Signal quality of single dose gadobenate dimeglumine pulmonary MRA examinations exceeds quality of MRA performed with double dose gadopentetate dimeglumine

  • Pamela K. Woodard
  • Thomas L. Chenevert
  • H. Dirk Sostman
  • Kathleen A. Jablonski
  • Paul D. Stein
  • Lawrence R. Goodman
  • Frank J. Londy
  • Vamsidhar Narra
  • Charles A. Hales
  • Russell D. Hull
  • Victor F. Tapson
  • John G. Weg
Original Paper


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.


Pulmonary MR angiography Contrast agents Image quality Pulmonary embolism 


  1. 1.
    Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Jablonski KA, Leeper KV, Naidich DP, Sak DJ, Sostman HD, Tapson VF, Weg JG, Woodard PK (2010) Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Annals Int Med 152(7):434–443Google Scholar
  2. 2.
    US Food and Drug Administration (2010) Information on gadolinium-containing contrast agents. Accessed 24 Sep 2010
  3. 3.
    Cowper SE (2009) International Center for Nephrogenic Fibrosing Dermopathy Research (ICNFDR). last updated 25 Oct 2009
  4. 4.
    Prince MR, Arnoldus C, Frisoli JK (1996) Nephrotoxicity of high-dose gadolinium compared with iodinated contrast. J Magn Reson Imaging 6(1):162–166PubMedCrossRefGoogle Scholar
  5. 5.
    Ledneva E, Karie S, Launay-Vacher V, Janus N, Deray G (2009) Renal safety of gadolinium-based contrast media in patients with chronic renal insufficiency. Radiology 250(3):618–628PubMedCrossRefGoogle Scholar
  6. 6.
    Sam AD II, Morasch MD, Collins H, Song G, Chen R, Pereles FS (2003) Safety of gadolinium contrast angiography in patients with chronic renal insufficiency. J Vasc Surg 38(2):313–318PubMedCrossRefGoogle Scholar
  7. 7.
    Stein PD, Woodard PK, Hull RD, Kayali F, Weg JG, Olson RE, Fowler SE (2003) Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review. Chest 124(6):2324–2328PubMedCrossRefGoogle Scholar
  8. 8.
    Hany TF, Schmidt M, Hilfiker PR, Steiner P, Bachmann U, Debatin JF (1998) Optimization of contrast dosage for gadolinium-enhanced 3D MRA of the pulmonary and renal arteries. Magn Reson Imaging 16(8):901–906PubMedCrossRefGoogle Scholar
  9. 9.
    Goyen M, Debatin JF (2004) Gadopentetate dimeglumine-enhanced three-dimensional MR-angiography: dosing, safety, and efficacy. J Magn Reson Imaging 19(3):261–273PubMedCrossRefGoogle Scholar
  10. 10.
    Stein PD, Gottschalk A, Sostman HD, Chenevert TL, Fowler SE, Goodman LR, Hales CA, Hull RD, Kanal E, Leeper KV Jr, Nadich DP, Sak DJ, Tapson VF, Wakefield TW, Weg JG, Woodard PK (2008) Methods of prospective investigation of pulmonary embolism diagnosis III (PIOPED III). Semin Nucl Med 38(6):462–470PubMedCrossRefGoogle Scholar
  11. 11.
    Pintaskse J, Martirosian P, Graf H, Erb G, Lodemann KP, Claussen CD, Schick F (2006) Relaxivity of gadopentetate dimeglumine (Magnevist), gadobutrol (Gadovist), and gadobenate dimeglumine (MultiHance) in human blood plasma at 0.2, 1.5, and 3 tesla. Invest Radiol 41(3):213–221CrossRefGoogle Scholar
  12. 12.
    Murphy BW, Carson PL, Ellis JH, Zhang YT, Hyde RJ, Chenevert TL (1993) SNR measures for MR imagers. Magn Reson Imaging 11:425–428PubMedCrossRefGoogle Scholar
  13. 13.
    Gibbons JD, Chakraborti S (2005) Nonparametric statistical inference, 4th edn. Marcel Dekker, New York, p 314Google Scholar
  14. 14.
    Blum A, Bellou A, Guillemin F, Douek P, Laprévote-Heully MC, Wahl D (2005) Performance of magnetic resonance angiography in suspected acute pulmonary embolism. Thromb Haemost 93(3):503–511PubMedGoogle Scholar
  15. 15.
    Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR (1997) Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 336(20):1422–1427PubMedCrossRefGoogle Scholar
