, one with 0.5 M gadoterate meglumine and one with 1.0 M gadobutrol. Equimolar doses of gadolinium (0.1 mmol/kg body weight) were administered with identical injection speed (2 mL/s), resulting in differing gadolinium delivery rate. An identical region of interest (ROItz) within a BPH-node was identified on both scans. The area under the time-enhancement curve of each ROItz from 0 to 180 s post contrast arrival and pharmacokinetic parameters were calculated. Relative enhancement and signal-to-noise (SNR) and contrast-to-noise (CNR) ratios in the delayed phase at about 180 s were compared between both agents. RESULTS There was a significantly larger area under the time-enhancement curve (5.53 vs 4.97 p = 0.0007) and higher relative enhancement of BPH nodules (2.23 vs 1.96 p < 0.0001) with gadobutrol compared with gadoterate meglumine. There were no significant differences in SNR (44.55 vs 37.63 p = 0.12), CNR (31.22 vs 26.39 p = 0.18), and pharmacokinetic parameters Ktrans (0.31 vs 0.32 p = 0.86), Ve (1.36 vs 0.98 p = 0.13), and Kep (0.34 vs 0.36 p = 0.12). CONCLUSIONS At equimolar doses, increased gadolinium delivery over time using gadobutrol provides higher relative enhancement parameters in BPH nodules compared with gadoterate meglumine, but does not translate into improved SNR or CNR. KEY POINTS • At equal injection rate and equimolar total dose, gadobutrol compared with gadoterate meglumine provides a significantly greater relative enhancement in DCE-MR imaging of BPH over the first 180 s. • There are no significant differences in SNRs, CNRs, and pharmacokinetic parameters between the two GBCAs.
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Affiliation(s)
- Chau Hung Lee
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany. .,Department of Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Matthias Taupitz
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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Abstract
Intravenous gadobutrol [Gadovist™ (EU); Gadavist® (USA)] is a second-generation, extracellular non-ionic macrocyclic gadolinium-based contrast agent (GBCA) that is approved for use in paediatric (including term neonates) and adult patients undergoing diagnostic contrast-enhanced (CE) MRI for visualization of pathological lesions in all body regions or for CE MRA to evaluate perfusion and flow-related abnormalities. Its unique physicochemical profile, including its high thermostability and proton relaxation times, means that gadobutrol is formulated at twice the gadolinium ion concentration of other GBCAs, resulting in a narrower bolus and consequently, improved dynamic image enhancement. Based on > 20 years of experience in the clinical trial and real-world settings (> 50 million doses) and its low risk for developing nephrogenic systemic fibrosis (NSF), gadobutrol represents an effective and safe diagnostic GBCA for use in CE MRI and MRA to visualize pathological lesions and vascular perfusion and flow-related abnormalities in all body regions in a broad spectrum of patients, including term neonates and other paediatric patients, young and elderly adult patients, and those with moderate or severe renal or hepatic impairment or cardiovascular (CV) disease.
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Makino Y, Akimoto S, Hoshino H. [Influence of Different Contrast Agent Concentrations and Injection Protocols on Dynamic Contrast Enhanced MRI of Prostate: Equimolar Comparison of 1.0M Gadobutrol and 0.5M Gadolinium Chelates]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:685-691. [PMID: 30033962 DOI: 10.6009/jjrt.2018_jsrt_74.7.685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to evaluate the enhancement profile of 1.0M gadobutrol (high concentration: HC) in comparison to 0.5M gadopentetate dimeglumine and gadoterate meglumine (low concentration: LC) in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of prostate. In total, 48 patients who were diagnosed with prostate cancer by radiologist were included. Each patient was examined after intravenous injection of 0.1 mmol/kg body weight contrast agent with flow rate of 1.5 (HC) or 3.0 mL/s (LC). Circular regions of interest were placed at prostate cancer (PCa) and normal peripheral zone (normal PZ) in DCE-MRI. The enhancement curves were calculated as a relative enhancement. Statistical analysis was performed by Mann-Whitney U test (p<0.05 were considered significant). As a result, the enhancement at first phase of HC was significantly lower compared with LC in PCa (HC, 0.47; LC, 0.85; p=0.029), and in normal PZ (HC, 0.12; LC, 0.22; p=0.033). The enhancement of HC in PCa was significantly higher compared with LC at late phase. Although not significant, a similar tendency was observed in normal PZ. The present study suggested that the enhancement profile with HC was higher at late phase but the rise of the enhancement curve with HC tended to be delayed.
