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  • Title: Ultra low-dose of gadobenate dimeglumine for late gadolinium enhancement (LGE) imaging in acute myocardial infarction: a feasibility study.
    Author: Galea N, Francone M, Zaccagna F, Ciolina F, Cannata D, Algeri E, Agati L, Catalano C, Carbone I.
    Journal: Eur J Radiol; 2014 Dec; 83(12):2151-2158. PubMed ID: 25293818.
    Abstract:
    PURPOSE: To assess the feasibility of using an ultra-low dose (0.05 mmol/kg of body weight [BW]) of high relaxivity contrast agent for late gadolinium enhancement (LGE) imaging in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: 17 consecutive patients (mean age, 60.1 ± 10.3 years) with ST-segment elevation AMI underwent two randomized cardiac magnetic resonance studies (exam intervals between 24 and 48h) on a 1.5T unit during the first week after the event using gadobenate dimeglumine (Gd-BOPTA) at the dose of 0.1 mmol/kg BW (standard dose or SD group) and 0.05 mmol/kg BW (half dose or HD group). Image quality was qualitatively assessed. Quantitative analysis of LGE were performed by measuring signal intensity (SI), signal-to-noise ratio (SNR) in the infarcted myocardium (IM), non-infarcted myocardium (N-IM) and left ventricular cavity (LVC) in images acquired at 1, 3, 5, 10, 15 and 20 min after administration of Gd-BOPTA using both contrast media protocol. Contrast-to-noise ratio (CNR) between IM and N-IM (CNR IM/N-IM) and between IM and LVC (CNR IM/LVC) were also quantified for each time point. Moreover the extent of infarcted myocardium was measured. RESULTS: 102 LGE images were evaluated for each dose group. Quality score was significantly higher for SD at 1, 15 and 20 min (0.002<p<0.046) and for HD at 5 min (p=0.013). SNR has been higher in the SD group compared to the HD group even though not statistically significant at any time-point for both IM (SD vs. HD: 87.7 ± 73 vs. 65 ± 66; 0.15<p<0.38) and N-IM (SD vs. HD: 22 ± 61 vs. 9.9 ± 6.5; 0.09<p<0.43). LVC SNR was significantly higher with SD at 10 min (p=0.03), 15 min (p=0.001) and 20 min (p=0.004). CNR between the IM and N-IM was significantly higher using SD compared to HD (1382.24 ± 1049 vs. 695.4 ± 500; 0.000<p<0.028) at 10, 15 and 20 min. No significant differences in CNR IM/LVC were noted for HD acquired 5 min after CM administration compared to SD acquired at 10 (p=0.34), 15 (p=0.96) and 20 (p=0.41) min, and between HD at 10 min compared to SD acquired at 15 min (p=0.78) and 20 min (p=0.32). Good correlation between SD and HD (0.56<r(2)<0.85, p<0.024) was found at all time-points in the measuring of IA. CONCLUSION: The use of a 0.05 mmol/kg dose of gadobenate dimeglumine is feasible for LGE imaging of acute MI and the best image quality is obtained at 5 min after contrast administration. It could be beneficial in patient with renal failure and a solution to improve the identification of subendocardial infarction reducing examination time, costs and total gadolinium load. However, the standard dose of 0.1 mmol/kg provides overall better image quality, with the best performance obtained at the delay of 10 min or more after Gd-BOPTA administration, and it should be routinely preferred.
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