Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy: comparison of diagnostic performance in myocardial fibrosis between gadobutrol and gadopentetate dimeglumine
- 483 Downloads
The purpose of this study was to compare different semi-automated late gadolinium enhancement (LGE) quantification techniques using gadobutrol and gadopentetate dimeglumine contrast agents with regard to the diagnosis of fibrotic myocardium in patients with hypertrophic cardiomyopathy (HCM). Thirty patients with HCM underwent two cardiac MRI protocols with use of gadobutrol and gadopentetate dimeglumine. Contrast-to-noise ratio (CNR) between LGE area and remote myocardium (CNRremote), between LGE area and left ventricular blood pool (CNRpool), and signal-to-noise ratio (SNR) in LGE were compared. The presence and quantity of LGE were determined by visual assessment. With signal threshold versus reference mean (STRM) based thresholds of 2 SD, 5 SD, and 6 SD above the mean signal intensity (SI) of reference myocardium, the full-width at half-maximum (FWHM) technique was used. The volume and segments of the LGE area were compared between the two types of contrast agents. LGE was present in 26 of 30 (86.6%) patients in both protocols. The CNRremote of fibrotic myocardium in gadobutrol and gadopentetate dimeglumine agents was 26.82 ± 14.24 and 21.46 ± 10.59, respectively (P < 0.05). The CNRpool was significantly higher in gadobutrol (9.32 ± 7.64 vs. 6.39 ± 6.11, P < 0.05). The SNR was higher in gadobutrol (33.36 ± 14.35 vs. 27.53 ± 10.91, P < 0.05). The volume of scar size in MR images acquired with gadobutrol were significantly higher than those with gadopentetate dimeglumine (P < 0.05), and the STRM of 5 SD technique showed the greatest agreement with visual assessment (ICC = 0.99) in both examinations. There was no significant difference in fibrotic segments of the fibrotic myocardium in the LGE area (P < 0.05). This study proved that the Gadobutrol was an effective contrast agent for LGE imaging with superior delineation of fibrotic myocardium as compared to gadopentetate dimeglumine. The 5 SD technique yields the closest approximation of the extent of LGE identified by visual assessment.
KeywordsContrast agent Gadobutrol Gadopentetate dimeglumine Hypertrophic cardiomyopathy (HCM) Late gadolinium enhancement (LGE) Cardiovascular magnetic resonance (CMR)
The authors thank Ms. Jing An of Siemens Medical Systems for technical consultation and support for this study. The study was supported by the Natural Science Foundation of China (81671647), Capital Health Research and Development of Special (2016-4-2063).
Compliance with ethical standards
Conflict of interest
Authors declared that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M et al (2003) Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 361(9355):374–379. doi: 10.1016/S0140-6736(03)12389-6 CrossRefPubMedGoogle Scholar
- 7.Mikami Y, Kolman L, Joncas SX, Stirrat J, Scholl D, Rajchl M et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85. doi: 10.1186/s12968-014-0085-x CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Yan AT, Shayne AJ, Brown KA, Gupta SN, Chan CW, Luu TM et al (2006) Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation 114(1):32–39. doi: 10.1161/CIRCULATIONAHA.106.613414 CrossRefPubMedGoogle Scholar
- 14.Knopp MV, Runge VM, Essig M, Hartman M, Jansen O, Kirchin MA et al (2004) Primary and secondary brain tumors at MR imaging: bicentric intraindividual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine. Radiology 230(1):55–64. doi: 10.1148/radiol.2301021085 CrossRefPubMedGoogle Scholar
- 15.Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 18(1):539–542PubMedGoogle Scholar
- 16.De Cobelli F, Esposito A, Perseghin G, Sallemi C, Belloni E, Ravelli S, et al (2012) Intraindividual comparison of gadobutrol and gadopentetate dimeglumine for detection of myocardial late enhancement in cardiac MRI. AJR Am J Roentgenol 198(4):809–816. doi: 10.2214/AJR.11.7118 CrossRefPubMedGoogle Scholar
