title: Single bolus versus split dose gadolinium administration in extra-cellular volume calculation at 3 Tesla.
abstract: BACKGROUND
  Diffuse myocardial fibrosis may be quantified with cardiovascular magnetic resonance (CMR) by calculating extra-cellular volume (ECV) from native and post-contrast T1 values. Accurate ECV calculation is dependent upon the contrast agent having reached equilibrium within tissue compartments. Previous studies have used infusion or single bolus injections of contrast to calculate ECV. In clinical practice however, split dose contrast injection is commonly used as part of stress/rest perfusion studies. In this study we sought to assess the effects of split dose versus single bolus contrast administration on ECV calculation.
  
  
  METHODS
  Ten healthy volunteers and five patients ( 4 ischaemic heart disease, 1 hypertrophic cardiomyopathy) were studied on a 3.0 Tesla (Philips Achieva TX) MR system and underwent two (patients) or three (volunteers) separate CMR studies over a mean of 12 and 30 days respectively. Volunteers underwent one single bolus contrast study (Gadovist 0.15mmol/kg). In two further studies, contrast was given in two boluses (0.075mmol/kg per bolus) as part of a clinical adenosine stress/rest perfusion protocol, boluses were separated by 12 minutes. Patients underwent one bolus and one stress perfusion study only. T1 maps were acquired pre contrast and 15 minutes following the single bolus or second contrast injection.
  
  
  RESULTS
  ECV agreed between bolus and split dose contrast administration (coefficient of variability 5.04%, bias 0.009, 95% CI -3.754 to 3.772, r2 = 0.973, p = 0.001)). Inter-study agreement with split dose administration was good (coefficient of variability, 5.67%, bias -0.018, 95% CI -4.045 to 4.009, r2 = 0.766, p > 0.001).
  
  
  CONCLUSIONS
  ECV quantification using split dose contrast administration is reproducible and agrees well with previously validated methods in healthy volunteers, as well as abnormal and remote myocardium in patients. This suggests that clinical perfusion CMR studies may incorporate assessment of tissue composition by ECV based on T1 mapping.
authors: Adam K
authors: AK
authors: McDiarmid
authors: Peter P
authors: PP
authors: Swoboda
authors: Bara
authors: B
authors: Erhayiem
authors: David P
authors: DP
authors: Ripley
authors: Ananth
authors: A
authors: Kidambi
authors: David A
authors: DA
authors: Broadbent
authors: David M
authors: DM
authors: Higgins
authors: John P
authors: JP
authors: Greenwood
authors: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. s.plein@leeds.ac.uk.
authors: Sven
authors: S
authors: Plein
mesh_terms: D000241:Adenosine; D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005109:Extracellular Matrix / Q000473:pathology*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds / Q000008:administration & dosage*; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D014665:Vasodilator Agents; C090600:gadobutrol; D000241:Adenosine
references: Circulation. 2005 Sep 27;112(13):2047-60
references: 16186440
references: Eur Heart J. 2012 May;33(10):1268-78
references: 22279111
references: Circulation. 1990 Nov;82(5):1595-606
references: 2225364
references: Circulation. 1997 Dec 2;96(11):4065-82
references: 9403633
references: Radiology. 2005 Apr;235(1):229-36
references: 15731374
references: Lancet. 2012 Feb 4;379(9814):453-60
references: 22196944
references: J Cardiovasc Magn Reson. 2011;13:16
references: 21375743
references: Circulation. 2009 Mar 31;119(12):1671-81
references: 19332480
references: J Cardiovasc Med (Hagerstown). 2007 Dec;8(12):1076-9
references: 18163027
references: Magn Reson Med. 2004 Jul;52(1):141-6
references: 15236377
references: Circulation. 1983 Dec;68(6):1194-200
references: 6640872
references: Cardiovasc Res. 1998 Jan;37(1):123-9
references: 9539866
references: J Cardiovasc Magn Reson. 2014;16:2
references: 24387626
references: J Cardiovasc Magn Reson. 2013;15:92
references: 24124732
references: J Cardiovasc Magn Reson. 2013;15:78
references: 24025486
references: Eur Heart J. 2013 Oct;34(38):2949-3003
references: 23996286
references: JACC Cardiovasc Imaging. 2013 Sep;6(9):955-62
references: 23582361
references: JACC Cardiovasc Imaging. 2013 Jun;6(6):672-83
references: 23643283
references: J Cardiovasc Magn Reson. 2012;14:88
references: 23272651
references: J Cardiovasc Magn Reson. 2012;14:64
references: 22967246
references: Heart. 2012 Oct;98(19):1436-41
references: 22936681
references: Eur J Cardiothorac Surg. 2006 Oct;30(4):604-10
references: 16935520