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Affiliation(s)
- Yuya Makino
- Department of Radiological Technology, Japan Community Health care Organization (JCHO) Sapporo Hokushin Hospital
| | - Satoru Akimoto
- Department of Radiological Technology, Japan Community Health care Organization (JCHO) Sapporo Hokushin Hospital
| | - Hirobumi Hoshino
- Department of Radiological Technology, Japan Community Health care Organization (JCHO) Sapporo Hokushin Hospital (Current address: Department of Radiological Technology, Japan Community Health care Organization (JCHO) Hokkaido Hospital)
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Noda Y, Goshima S, Namimoto T, Shinkawa N, Nakagawa M, Kajita K, Kawada H, Kawai N, Tanahashi Y, Matsuo M, Bae KT, Hirai T, Yamashita Y. Simultaneous acquisition of MR angiography and diagnostic images of abdomen at view-sharing multiarterial phases and comparing the effect of two different contrast agents. J Magn Reson Imaging 2017; 48:102-110. [PMID: 29247585 DOI: 10.1002/jmri.25925] [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] [Received: 10/09/2017] [Accepted: 11/21/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Simultaneous acquisition of magnetic resonance angiography (MRA) and diagnostic images is challenging in contrast-enhanced upper abdominal MRI. PURPOSE To evaluate the image quality of MRA of the abdomen acquired simultaneously with diagnostic MR images, and to compare the contrast effect, conspicuity of aortic branches, and pancreatic lesions in MRA between gadobutrol and gadoterate meglumine. STUDY TYPE Prospective. POPULATION Eighty-eight patients with known and suspected upper abdominal disease. FIELD STRENGTH/SEQUENCES 3T/4D-eTHRIVE (T1 -weighted fat-suppressed 3D fast gradient echo) for multiarterial phase imaging. ASSESSMENT The artery-to-muscle signal intensity ratio (SIR), conspicuity of aortic branches on the axial, maximum intensity projection (MIP), and volume-rendered (VR) images, and conspicuity of focal pancreatic lesions were compared between gadobutrol and gadoterate meglumine. The diameters of aortic branches were measured on axial MRA and computed tomography angiography (CTA) images and then compared. STATISTICAL TESTS Quantitative and qualitative data were assessed with the Mann-Whitney U-test. The diameters of aortic branches between MRA and CTA were compared with a Spearman rank correlation test. RESULTS View-sharing multiarterial phase imaging was successfully performed in all patients. The SIRs of common hepatic artery (P = 0.0051) and left renal artery (RA) (P = 0.045), vascular conspicuities of right and left hepatic arteries (P = 0.010 and 0.030) and right and left RAs on axial (P = 0.0065 and 0.036), and that of gastroduodenal artery on MIP (P = 0.039) with gadobutrol were significantly higher than those with gadoterate meglumine. The conspicuity of focal pancreatic lesions were comparable between the gadobutrol and gadoterate meglumine (P = 0.73). The vascular diameters on MRA and CTA were strongly correlated in all aortic branches (r = 0.842-0.942, P < 0.0001). DATA CONCLUSION High-quality MRA of the abdomen was obtained simultaneously with the diagnostic MR images using view-sharing multiarterial phase imaging that also demonstrated comparable image quality between gadobutrol and gadoterate meglumine. LEVEL OF EVIDENCE 2 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
| | | | - Tomohiro Namimoto
- Department of Diagnostic Radiology, Faculty of Medicine, Kumamoto University, Kumamoto, Japan
| | - Norihiro Shinkawa
- Department of Diagnostic Radiology, Faculty of Life Sciences, University of Miyazaki, Miyazaki, Japan
| | - Masataka Nakagawa
- Department of Diagnostic Radiology, Faculty of Medicine, Kumamoto University, Kumamoto, Japan
| | | | | | | | | | | | - Kyongtae T Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, University of Miyazaki, Miyazaki, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Medicine, Kumamoto University, Kumamoto, Japan
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Endrikat J, Anzalone N. Gadobutrol in India-A Comprehensive Review of Safety and Efficacy. MAGNETIC RESONANCE INSIGHTS 2017; 10:1178623X17730048. [PMID: 28932122 PMCID: PMC5598798 DOI: 10.1177/1178623x17730048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
Gadobutrol is a gadolinium (Gd)-based contrast agent for magnetic resonance imaging (MRI). In India, gadobutrol is approved for MRI of the central nervous system (CNS), liver, kidneys, breast and for MR angiography for patients 2 years and older. The standard dose for all age groups is 0.1 mmol/kg body weight. The safety profile has been demonstrated in 42 clinical phase 2 to 4 studies (>6800 patients), 7 observational studies, and by assessing pharmacovigilance data of 29 million applications. Furthermore, studies in children, adults, and elderly and in patients with impaired liver or kidney function did not show any increased adverse event rate. Diagnostic efficacy was demonstrated in numerous studies and various indications, such as diseases of the CNS, peripheral and supra-aortic vessels, kidneys, liver, and breast.
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Affiliation(s)
- Jan Endrikat
- Radiology, Bayer AG, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Nicoletta Anzalone
- Department of Neuroradiology, Scientific Institute HS Raffaele, Milan, Italy
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