Ultra low-dose of gadobenate dimeglumine for late gadolinium enhancement (LGE) imaging in acute myocardial infarction: A feasibility study

Abstract

Purpose To assess the feasibility of using an ultra-low dose (0.05 mmol/kg of body weight [BW]) of high relaxivity contrast agent for late gadolinium enhancement (LGE) imaging in patients with acute myocardial infarction (AMI). Materials and methods 17 consecutive patients (mean age, 60.1 ± 10.3 years) with ST-segment elevation AMI underwent two randomized cardiac magnetic resonance studies (exam intervals between 24 and 48 h) on a 1.5 T unit during the first week after the event using gadobenate dimeglumine (Gd-BOPTA) at the dose of 0.1 mmol/kg BW (standard dose or SD group) and 0.05 mmol/kg BW (half dose or HD group). Image quality was qualitatively assessed. Quantitative analysis of LGE were performed by measuring signal intensity (SI), signal-to-noise ratio (SNR) in the infarcted myocardium (IM), non-infarcted myocardium (N-IM) and left ventricular cavity (LVC) in images acquired at 1, 3, 5, 10, 15 and 20 min after administration of Gd-BOPTA using both contrast media protocol. Contrast-to-noise ratio (CNR) between IM and N-IM (CNR IM/N-IM) and between IM and LVC (CNR IM/LVC) were also quantified for each time point. Moreover the extent of infarcted myocardium was measured. Results 102 LGE images were evaluated for each dose group. Quality score was significantly higher for SD at 1, 15 and 20 min (0.002 < p < 0.046) and for HD at 5 min (p = 0.013). SNR has been higher in the SD group compared to the HD group even though not statistically significant at any time-point for both IM (SD vs. HD: 87.7 ± 73 vs. 65 ± 66; 0.15 < p < 0.38) and N-IM (SD vs. HD: 22 ± 61 vs. 9.9 ± 6.5; 0.09 < p < 0.43). LVC SNR was significantly higher with SD at 10 min (p = 0.03), 15 min (p = 0.001) and 20 min (p = 0.004). CNR between the IM and N-IM was significantly higher using SD compared to HD (1382.24 ± 1049 vs. 695.4 ± 500; 0.000 < p < 0.028) at 10, 15 and 20 min. No significant differences in CNR IM/LVC were noted for HD acquired 5 min after CM administration compared to SD acquired at 10 (p = 0.34), 15 (p = 0.96) and 20 (p = 0.41) min, and between HD at 10 min compared to SD acquired at 15 min (p = 0.78) and 20 min (p = 0.32). Good correlation between SD and HD (0.56 < r2 < 0.85, p < 0.024) was found at all time-points in the measuring of IA. Conclusion The use of a 0.05 mmol/kg dose of gadobenate dimeglumine is feasible for LGE imaging of acute MI and the best image quality is obtained at 5 min after contrast administration. It could be beneficial in patient with renal failure and a solution to improve the identification of subendocardial infarction reducing examination time, costs and total gadolinium load. However, the standard dose of 0.1 mmol/kg provides overall better image quality, with the best performance obtained at the delay of 10 min or more after Gd-BOPTA administration, and it should be routinely preferred.