Macrocyclic contrast agents for magnetic resonance imaging of chronic myocardial infarction: intraindividual comparison of gadobutrol and gadoterate meglumine.

OBJECTIVES: To compare 0.15 mmol/kg gadobutrol for late gadolinium enhancement (LGE) imaging of chronic myocardial infarction with a relaxivity-adjusted dose of gadoterate meglumine (Gd-DOTA). METHODS: Seventeen patients with suspected chronic myocardial infarction underwent LGE imaging at 1.5 T, acquiring an inversion-recovery-prepared gradient echo sequence 15 min after contrast agent administration. Each patient underwent LGE imaging twice, once after administration of 0.15 mmol/kg gadobutrol (r1 = 5.2 l mmol(-1) s(-1)) and after 0.22 mmol/kg Gd-DOTA (r1 = 3.6 l mmol(-1) s(-1)). Two readers independently determined infarct size and contrast-to-noise ratios of infarcted myocardium to remote myocardium (CNR(remote)) and to the left ventricular lumen (CNR(lumen)). RESULTS: LGE was present in 14 patients. Infarct sizes determined after administration of gadobutrol [23.4 ml; 95 % CI (14.4; 32.5)] and Gd-DOTA [22.1 ml; 95 % CI (13.0; 31.1)] were not statistically different (P = 0.22). The CNR(remote) of LGE in infarcted myocardium on gadobutrol- and Gd-DOTA-enhanced images was 44.1 [95 % CI (31.0; 57.1)] and 45.2 [95 % CI (32.2; 58.3)], respectively (P = 0.73). CNR(lumen) was significantly higher on gadobutrol-enhanced LGE images [12.7; 95 % CI (2.5; 23.0) versus 6.8; 95 % CI (-3.5; 17.0); P = 0.02]. CONCLUSION: At relaxivity-adjusted doses, gadobutrol and Gd-DOTA yielded similar infarct sizes with superior contrast between infarcted myocardium and left ventricular lumen on gadobutrol-enhanced images.

Accuracy of coronary artery calcium scoring with tube current reduction by 75%, using an adaptive iterative reconstruction algorithm.

OBJECTIVE: To assess the accuracy of an iterative reconstruction (IR) technique for coronary artery calcium scoring with reduced radiation dose. METHODS: 163 consecutive patients underwent twofold scanning by 320-row detector CT at 120 kVp. A low-dose scan at 25% tube current but with standard scan length (14 cm) was followed by a standard dose scan with routine tube current but reduced scan length (10 cm). Reduced dose images were constructed using filtered back-projection (FBP) and IR (adaptive iterative dose reduction in three dimensions). The standard dose scan reconstructed with FBP served as the gold standard for comparisons. Image noise and Agatston coronary calcium scores were determined and compared between the groups. RESULTS: Compared with FBP at standard dose, noise at reduced dose increased markedly with FBP but remained low with IR. Mean Agatston score with FBP at reduced dose showed a significant increase as compared with FBP at standard dose. No significant difference was observed when applying IR at reduced dose. At reduced dose, 38 (23.3%) patients were reassigned to a different cardiovascular risk category with FBP but only 8 (4.9%) with IR. Out of 47 patients with a zero Agatston score, 15 patients (31.9%) were false-positive with FBP at reduced dose, but no false positives were found with IR. CONCLUSION: IR allows accurate coronary artery calcium scoring with a radiation dose reduced by 75%. Advances in knowledge: The application of adaptive iterative dose reduction in three dimensions allows the maintenance of accurate Agatston scores and risk stratification at significantly reduced tube current, thus reducing the patient's exposure to ionizing radiation.

Individual selection of X-ray tube settings in computed tomography coronary angiography: Reliability of an automated software algorithm to maintain constant image quality.

OBJECTIVES: To evaluate a software tool that claims to maintain a constant contrast-to-noise ratio (CNR) in high-pitch dual-source computed tomography coronary angiography (CTCA) by automatically selecting both X-ray tube voltage and current. METHODS: A total of 302 patients (171 males; age 61±12years; body weight 82±17kg, body mass index 27.3±4.6kg/cm(2)) underwent CTCA with a topogram-based, automatic selection of both tube voltage and current using dedicated software with quality reference values of 100kV and 250mAs/rotation (i.e., standard values for an average adult weighing 75kg) and an injected iodine load of 222mg/kg. RESULTS: The average radiation dose was estimated to be 1.02±0.64mSv. All data sets had adequate contrast enhancement. Average CNR in the aortic root, left ventricle, and left and right coronary artery was 15.7±4.5, 8.3±2.9, 16.1±4.3 and 15.3±3.9 respectively. Individual CNR values were independent of patients' body size and radiation dose. However, individual CNR values may vary considerably between subjects as reflected by interquartile ranges of 12.6-18.6, 6.2-9.9, 12.8-18.9 and 12.5-17.9 respectively. Moreover, average CNR values were significantly lower in males than females (15.1±4.1 vs. 16.6±11.7 and 7.9±2.7 vs. 8.9±3.0, 15.5±3.9 vs. 16.9±4.6 and 14.7±3.6 vs. 16.0±4.1 respectively). CONCLUSION: A topogram-based automatic selection of X-ray tube settings in CTCA provides diagnostic image quality independent of patients' body size. Nevertheless, considerable variation of individual CNR values between patients and significant differences of CNR values between males and females occur which questions the reliability of this approach.

Intraindividual comparison of T1 relaxation times after gadobutrol and Gd-DTPA administration for cardiac late enhancement imaging.

PURPOSE: To evaluate T1-relaxation times of chronic myocardial infarction (CMI) using gadobutrol and gadopentetate dimeglumine (Gd-DTPA) over time and to determine the optimal imaging window for late enhancement imaging with both contrast agents. MATERIAL AND METHODS: Twelve patients with CMI were prospectively included and examined on a 1.5 T magnetic resonance (MR) system using relaxivity-adjusted doses of gadobutrol (0.15 mmol/kg) and Gd-DTPA (0.2 mmol/kg) in random order. T1-relaxation times of remote myocardium (RM), infarcted myocardium (IM), and left ventricular cavity (LVC) were assessed from short-axis TI scout imaging using the Look-Locker approach and compared intraindividually using a Wilcoxon paired signed-rank test (α<0.05). RESULTS: Within 3 min of contrast agent administration (CA), IM showed significantly lower T1-relaxation times than RM with both contrast agents, indicating beginning cardiac late enhancement. Differences between gadobutrol and Gd-DTPA in T1-relaxation times of IM and RM were statistically not significant through all time points. However, gadobutrol led to significantly higher T1-relaxation times of LVC than Gd-DTPA from 6 to 9 min (220 ± 15 ms vs. 195 ± 30 ms p<0.01) onwards, resulting in a significantly greater ΔT1 of IM to LVC at 9-12 min (-20 ± 35 ms vs. 0 ± 35 ms, p<0.05) and 12-15 min (-25 ± 45 ms vs. -10 ± 60 ms, p<0.05). Using Gd-DTPA, comparable ΔT1 values were reached only after 25-35 min. CONCLUSION: This study indicates good delineation of IM to RM with both contrast agents as early as 3 min after administration. However, we found significant differences in T1 relaxation times with greater ΔT1 IM-LVC using 0.15 mmol/kg gadobutrol compared to 0.20 mmol/kg Gd-DTPA after 9-15 min post-CA suggesting earlier differentiability of IM and LVC using gadobutrol.