Fabio Raman BS, Presenter: Nothing to Disclose

Mark Allan Ahlman MD, Abstract Co-Author: Nothing to Disclose

Jianing Pang, Abstract Co-Author: Nothing to Disclose

Debiao Li PhD, Abstract Co-Author: Nothing to Disclose

David A. Bluemke MD, PhD, Abstract Co-Author: Research support, Siemens AG

Coronary magnetic resonance angiography (MRA) at 3T suffers from imaging inconsistencies compared to 1.5T despite the use of gadolinium-based contrast agents (GBCAs). Gadofosveset Trisodium (Ablavar®, Lantheus Medical Imaging), with its high relaxivity and long intravascular residence time, offers greater potential over standard GBCAs to improve evaluation of the coronary arteries. The purpose of the study was to evaluate the diagnostic potential of a 0.06 mmol/kg dose of Gadofosveset compared to a standard clinical dose of 0.03 mmol/kg, using a free-breathing whole-heart coronary MRA protocol with (1.0 mm)3 spatial resolution and 100% navigator efficiency. The injection protocol was optimized for the prolonged pharmacokinetics of Gadofosveset.      

Thirty-eight contrast enhanced CMR scans were performed in 19 subjects [4 (21.1%) male; 29.5 ± 7 years; BMI=25.8 ± 6 kg/m2] on a 3.0T Verio Siemens scanner, using an inversion-prepared spoiled gradient-echo sequence. The two scans were separated by a 30-60 day interval, using dosages of either 0.06 mmol/kg or 0.03 mmol/kg of Gadofosveset. Signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR) were measured. Qualitative AHA quality scores were evaluated in 11 subjects. Pairwise, Student’s t-test and Wilcoxon rank test were performed for quantitative and qualitative assessment (MedCalc Software v12.2.1, MariaKerke, Belgium).

Both SNR and CNR were greater in the coronary arteries for double- over single-dose of Gadofosveset (21.2 ± 9.5 vs. 13.3 ± 5.4 and 12.3 ± 8.6 vs. 7.9 ± 4.6, respectively, p<0.001). Individual coronary arteries demonstrated greater SNR enhancement for 0.06 mmol/kg vs. 0.03 mmol/kg for the LMS (18.7 ± 8.5 vs. 10.9 ± 4.9, p<0.001), LAD (24.4 ± 9.0 vs. 15.1 ± 4.3, p=0.001), LCX (16.3 ± 4.6 vs. 11.3 ± 3.5, p=0.005), and RCA (25.4 ± 11.7 vs. 16.1 ± 6.7, p=0.003). CNR comparisons revealed similar results. Qualitatively, a similar number of main and branch vessels were identified by two reviewers.

Double dose of Gadofosveset shows improvement in coronary arterial enhancement over standard clinical dose. Patient studies are required to validate its diagnostic efficacy. 

Because of the small size of the coronary arteries, improved diagnostic quality of MRA is necessary in order to further develop a viable alternative to CT in the evaluation of coronary artery disease.

Raman, F, Ahlman, M, Pang, J, Li, D, Bluemke, D, Gadofosvest Trisodium for 100% Navigator Efficiency Coronary Magnetic Resonance Angiography at 3 Tesla.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011724.html