Gadobenate dimeglumine‐enhanced magnetic resonance imaging of intracranial metastases: Effect of dose on lesion detection and delineation

Abstract

Seventy-four patients with one to eight proven intraaxial metastatic lesions to the brain received a total gadobenate dimeglumine dose of 0.3 mmol/kg of body weight, administered as three sequential bolus injections of 0.1 mmol/ kg, at 10-minute intervals over a 20-minute period. Quantitative and qualitative assessments of efficacy were performed after each injection and a full evaluation of safety was conducted. Cumulative dosing produced significant (P < 0.01) dose-related increases in lesion-to-brain (L/B) ratio and lesion signal intensity (SI) enhancement. Two independent, blinded assessors noted additional lesions, compared to unenhanced images in 31% and 33%, 49% and 42%, and 50% and 48% of patients after each cumulative dose, respectively. Significantly more lesions were noted after the first injection, compared to unenhanced images (P ‫؍‬ 0.002 and P < 0.001; assessors 1 and 2, respectively), and after a second injection, compared to the first (P < 0.001 and P ‫؍‬ 0.039; assessors 1 and 2, respectively). Neither assessor noted significantly more lesions after the third injection. For patients with just one lesion observed on unenhanced T1-and T2-weighted images, additional lesions were noted by assessors 1 and 2 for 27% and 26%, 48% and 35%, and 42% and 41% of patients, respectively, following each injection. Contemporaneously, diagnostic confidence was increased and lesion conspicuity improved over unenhanced magnetic resonance imaging (MRI). For patients with one lesion observed after 0.1 mmol/kg of gadobenate dimeglumine, additional lesions were noted for 24% and 17% of patients Index terms: gadobenate dimeglumine; Gd-BOPTA; MRI; CNS metastases; lesion detection THE CHOICE BETWEEN SURGERY AND TUMOR irradiation for the treatment of metastatic lesions to the central nervous system (CNS) is highly dependent on the number and size of lesions detected, as well as on their location (1). At present, contrast-enhanced magnetic resonance imaging (MRI) with gadolinium-based MR contrast agents is the diagnostic technique of choice for the detection of CNS metastases, offering greater sensitivity and specificity than unenhanced MRI and contrast-enhanced computed tomography (1-6). However, as regards the specific contrast agent to use for MRI of CNS metastases, there appears little to choose between the majority of agents available; traditional agents (i.e., gadopentetate dimeglumine, Schering AG, Berlin, Germany; gadoterate meglumine, Guerbet, Aulnay-sous-Bois, France; gadodiamide, Nycomed-Amersham, Oslo, Norway; and gadoteridol, Bracco Imaging SpA, Milano, Italy), as well as newer agents, such as gadoversetamide (Mallinckrodt, St. Louis, MO) and new formulations of existing agents (e.g., gadovist, Schering AG, Berlin, Germany), all possess similar T1 relaxivities in plasma or protein-containing aqueous solution (between 4.3-5.6 mM -1 second -1 ) (7-9) and may be expected to produce similar signal intensity (SI) enhancement when administered at equal dose. Studies at the recommended and approved standard dose of ...

Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide

“…Concerning quantitative enhancement, the increases in CNR with gadobenate dimeglumine compared with gadodiamide on T1SE images were generally between 20% and 35%, which correspond to the magnitude of increase typically observed with a double dose of gadolinium contrast agent compared with a single dose. 17,18 Our results are similar to those of a recent intraindividual crossover comparison of 0.1-mmol/kg BW gadobenate dimeglumine with an identical dose of gadopentetate dimeglumine 8 and may be attributed to the roughly twofold higher R1 relaxivity of gadobenate dimeglumine in blood. [3][4][5][6] This twofold higher R1 relaxivity, which is independent of the field strength of the MR magnet, 3 is due to weak and transient interactions of the Gd-BOPTA molecule with serum albumin, 5,6 which slow the tumbling rate of the Gd-BOPTA complex in blood.…”

Does Higher Gadolinium Concentration Play a Role in the Morphologic Assessment of Brain Tumors? Results of a Multicenter Intraindividual Crossover Comparison of Gadobutrol versus Gadobenate Dimeglumine (the MERIT Study)

“…As noted in comparisons with other GBCAs, 5-8 the increase in CNR with gadobenate dimeglumine compared with gadobutrol can be considered comparable with the magnitude typically observed with a double dose of GBCA compared with a single dose. 21,22 Although comparable enhancement to that achieved with gadobenate dimeglumine might have been obtained with a double dose of gadobutrol (ie, an identical volume), injections of high doses of GBCAs are not to be recommended, given the risk of NSF in certain patients with severe renal impairment. In this regard, although gadobutrol is a macrocyclic agent and thus widely considered one of the "safer" GBCAs, cases of NSF following its sole injection have been reported.…”

High-relaxivity contrast-enhanced magnetic resonance neuroimaging: a review

“…Early dosing studies demonstrated that, as expected, double doses of gadobenate dimeglumine (MultiHance®) are potentially beneficial with increased sensitivity in brain lesion detection, but, unlike other contrast agents, no further benefit is derived from triple doses [15,19]. However, the more significant evidence of improved diagnostic performance with the higher relaxivity agent derives from a series of intraindividual crossover studies directly comparing gadobenate dimeglumine (MultiHance®) with gadopentetate dimeglumine (Magnevist®, Bayer Schering Pharma AG, Berlin, Germany) [20][21][22][23][24][25], gadoterate meglumine (Dotarem®, Guerbet Aulnay s/ Bois, France) [20,22], gadodiamide (Omniscan™, GE Healthcare AS, Oslo, Norway) [20,26] and gadofosveset trisodium (Vasovist®) [6].…”

“…In light of the excellent safety profile of CE-MRI with Gd contrast agents, the use of higher doses became routine clinical practice when determination of the disease extent was the main goal of the examination. However, higher doses of contrast agent increased the cost of MRI and were associated with potentially more false-positive results [14,15]. Additionally, of late, there has been increased concern for the development of nephrogenic systemic fibrosis (NSF) in at-risk patients when higher doses are used [16][17][18].…”