  16. 16.
    De Haën C, Cabrini M, Akhnana L et al (1999) Gadobenate dimeglumine 0.5 mM solution for injection (MultiHance®): pharmaceutical formulation and physicochemical properties of a new magnetic resonance imaging contrast medium. J Comput Assisted Tomogr 23(Suppl 1):S161–S168Google Scholar
  17. 17.
    Aime S, Chiaussa M, Digilio G et al (1999) Contrast agents for magnetic resonance angiographic applications: 1H and 17O NMR relaxometric investigations on two gadolinium(III) DPTA-like chelates endowed with high binding affinity to human serum albumin. J Biol Inorg Chem 4:766–774PubMedCrossRefGoogle Scholar
  18. 18.
    Blockley NP, Jiang L, Gardener AG, Ludman CN, Francis ST, Gowland PA (2008) Field strength dependence of R1 and R2* relaxivities of human whole blood to ProHance, Vasovist, and deoxyhemoglobin. Magn Reson Med 60(6):1313–1320PubMedCrossRefGoogle Scholar
  19. 19.
    Krishnam MS, Tomasian A, Lohan DG, Tran L, Finn JP, Ruehm SG (2008) Low-dose, time-resolved, contrast-enhanced 3D MR angiography in cardiac and vascular diseases: correlation to high spatial resolution 3D contrast-enhanced MRA. Clin Radiol 63(7):744–755PubMedCrossRefGoogle Scholar
  20. 20.
    Ersoy H, Goldhaber SZ, Cai T, Luu T, Rosebrook J, Mulkern R, Rybicki F (2007) Time-resolved MR angiography: a primary screening examination of patients with suspected pulmonary embolism and contraindications to administration of iodinated contrast material. AJR Am J Roentgenol 188(5):1246–1254PubMedCrossRefGoogle Scholar
  21. 21.
    Krishnam MS, Tomasian A, Malik S, Desphande V, Laub G, Ruehm SG (2010) Image quality and diagnostic accuracy of unenhanced SSFP MR angiography compared with conventional contrast-enhanced MR angiography for the assessment of thoracic aortic diseases. Eur Radiol 20(6):1311–1320PubMedCrossRefGoogle Scholar
  22. 22.
    Gerretsen SC, le Maire TF, Miller S, Thurnher SA, Herborn CU, Michaely HJ, Kramer h, Vanzulli A, Vymazal J, Wasser MN, Ballarati CE, Kirchin MA, Pirovano G, Leiner T (2010) Multicenter, double-blind, randomized intraindividual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine for MR angiography of peripheral arteries. Radiology 255(3):988–1000PubMedCrossRefGoogle Scholar
  23. 23.
    Prokop M, Schneider G, Vanzulli A, Goyen M, Ruehm SG, Douek P, Dapra M, Pirovano G, Kirchin MA, Spinazzi A (2005) Contrast-enhanced MR angiography of the renal arteries: blinded multicenter crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine. Radiology 234:399–408PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Pamela K. Woodard
    • 1
  • Thomas L. Chenevert
    • 2
  • H. Dirk Sostman
    • 3
  • Kathleen A. Jablonski
    • 4
  • Paul D. Stein
    • 5
  • Lawrence R. Goodman
    • 6
  • Frank J. Londy
    • 2
  • Vamsidhar Narra
    • 1
  • Charles A. Hales
    • 7
  • Russell D. Hull
    • 8
  • Victor F. Tapson
    • 9
  • John G. Weg
    • 2
  1. 1.Department of Radiology, Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA
  2. 2.Department of RadiologyUniversity of MichiganAnn ArborUSA
  3. 3.Office of the Dean and Department of RadiologyWeill Cornell Medical College and Methodist HospitalHoustonUSA
  4. 4.The Biostatistics CenterGeorge Washington UniversityRockvilleUSA
  5. 5.Department of Internal Medicine, College of Osteopathic MedicineMichigan State UniversityEast LansingUSA
  6. 6.Department of RadiologyMedical College of WisconsinMilwaukeeUSA
  7. 7.Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  8. 8.Department of MedicineUniversity of CalgaryCalgaryCanada
  9. 9.Department of MedicineDuke UniversityDurhamUSA

Personalised recommendations