Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110, USA.
Int J Cardiovasc Imaging. 2012 Feb;28(2):295-301. doi: 10.1007/s10554-011-9821-6. Epub 2011 Feb 20.
During a recent multi-center trial assessing gadolinium (Gd)-enhanced magnetic resonance angiography (MRA) for diagnosis of acute pulmonary embolism (PE), the Food and Drug Administration announced a risk of nephrogenic sclerosing fibrosis in patients with renal insufficiency who had received intravenous Gd-based MR contrast agents. Although no patients in this trial had renal insufficiency, in cautious response to this announcement, the trial protocol was changed from an intravenous administration of 0.2 mmol/Kg of a conventional Gd-based MR contrast agent to 0.1 mmol/Kg of gadobenate dimeglumine. The study described herein compares the signal quality of pulmonary MRA performed with double dose conventional agent to single dose gadobenate dimeglumine. This study is a retrospective analysis of data from a prospective, multicenter study in men and women ≥18 years with documented presence or absence of PE. The study was approved by the Institutional Review Board at all participating centers, and all patients provided written indication of informed consent. We performed both objective and subjective analysis of pulmonary artery image quality. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the main pulmonary artery were assessed in single and double dose protocols and compared. SNR and CNR of the main PA were correlated with subjective quality assessment of main/lobar, segmental and subsegmental pulmonary arteries. Although there were individual outliers, both SNR (P = 0.01) and CNR (P = 0.008) were higher in all quartiles for examinations using gadobenate dimeglumine than with gadopentetate dimeglumine. Subjective quality of vascular signal intensity at each vessel order was significantly better for gadobenate dimeglumine (P < 0.0001), and correlated well with SNR and CNR at each order (<0.001). Because of agent high relaxivity, a single dose of gadobenate dimeglumine provides better pulmonary MRA signal quality than double dose of a conventional Gd-based MR contrast agent.
在最近一项评估钆增强磁共振血管造影（MRA）诊断急性肺栓塞（PE）的多中心试验中，美国食品和药物管理局宣布，肾功能不全患者静脉内使用基于 Gd 的磁共振对比剂存在肾源性硬化性纤维瘤的风险。尽管该试验中没有肾功能不全患者，但为谨慎起见，试验方案从静脉注射 0.2mmol/kg 的常规 Gd 基磁共振对比剂改为 0.1mmol/kg 的钆贝葡胺。本文描述的研究比较了双剂量常规造影剂与单剂量钆贝葡胺进行肺动脉 MRA 的信号质量。这项研究是对一项前瞻性、多中心研究数据的回顾性分析，纳入了有或无 PE 记录的年龄≥18 岁的男性和女性。该研究得到了所有参与中心机构审查委员会的批准，所有患者均提供了书面知情同意书。我们对肺动脉图像质量进行了客观和主观分析。在单剂量和双剂量方案中评估主肺动脉的信噪比（SNR）和对比噪声比（CNR），并进行比较。主肺动脉的 SNR 和 CNR 与主/叶、段和亚段肺动脉主观质量评估相关。尽管存在个别离群值，但使用钆贝葡胺的检查在所有四分位数中 SNR（P=0.01）和 CNR（P=0.008）均高于使用钆喷替酸葡甲胺的检查。在每个血管等级，血管信号强度的主观质量均明显优于钆贝葡胺（P<0.0001），与每个等级的 SNR 和 CNR 相关性良好（<0.001）。由于造影剂的高弛豫率，单剂量钆贝葡胺可提供比常规 Gd 基磁共振对比剂双剂量更好的肺动脉 MRA 信号质量。
