Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., Suite 1600, Chicago, IL, 60611, USA.
Department of Radiology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA.
Eur Radiol. 2019 Aug;29(8):4357-4367. doi: 10.1007/s00330-018-5956-3. Epub 2019 Jan 7.
Late gadolinium enhancement cardiac MR (LGE-CMR) and extracellular volume fraction (ECV-CMR) are widely used to evaluate macroscopic and microscopic myocardial fibrosis. Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the superior safety profile of these agents. We aimed to assess the performance of two macrocyclic contrast agents, gadoterate meglumine and gadobutrol, for the evaluation of myocardial scar.
Forty subjects (61 ± 11 years, 67.5% men) who underwent LGE-CMR using gadobutrol were prospectively recruited for a research CMR scan using same-dose gadoterate meglumine (0.2 mmol/kg) at 1.5 T. Myocardial scar quantification was performed using a short-axis phase-sensitive inversion recovery (PSIR) Turbo-FLASH and steady-state free precession (SSFP) images. Pre- and post-contrast T1-mapping was employed to assess myocardial ECV. An intraclass correlation coefficient (ICC) was used to check for reliability between the two contrast agents.
Using manual thresholding on PSIR Turbo-FLASH images, mean LGE scar percentage (LGE%) was 9.9 ± 9.7% and 9.4 ± 9.7% for gadobutrol and gadoterate meglumine, respectively (p > 0.05) (ICC: 0.99, 95% CI: 0.97-0.99). Using the PSIR SSFP technique and manual thresholding, LGE% averaged 7.5 ± 9.0% and 7.1 ± 8.6% for gadobutrol and gadoterate meglumine, respectively (p > 0.05) (ICC: 0.99, 95% CI: 0.98-0.99). Average ECV with gadobutrol and gadoterate meglumine were similar at 28.40 ± 4.88 and 28.46 ± 4.73 (p > 0.05) with a strong correlation (ICC: 0.98, 95% CI: 0.94-0.99).
We found LGE- and ECV-CMR values derived from gadoterate meglumine comparable to values derived from gadobutrol. Gadoterate meglumine has a comparable performance to gadobutrol in identifying LGE-derived myocardial scar both qualitatively and quantitatively.
• Late gadolinium-enhancement cardiac MR (LGE-MR) and extracellular volume (ECV) fraction are widely used to evaluate macroscopic and microscopic myocardial fibrosis. • Macrocyclic contrast media are increasingly used off-label for myocardial scar assessment, given the presumed superior safety profile of these agents. • LGE- and ECV-CMR values derived from gadoterate meglumine are comparable to values derived from gadobutrol.
心脏磁共振晚期钆增强（LGE-CMR）和细胞外容积分数（ECV-CMR）广泛用于评估宏观和微观心肌纤维化。鉴于大环造影剂具有更好的安全性，越来越多的大环造影剂被超适应证用于心肌瘢痕评估。本研究旨在评估两种大环造影剂——钆特酸葡胺和钆布醇——在心肌瘢痕评估中的性能。
前瞻性纳入 40 例（61±11 岁，67.5%为男性）使用钆布醇行 LGE-CMR 的患者，行同剂量（0.2mmol/kg）钆特酸葡胺 1.5T 心脏磁共振检查。使用短轴相位敏感反转恢复（PSIR）Turbo-FLASH 和稳态自由进动（SSFP）图像进行心肌瘢痕定量。使用预对比和后对比 T1 映射评估心肌 ECV。采用组内相关系数（ICC）评估两种对比剂之间的可靠性。
使用 PSIR Turbo-FLASH 图像的手动阈值，钆布醇和钆特酸葡胺的平均 LGE 瘢痕百分比（LGE%）分别为 9.9%±9.7%和 9.4%±9.7%（p>0.05）（ICC：0.99，95%置信区间：0.97-0.99）。使用 PSIR SSFP 技术和手动阈值，钆布醇和钆特酸葡胺的 LGE%平均值分别为 7.5%±9.0%和 7.1%±8.6%（p>0.05）（ICC：0.99，95%置信区间：0.98-0.99）。钆布醇和钆特酸葡胺的平均 ECV 分别为 28.40±4.88 和 28.46±4.73（p>0.05），相关性较强（ICC：0.98，95%置信区间：0.94-0.99）。
我们发现，钆特酸葡胺衍生的 LGE 和 ECV-CMR 值与钆布醇衍生的值相当。钆特酸葡胺在定性和定量上均与钆布醇具有相当的性能，可用于识别 LGE 衍生的心肌瘢痕。
• 心脏磁共振晚期钆增强（LGE-MR）和细胞外容积（ECV）分数广泛用于评估宏观和微观心肌纤维化。
• 鉴于大环造影剂具有更好的安全性，越来越多的大环造影剂被超适应证用于心肌瘢痕评估。
• 钆特酸葡胺衍生的 LGE 和 ECV-CMR 值与钆布醇衍生的值相当。
