Interaction of gadolinium‐based MR contrast agents with choline: Implications for MR spectroscopy (MRS) of the breast

Abstract

It has been shown that magnetic resonance spectroscopy (MRS) can improve the specificity of the MR examination by the spectroscopic detection of choline (Cho). Commonly, the lesion is first visualized on postcontrast studies, and the MRS voxel is prescribed accordingly. The implicit assumption made in this approach is that the presence of gadolinium-based contrast agents will have a negligible effect on the MR spectra obtained from the lesion. In this work, we examined this assumption by determining the effects of six gadolinium-based contrast agents: Magnevist, Multihance, Omniscan, Optimark, ProHance, and Dotarem, on the Cho peak in phantoms and in a rat model for breast cancer. We found that only the three negatively-charged chelates: Magnevist, MultiHance, and Dotarem, broadened the Cho peak in phantoms and reduced the area of the Key words: breast MRS; contrast agents; interactions; choline; in vivoThere is increasing adoption of MRI of the breast both as a screening examination for younger women who are at high risk for developing breast cancer (1-3) or as a problemsolving tool following mammography and/or ultrasound imaging (4 -8). The visualization and characterization of breast lesions on MRI is based on a combination of morphological features of the lesion precontrast injection and patterns of dynamic contrast enhancement postinjection of gadolinium-based contrast agents. Recently, it has been shown that magnetic resonance spectroscopy (MRS) can improve the specificity of the MR examination by the spectroscopic detection of choline (Cho)-containing compounds (see Refs. 9 -13 for reviews). The majority of the in vivo MRS studies were performed using single-voxel methods, where the lesion was first visualized on the postcontrast studies and the MRS voxel prescribed accordingly. The implicit assumption made in this approach is that the presence of gadolinium-based contrast agents will have a negligible effect on the MR spectra obtained from the lesion. The only report that has addressed this issue explicitly in breast MRS is the study of Joe et al. (14), which showed that there were changes in both the linewidth (increase of 15-21%) and area (decrease of 11-18%) of the Cho peak, in the same subjects, pre-and postinjection of Omniscan (gadodiamide). There have been several reports addressing the effects of gadolinium-containing contrast agents on MR spectra both in vitro (15,16) and in vivo (17-22). All of the in vivo studies involved determining the effects of gadolinium diethylenetriamine penta acetate (Gd-DTPA; Magnevist) or gadolinium-tetraazacyclododecane tetra acetate (Gd-DOTA; Dotarem) on the proton MRS of brain tumors. Although the in vitro studies reported significant alterations in the spectral properties of Cho in phantoms, in the presence of Gd-DTPA, the in vivo studies reported smaller changes (10 -15%) in the Cho peak postcontrast administration. This smaller change was attributed to the fact that in the brain the Cho is predominantly intracellular and thus cannot come into direct contact wi...

In vivo MRS of locally advanced breast cancer: characteristics related to negative or positive choline detection and early monitoring of treatment response

“…It has previously been shown that negatively charged chelates (such as Magnevist) may lead to an underestimation of tCho levels [28]. The tCho detection was higher in patients examined after administration of Magnevist as contrast agent (86%) compared to Omniscan (55%).…”

Clinical Breast MR Using MRS or DWI: Who Is the Winner?

“…Of note, a trend for a higher sensitivity of 1H-MRS was observed when acquisition is performed before contrast injection, due to a detrimental effect of ionic-charged contrast materials in both experimental and clinical settings (38). As lesion localization (the placement of the spectroscopic volume of interest) has to be made on CE images (especially for otherwise not visible small lesions), the majority of 1H-MRS studies were performed after contrast injection, potentially implying a suboptimal sensitivity.…”

Proton MR Spectroscopy in Metabolic Assessment of Musculoskeletal Lesions

“…In addition, contrast-enhanced sequences can be used to directly position the voxel of interest over well-vascularized and viable areas of tumor [21]. Findings by Lenkinski et al [22] are evidence of exclusive use of neutral chelates of gadolinium in choline MRS to avoid underestimation of the choline peak if MRS is performed after contrast administration.…”