Michele Anzidei MD, Presenter: Nothing to Disclose

Alessandro Napoli MD, Abstract Co-Author: Nothing to Disclose

Fulvio Zaccagna MD, Abstract Co-Author: Nothing to Disclose

Gaia Cartocci, Abstract Co-Author: Nothing to Disclose

Beatrice Cavallo Marincola MD, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

To evaluate gadofosveset (Vasovist, MS-325), gadobenate dimeglumine (MultiHance, Gd-BOPTA) and gadopentetate dimeglumine (Magnevist, Gd-DTPA) for high-resolution steady state (SS) MR-angiography (MRA) of the carotid arteries and to compare image quality and diagnostic accuracy using digital subtraction angiography (DSA) as reference standard.

Three groups of 20 subjects with symptomatic stenosis of the internal carotid artery at Doppler ultrasound underwent first-pass (FP) and SS MRA of the carotid arteries with MS-325 (0.03 mmol/kg; group 1), Gd-BOPTA (0.1 mmol/kg; group 2) or Gd-DTPA (0.1 mmol/kg; group 3). SS images were acquired immediately after the FP acquisition with the same standardized high-resolution protocol (voxel size: 0.7 mm3). Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated for both acquisitions. Two readers in consensus evaluated vessel stenosis (NASCET criteria) and plaque morphology. The sensitivity, specificity and accuracy of FP and combined FP+SS datasets for detection of relevant (>70%) stenosis was assessed and differences between groups determined (McNemar test).

Significantly (p<0.001) higher SNR and CNR for FP and SS images was noted for group 1 compared to groups 2 and 3 and for group 2 compared to group 3. The sensitivity, specificity and accuracy of FP/FP+SS for stenosis assessment was 94/96%, 94/98% and 95/97% for group 1, 93/96%, 94/97% and 94/97% for group 2, and 90/82%, 91/84% and 91/85% for group 3, respectively. The sensitivity, specificity and accuracy of FP/FP+SS for plaque morphology assessment was 92/98%, 93/98% and 94/99% for group 1, 91/98%, 92/97% and 94/98% for group 2, and 89/81%, 88/83% and 87/81% for group 3. No significant differences (p>0.05) were noted between groups 1 and 2 for stenosis assessment or evaluation of plaque morphology. Conversely, findings for groups 1 and 2 were all significantly (p<0.001) superior to those of group 3.

The diagnostic performance achieved on FP and SS MRA with Gd-BOPTA and MS-325 is similar, despite higher SNR and CNR with MS-325. Conversely, Gd-DTPA is not appropriate for high-resolution SS MRA.

MS-325 and Gd-BOPTA offer similar diagnostic performance for high-resolution SS MRA and are superior to Gd-DTPA for stenosis assessment and plaque characterization as compared to DSA.

Anzidei, M, Napoli, A, Zaccagna, F, Cartocci, G, Cavallo Marincola, B, Catalano, C, High Resolution Steady State MR Angiography of the Carotid Arteries: Comparison of Three Contrast Agents for Image Quality and Diagnostic Accuracy.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9009049.html