- 17.Bondarenko O, Beek AM, Hofman MB, Kuhl HP, Twisk JW, van Dockum WG, et al (2005) Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR. J Cardiovasc Magn Reson 7(2):481–485CrossRefPubMedGoogle Scholar
- 18.Bruder O, Wagner A, Jensen CJ, Schneider S, Ong P, Kispert EM, et al (2010) Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 56(11):875–887. doi: 10.1016/j.jacc.2010.05.007 CrossRefPubMedGoogle Scholar
- 19.Rubinshtein R, Glockner JF, Ommen SR, Araoz PA, Ackerman MJ, Sorajja P, et al (2010) Characteristics and clinical significance of late gadolinium enhancement by contrast-enhanced magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Circ Heart Fail 3(1):51–58. doi: 10.1161/CIRCHEARTFAILURE.109.854026 CrossRefPubMedGoogle Scholar
- 21.Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T et al (2014) Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 130(6):484–495. doi: 10.1161/CIRCULATIONAHA.113.007094 CrossRefPubMedGoogle Scholar
- 22.Saeed M, Martin A, Ursell P, Do L, Bucknor M, Higgins CB, et al (2008) MR assessment of myocardial perfusion, viability, and function after intramyocardial transfer of VM202, a new plasmid human hepatocyte growth factor in ischemic swine myocardium. Radiology 249(1):107–118. doi: 10.1148/radiol.2483071579 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Salemi VM, Rochitte CE, Shiozaki AA, Andrade JM, Parga JR, de Avila LF, et al (2011) Late gadolinium enhancement magnetic resonance imaging in the diagnosis and prognosis of endomyocardial fibrosis patients. Circ Cardiovasc Imaging 4(3):304–311. doi: 10.1161/CIRCIMAGING.110.950675 CrossRefPubMedGoogle Scholar
- 25.Nojiri A, Hongo K, Kawai M, Komukai K, Sakuma T, Taniguchi I, et al (2011) Scoring of late gadolinium enhancement in cardiac magnetic resonance imaging can predict cardiac events in patients with hypertrophic cardiomyopathy. J Cardiol 58(3):253–260. doi: 10.1016/j.jjcc.2011.07.007 CrossRefPubMedGoogle Scholar
- 26.Rutz T, Piccini D, Coppo S, Chaptinel J, Ginami G, Vincenti G, et al (2016) Improved border sharpness of post-infarct scar by a novel self-navigated free-breathing high-resolution 3D whole-heart inversion recovery magnetic resonance approach. Int J Cardiovasc Imaging 32(12):1735–1744. doi: 10.1007/s10554-016-0963-4 CrossRefPubMedGoogle Scholar
- 27.Wildgruber M, Stadlbauer T, Rasper M, Hapfelmeier A, Zelger O, Eckstein HH, et al. (2014) Single-dose gadobutrol in comparison with single-dose gadobenate dimeglumine for magnetic resonance imaging of chronic myocardial infarction at 3 T. Invest Radiol 49(11):728–734. doi: 10.1097/RLI.0000000000000076 CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Rudolph A, Messroghli D, von Knobelsdorff-Brenkenhoff F, Traber J, Schuler J, Wassmuth R et al (2015) Prospective, randomized comparison of gadopentetate and gadobutrol to assess chronic myocardial infarction applying cardiovascular magnetic resonance. BMC Med Imaging 15:55. doi: 10.1186/s12880-015-0099-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Wagner M, Schilling R, Doeblin P, Huppertz A, Luhur R, Schwenke C et al (2013) Macrocyclic contrast agents for magnetic resonance imaging of chronic myocardial infarction: intraindividual comparison of gadobutrol and gadoterate meglumine. Eur Radiol 23(1):108–114. doi: 10.1007/s00330-012-2563-6 CrossRefPubMedGoogle Scholar
- 34.Tombach B, Bremer C, Reimer P, Kisters K, Schaefer RM, Geens V et al (2001) Renal tolerance of a neutral gadolinium chelate (gadobutrol) in patients with chronic renal failure: results of a randomized study. Radiology 218(3):651–657. doi: 10.1148/radiology.218.3.r01mr12651 CrossRefPubMedGoogle Scholar
- 40.Edwards BJ, Laumann AE, Nardone B et al. (2014) Advancing pharmacovigilance through academic-legal collaboration: the case of gadolinium-based contrast agents and nephrogenic systemic fibrosis—a research on adverse drug events and reports (RADAR) report. Br J Radiol 87(1042):20140307. doi: 10.1259/bjr.20140307 CrossRefPubMedPubMedCentralGoogle Scholar