Comparison of blood pool and extracellular gadolinium chelate for functional MR evaluation of vascular thoracic outlet syndrome.
OBJECTIVE
To compare performance of single-injection blood pool agent (gadofosveset trisodium, BPA) against dual-injection extracellular contrast (gadopentetate dimeglumine, ECA) for MRA/MRV in assessment of suspected vascular TOS.


METHODS
Thirty-one patients referred for vascular TOS evaluation were assessed with BPA (n=18) or ECA (n=13) MRA/MRV in arm abduction and adduction. Images were retrospectively assessed for: image quality (1=non-diagnostic, 5=excellent), vessel contrast (1=same signal as muscle, 4=much brighter than muscle) and vascular pathology by two independent readers, with a separate experienced reader providing reference assessment of vascular pathology.


RESULTS
Median image quality was diagnostic or better (score ≥ 3) for ECA and BPA at all time points, with BPA image quality superior at abduction late (BPA 4.5, ECA 4, p=0.042) and ECA image quality superior at adduction-early (BPA 4.5; ECA 4.0, p=0.018). High qualitative vessel contrast (mean score ≥ 3) was observed at all time points with both BPA and ECA, with superior BPA vessel contrast at abduction-late (BPA 3.97 ± 0.12; ECA 3.73 ± 0.26, p=0.007) and ECA at adduction-early (BPA 3.42 ± 0.52; ECA 3.96 ± 0.14, p<0.001). Readers readily identified arterial and venous pathology with BPA, similar to ECA examinations.


CONCLUSIONS
Single-injection BPA MRA/MRV for TOS evaluation demonstrated diagnostic image quality and high vessel contrast, similar to dual-injection ECA imaging, enabling identification of fixed and functional arterial and venous pathology.
New York University School of Medicine, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, 660 1st Avenue, New York, NY 10016, USA; Austin Health, Department of Radiology, Heidelberg, Victoria 3084, Australia; The University of Melbourne, School of Medicine, Parkville, Victoria 3010, Australia. Electronic address: ruthplim74@gmail.com.
Ruth P
RP
Lim
New York University School of Medicine, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, 660 1st Avenue, New York, NY 10016, USA. Electronic address: mary.bruno@nyumc.org.
Mary
M
Bruno
New York University School of Medicine, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, 660 1st Avenue, New York, NY 10016, USA. Electronic address: Andrew.rosenkrantz@nyumc.org.
Andrew B
AB
Rosenkrantz
New York University School of Medicine, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, 660 1st Avenue, New York, NY 10016, USA. Electronic address: danny.kim@nyumc.org.
Danny C
DC
Kim
New York University School of Medicine, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, 660 1st Avenue, New York, NY 10016, USA. Electronic address: Thomas.mulholland@nyumc.org.
Thomas
T
Mulholland
New York University School of Medicine, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, 660 1st Avenue, New York, NY 10016, USA. Electronic address: jane.kwon@nyumc.org.
Jane
J
Kwon
St John's University, Department of Psychology, 8000 Utopia Parkway, Jamaica-Queens, NY 11439, USA. Electronic address: amy.pastva10@stjohns.edu.
Amy P
AP
Palfrey
New York University School of Medicine, Clinical and Translational Science Institute, 227 E30th St, 8th Floor, New York, NY 10016, USA. Electronic address: Olugbenga.Ogedegbe@nyumc.org.
Olugbenga
O
Ogedegbe
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013901:Thoracic Outlet Syndrome / Q000473:pathology*; D055815:Young Adult
D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; D019786:Gadolinium DTPA; C109932:gadofosveset trisodium
Blood pool agent; Magnetic resonance angiography; Thoracic outlet syndrome