Primary and Secondary Brain Tumors at MR Imaging: Bicentric Intraindividual Crossover Comparison of Gadobenate Dimeglumine and Gadopentetate Dimeglumine

Abstract

Significantly superior contrast enhancement of intraaxial enhancing brain tumors was achieved with 0.1 mmol/kg gadobenate dimeglumine compared with that with 0.1 mmol/kg gadopentetate dimeglumine.

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)

“…Concerning quantitative lesion enhancement, our results are again consistent with those in previous studies [1][2][3][4][5][6][7][8] in showing a significantly greater percentage of enhancement of lesions and significantly superior CNR and LBR with gadobenate dimeglumine. Although the magnitude of the difference in CNR was slightly lower for reader 1 (43.6% greater CNR with gadobenate dimeglumine compared with 72.3% and 73.0% greater CNR with gadobenate dimeglumine for readers 2 and 3, respectively), the differences were in all cases significant.…”

“…14 It has a macrocyclic structure similar to that of gadoteridol (ProHance, Bracco, Princeton, New Jersey) 19,20 and physicochemical properties that resemble those of other GBCAs that have conventional in vivo R1 relaxivity. 10,11,18.19 Consistent with the results of previous intraindividual comparisons, [1][2][3][4][5][6][7][8] the results of this study show that when administered at its approved dose of 0.1 mmol/kg, gadobutrol is preferred in significantly (P Ͻ .0001) fewer patients than gadobenate dimeglumine at the same dose. Specifically, 3 blinded independent readers reported superiority for gadobenate dimeglumine in significantly (P Ͻ .0001) more patients for all evaluated end points.…”

“…First, it is clear that contrast agent concentration in the vial has no effect on imaging performance because injection of the more highly concentrated (1.0 mol/L) GBCA at 0.1 mmol/kg of body weight provides no appreciable clinical advantage relative to published findings for conventional GBCAs at a standard concentration (0.5 mol/L) when compared with gadobenate dimeglumine at an identical dose of 0.1 mmol/kg of body weight. [1][2][3][4][5][6][7][8] The lack of any appreciable benefit with gadobutrol can be ascribed to the fact that the SI during the interstitial phase (ie, at postinjection acquisition times of 3-10 minutes as typically performed for brain tumor imaging) depends solely on the total amount of gadolinium in the lesion (ie, the total number of gadolinium molecules) and its relaxivity rather than on the gadolinium solution concentration. Second, it is clear that higher R1 relaxivity is instrumental in improving diagnostic performance relative to that achievable with conventional GBCAs at equivalent dose.…”

“…Among the GBCAs currently approved by the FDA, gadobenate dimeglumine (MultiHance; Bracco, Milan, Italy) has proved superior to other GBCAs at equivalent dose for MR imaging of tumors of the CNS. [1][2][3][4][5][6][7][8] The superior diagnostic performance achievable with gadobenate dimeglumine, which is reflected in a recently updated "Summary of Product Characteristics," 9 is due to high in vivo R1 relaxivity (6.3-7.9 L ϫ mmol Ϫ1 ϫ sec Ϫ1 at 1.5T, 10,11 ) which derives from weak and transient interactions of the gadobenate contrast-effective molecule with serum albumin. 12,13 The increased R1 relaxivity leads to increased SI enhancement and thus significantly improved lesion visualization and better depiction of morphologic features relative to those achieved with GBCAs, which do not interact with serum protein, when these agents are administered at an equivalent dose of 0.1 mmol/kg of body weight.…”

“…12,13 The increased R1 relaxivity leads to increased SI enhancement and thus significantly improved lesion visualization and better depiction of morphologic features relative to those achieved with GBCAs, which do not interact with serum protein, when these agents are administered at an equivalent dose of 0.1 mmol/kg of body weight. [1][2][3][4][5][6][7][8] Recently, gadobutrol (Gadavist [Gadovist]; Bayer Healthcare, Berlin, Germany) has been approved by the FDA for imaging of the CNS.…”