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Comprehensive evaluation of macroscopic and microscopic myocardial fibrosis by cardiac MR: intra-individual comparison of gadobutrol versus gadoterate meglumine

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Abstract

Purpose

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.

Material and methods

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.

Results

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).

Conclusion

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.

Key Points

• 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.

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Abbreviations

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

CNR:

Contrast-to-noise ratio

ECV:

Extracellular volume

GBCA:

Gadolinium-based contrast agents

GFR:

Glomerular filtration rate

ICC:

Intraclass correlation coefficients

LGE:

Late gadolinium enhancement

LV:

Left ventricle

MOLLI:

Modified Look-Locker inversion recovery

PSIR:

Phase-sensitive inversion recovery

SI:

Signal intensity

SNR:

Signal-to-noise ratio

SSFP:

Steady-state free precession

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Acknowledgements

We would like to particularly thank all the patients who participated in our study.

Funding

This study has received funding by Geurbet, LLC.

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Authors and Affiliations

  1. Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., Suite 1600, Chicago, IL, 60611, USA

    Amir Ali Rahsepar, Ahmadreza Ghasemiesfe, Kenichiro Suwa, Ryan S. Dolan, Monda L. Shehata, Monica J. Korell, Nivedita K. Naresh, Michael Markl, Jeremy D. Collins & James C. Carr

  2. Department of Radiology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA

    Amir Ali Rahsepar & Ahmadreza Ghasemiesfe

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Jeremy D. Collins

Authors
  1. Amir Ali Rahsepar
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  2. Ahmadreza Ghasemiesfe
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  3. Kenichiro Suwa
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  4. Ryan S. Dolan
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  5. Monda L. Shehata
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  6. Monica J. Korell
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  7. Nivedita K. Naresh
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  9. Jeremy D. Collins
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  10. James C. Carr
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Corresponding author

Correspondence to Amir Ali Rahsepar.

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Guarantor

The scientific guarantor of this publication is Professor James C. Carr, MD.

Conflict of interest

Dr. James Carr and Dr. Jeremy Collins are members of the advisory board of Guerbet, LLC.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Prospective

• Diagnostic study

• Performed at one institution

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Rahsepar, A.A., Ghasemiesfe, A., Suwa, K. et al. Comprehensive evaluation of macroscopic and microscopic myocardial fibrosis by cardiac MR: intra-individual comparison of gadobutrol versus gadoterate meglumine. Eur Radiol 29, 4357–4367 (2019). https://doi.org/10.1007/s00330-018-5956-3

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  • DOI: https://doi.org/10.1007/s00330-018-5956-3

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