Wildgruber Moritz, Stadlbauer Thomas, Rasper Michael, Hapfelmeier Alexander, Zelger Otto, Eckstein Hans-Henning, Halle Martin, Rummeny Ernst J, Huber Armin M
From the *Institut für Diagnostische und Interventionelle Radiologie; †Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, ‡Institut für Medizinische Statistik und Epidemiologie, and §Zentrum für Prävention und Sportmedizin, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
Invest Radiol. 2014 Nov;49(11):728-34. doi: 10.1097/RLI.0000000000000076.
The aim of this study was to compare the contrast-to-noise ratio (CNR) values of infarct and remote myocardium as well as infarct and blood after application of 0.1 mmol/kg gadobutrol and 0.1 mmol/kg gadobenate dimeglumine on late gadolinium enhancement magnetic resonance (MR) images.
The study was a prospective randomized controlled clinical study. After informed consent was obtained, 20 patients (12 men, 8 women; mean age, 67 ± 11 years) with known chronic myocardial infarction were included for an intraindividual comparison of a single-dose gadobutrol and a single-dose gadobenate dimeglumine. Two MR imaging examinations were performed within a period of 28 days in a crossover design. Late gadolinium enhancement imaging was performed 10 minutes after gadolinium administration using a 2-dimensional phase-sensitive inversion recovery gradient echo sequence at 3 T. Infarct size, signal intensities (SIs), signal-to-noise ratio, and CNR were determined on phase-sensitive MR images. Values for CNR were calculated as CNRinfarct/myocardium = (SIinfarct - SImyocardium)/SDnoise and CNRinfarct/blood = (SIinfarct - SIblood)/SDnoise. In addition, the areas of myocardial infarction were determined on single slices. The entire infarct volumes were calculated by adding the areas with hyperenhancement multiplied by the slice thickness.
Late gadolinium enhancement was present in all patients. Median values of the infarct area, infarct volume, and transmurality for gadobutrol and gadobenate dimeglumine showed good to excellent concordance (rc = 0.85, rc = 0.95, and rc = 0.71, respectively). The mean signal-to-noise ratio values for infarct, remote myocardium, and ventricular blood were 18.6 ± 6.5, 4.1 ± 3.7, and 14.6 ± 7.5, respectively, for gadobutrol and 18.8 ± 8.9, 4.9 ± 4.5, and 17.8 ± 10.1, respectively, for gadobenate dimeglumine (P = 0.93, P = 0.48, and P = 0.149, respectively). The mean values of CNRinfarct/myocardium and CNRinfarct/blood were 14.5 ± 5.9 and 4.0 ± 4.6, respectively, for gadobutrol and 13.9 ± 6.1 and 0.9 ± 4.5, respectively, for gadobenate dimeglumine (P = 0.69 and P = 0.02, respectively).
Both gadobutrol and gadobenate dimeglumine allow for successful late gadolinium enhancement imaging of chronic myocardial infarction after a single-dose application (0.1 mmol/kg) at 3 T. Gadobutrol provides a higher CNR between infarct and blood. The CNRs between infarct and normal myocardium, infarct size, and transmural extent were similar for both contrast agents.
本研究旨在比较在钆布醇0.1 mmol/kg和钆贝葡胺0.1 mmol/kg应用于延迟钆增强磁共振（MR）图像后，梗死心肌与远隔心肌以及梗死心肌与血液之间的对比噪声比（CNR）值。
本研究为前瞻性随机对照临床研究。在获得知情同意后，纳入20例已知慢性心肌梗死患者（12例男性，8例女性；平均年龄67±11岁），进行单剂量钆布醇和单剂量钆贝葡胺的个体内比较。采用交叉设计，在28天内进行两次MR成像检查。在3 T场强下，于钆剂注射后10分钟，使用二维相敏反转恢复梯度回波序列进行延迟钆增强成像。在相敏MR图像上测定梗死面积、信号强度（SI）、信噪比和CNR。CNR值计算为CNR梗死心肌/心肌=（SI梗死心肌 - SI心肌）/SD噪声，CNR梗死心肌/血液=（SI梗死心肌 - SI血液）/SD噪声。此外，在单一层面上测定心肌梗死面积。通过将强化区域面积乘以层厚来计算整个梗死体积。
所有患者均出现延迟钆增强。钆布醇和钆贝葡胺的梗死面积、梗死体积和透壁性的中位数显示出良好至极佳的一致性（相关系数分别为0.85、0.95和0.71）。钆布醇组梗死心肌、远隔心肌和心室血液的平均信噪比分别为18.6±6.5、4.1±3.7和14.6±7.5，钆贝葡胺组分别为18.8±8.9、4.9±4.5和17.8±10.1（P分别为0.93、0.48和0.149）。钆布醇组CNR梗死心肌/心肌和CNR梗死心肌/血液的平均值分别为14.5±5.9和4.0±4.6，钆贝葡胺组分别为13.9±6.1和0.9±4.5（P分别为0.69和0.02）。
钆布醇和钆贝葡胺在3 T场强下单剂量应用（0.1 mmol/kg）后，均可成功实现慢性心肌梗死的延迟钆增强成像。钆布醇在梗死心肌与血液之间提供了更高的CNR。两种对比剂在梗死心肌与正常心肌之间的CNR、梗死面积和透壁范围相似。
