Abstract
Objectives
To compare intraindividually two macrocyclic contrast agents - gadobutrol and gadoterate meglumine (Gd-DOTA) - for dynamic and quantitative assessment of relative enhancement (RE) in benign and malignant breast lesions.
Methods
This was an ethically approved, prospective, single-centre, randomized, crossover study in 52 women with suspected breast lesions referred for magnetic resonance imaging (MRI). Each patient underwent one examination with gadobutrol and one with Gd-DOTA (0.1 mmol/kg BW) on a 1.5 T system 1 – 7 days apart. Dynamic, T1-weighted, 3D gradient echo sequences were acquired under identical conditions. Quantitative evaluation with at least three regions of interest (ROI) per lesion was performed. Primary endpoint was RE during the initial postcontrast phase after the first and second dynamic acquisition, and peak RE. All lesions were histologically proven; differences between the examinations were evaluated.
Results
Forty-five patients with a total of 11 benign and 34 malignant lesions were assessed. Mean RE was significantly higher for gadobutrol than Gd-DOTA (p < 0.0001). Gadobutrol showed significantly less washout (64.4 %) than Gd-DOTA (75.4 %) in malignant lesions (p = 0.048)
Conclusions
Gadobutrol has higher RE values compared with Gd-DOTA, whereas Gd-DOTA shows more marked washout in malignant lesions. This might improve the detection of breast lesions and influence the specificity of breast MRI-imaging.
Key Points
• Contrast agents differ in terms of peak enhancement and postinitial contrast behaviour.
• Gadobutrol results in greater peak RE in lesions, likely due to relaxivity.
• Gd-DOTA shows more pronounced washout in postinitial contrast behaviour of malignant lesions.
• Further investigations of the differences among GD-CM may improve sensitivity and specificity.
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Acknowledgments
The scientific guarantor of this publication is Prof. Bernd Hamm. The authors of this manuscript declare relationships with the following companies: Prof. B. Hamm nearly all medical companies. Dr. A. Huppertz, Bayer Healthcare, Siemens Healthcare. Dr. E.M. Fallenberg, travel support and speaker’s fee by Bayer Healthcare, Guerbet, Siemens Healthcare, GE Healthcare. This study has received funding from Bayer Healthcare and Siemens Healthcare. The investigators had exclusive control of all data, manu- script drafting, and submission of this study. One of the authors has significant statistical expertise. Institutional review board approval was not required because the study was approved by the Federal Institute for Drugs and Medical Products and the local ethics committee (Clinical study phase: IIIb, EudraCT No.: 2009-013432-20). Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in Investigative Radiology. Renz DM, Durmus T, Bottcher J, Taupitz M, Diekmann F, Huppertz A, Pfeil A, Maurer MH, Streitparth F, Bick U, Hamm B, Fallenberg EM (2014) Comparison of Gadoteric Acid and Gadobutrol for Detection as Well as Morphologic and Dynamic Characterization of Lesions on Breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Investigative Radiology. Methodology: prospective, randomised controlled trial, performed at one institution. We are grateful to Nikola Bangemann, MD, Tahir Durmus, MD, Elke Keil, MD, Christiane Richter-Ehrenstein, MD, Achim Schneider, MD and Klaus- Jürgen Winzer MD for their contribution in the patient recruitment and inclusion. We are thankful to Bettina Herwig for editorial support.
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Fallenberg, E.M., Renz, D.M., Karle, B. et al. Intraindividual, randomized comparison of the macrocyclic contrast agents gadobutrol and gadoterate meglumine in breast magnetic resonance imaging. Eur Radiol 25, 837–849 (2015). https://doi.org/10.1007/s00330-014-3426-0
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DOI: https://doi.org/10.1007/s00330-014-3426-0