Breast lesion detection and characterization with contrast‐enhanced magnetic resonance imaging: Prospective randomized intraindividual comparison of gadoterate meglumine (0.15 mmol/kg) and gadobenate dimeglumine (0.075 mmol/kg) at 3T

Abstract

Background Contrast‐enhanced magnetic resonance imaging (CE‐MRI) of the breast is highly sensitive for breast cancer detection. Multichannel coils and 3T scanners can increase signal, spatial, and temporal resolution. In addition, the T 1 ‐reduction effect of a gadolinium‐based contrast agent (GBCA) is higher at 3T. Thus, it might be possible to reduce the dose of GBCA at 3T without losing diagnostic information. Purpose To compare a three‐quarter (0.075 mmol/kg) dose of the high‐relaxivity GBCA gadobenate dimeglumine, with a 1.5‐fold higher than on‐label dose (0.15 mmol/kg) of gadoterate meglumine for breast lesion detection and characterization at 3T CE‐MRI. Study Type Prospective, randomized, intraindividual comparative study. Population Eligible were patients with imaging abnormalities (BI‐RADS 0, 4, 5) on conventional imaging. Each patient underwent two examinations, 24–72 hours apart, one with 0.075 mmol/kg gadobenate and the other with 0.15 mmol/kg gadoterate administered in a randomized order. In all, 109 patients were prospectively recruited. Field Strength/Sequence 3T MRI with a standard breast protocol (dynamic‐CE, T 2 w‐TSE, STIR‐T 2 w, DWI). Assessment Histopathology was the standard of reference. Three blinded, off‐site breast radiologists evaluated the examinations using the BI‐RADS lexicon. Statistical Tests Lesion detection, sensitivity, specificity, and diagnostic accuracy were calculated per‐lesion and per‐region, and compared by univariate and multivariate analysis (Generalized Estimating Equations, GEE). Results Five patients were excluded, leaving 104 women with 142 histologically verified breast lesions (109 malignant, 33 benign) available for evaluation. Lesion detection with gadobenate (84.5‐88.7%) was not inferior to gadoterate (84.5–90.8%) ( P ≥ 0.165). At per‐region analysis, gadobenate demonstrated higher specificity (96.4–98.7% vs. 92.6–97.3%, P ≤ 0.007) and accuracy (96.3–97.8% vs. 93.6–96.1%, P ≤ 0.001) compared with gadoterate. Multivariate analysis demonstrated superior, reader‐independent diagnostic accuracy with gadobenate (odds ratio = 1.7, P < 0.001 using GEE). Data Conclusion A 0.075 mmol/kg dose of the high‐relaxivity contrast agent gadobenate was not inferior to a 0.15 mmol/kg dose of gadoterate for breast lesion detection. Gadobenate allowed increased specificity and accuracy. Level of Evidence : 1 Technical Efficacy : Stage 2 J. Magn. Reson. Imaging 2019;49:1157–1165.

Review of strategies to reduce the contamination of the water environment by gadolinium-based contrast agents

“…Reduced doses of gadobenate are non-inferior for liver MRI [ 60 – 62 ] and for dynamic contrast-enhancement (DCE) in prostate MRI [ 63 ]. Similar results have been achieved in breast MRI at 3 T, with either half dose gadobenate [ 64 ] or gadobutrol [ 65 ]. Half dose higher-relaxivity GBCA was sufficient for adequate 3 T imaging of bone and soft tissues in adults and children [ 66 , 67 ], and for imaging synovitis in rheumatoid arthritis [ 68 ].…”

Editorial for “Does the Higher Relaxivity of Gadobenate Dimeglumine Permit Gadolinium Dose‐Lowering in MRI of the Central Nervous System? Results of a Retrospective, Parallel Group Comparison”

“…Gadobenate dimeglumine has the highest r1 relaxivity of all GBCA approved and routinely used for neuroradiologic examinations. There have been several studies published in the peer‐reviewed literature that have demonstrated the advantages that higher relaxivity brings to diagnostic imaging, including the diagnostic similarity or even superiority of partial dose gadobenate dimeglumine compared to full doses of lower relaxivity GBCA 3–10 . It is important to note that while this study documents the clinical relevance and non‐inferiority of half‐dose gadobenate dimeglumine for general diagnostic neuroradiologic imaging at 1.5 T and 3 T, it does not ignore the benefits of standard dosing when clinically indicated.…”

“…There have been several studies published in the peer-reviewed literature that have demonstrated the advantages that higher relaxivity brings to diagnostic imaging, including the diagnostic similarity or even superiority of partial dose gadobenate dimeglumine compared to full doses of lower relaxivity GBCA. [3][4][5][6][7][8][9][10] It is important to note that while this study documents the clinical relevance and noninferiority of half-dose gadobenate dimeglumine for general diagnostic neuroradiologic imaging at 1.5 T and 3 T, it does not ignore the benefits of standard dosing when clinically indicated. Several studies have documented the superiority and improved diagnostic capabilities and sensitivities of standard dose gadobenate relative to standard doses of lower relaxivity agents.…”

Optimizing ultrafast dynamic contrast-enhanced MRI scan duration in the differentiation of benign and malignant breast lesions

“…The ultrafast DCE-MRI parameters are subject to numerous factors, including scan duration, contrast agent characteristics, and technical settings [ 35 – 37 ]. Our study can only offer preliminary insights into optimizing breast ultrafast DCE-MRI protocols, particularly with CS-VIBE techniques and 4.5-s temporal resolution.…”