title: Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Quantitative Lung Perfusion Imaging Using the Dual-Bolus Approach: Comparison of 3 Contrast Agents and Recommendation of Feasible Doses.
abstract: OBJECTIVE
  The aims of this study were to compare 3 contrast agents and to define feasible doses for quantitative lung perfusion imaging using the dual-bolus approach in dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI).
  
  
  METHODS
  Ten healthy volunteers (6 males, 4 females; mean age, 23.5 years) underwent DCE-MRI at 1.5 T using a 3D FLASH sequence. After a prebolus, 3 doses of gadopentetate dimeglumine (Gd-DTPA), gadofosveset, and gadobenate dimeglumine (Gd-BOPTA) were evaluated. Dose regimes were as follows: Gd-DTPA: 3.0 mL, 6.0 mL, and 12.0 mL with 1.5 mL prebolus; gadofosveset: 1.5 mL, 3.0 mL, and 6.0 mL with 0.8 mL prebolus; and Gd-BOPTA: 1.5 mL, 3.0 mL, and 6.0 mL with 0.8 mL prebolus. Pulmonary blood flow (PBF), pulmonary distribution volume, and mean transit time were assessed for each bolus. Region of interest measurements were used to determine the arterial input function (AIF) in the pulmonary trunk and signal intensities in lung parenchyma. Two radiologists independently rated the subjective image quality of the quantitative perfusion maps based on a 4-point Likert scale.
  
  
  RESULTS
  Dose-dependent signal saturation effects were observed for all 3 contrast agents concerning AIF and parenchyma measurements. Signal yields were comparable using Gd-BOPTA (AIF, 214.49 arbitrary units [AU]; parenchyma, 41.7 AU) and Gd-DTPA (207.43 AU; 36.3 AU). Gadofosveset showed significantly lower signal yield (165.74 AU; 25.2 AU; p < 0.008). Highest signal increase was observed for Gd-DTPA. Using Gd-DTPA, mean PBF values for the 3 doses (3 mL, 6 mL, 12 mL) in mL/min per milliliter lung volume were 2.9 ± 1.5, 2.4 ± 1.1, and 1.6 ± 1.0. For the 3 doses of gadofosveset (1.5 mL, 3 mL, 6 mL) mean PBF results were 3.1 ± 1.1, 1.9 ± 0.7, and 1.2 ± 0.6. Last, mean PBF values for Gd-BOPTA (1.5 mL, 3 mL, 6 mL) were 3.4 ± 1.7, 2.8 ± 1.3, and 2.0 ± 0.8. Measurements provided consistent values for all perfusion parameters (PBF, pulmonary distribution volume, mean transit time) when compared with reference literature. Contrast dose volume and the applied contrast agent had no relevant effects on the image quality scores.
  
  
  CONCLUSIONS
  The dual-bolus approach using a 3D FLASH sequence is a feasible tool for quantitative lung perfusion imaging. Small boluses of 3 mL for Gd-DTPA, 1.5 mL for Gd-BOPTA, and 1.5 mL for gadofosveset provide sufficient signal yield for quantitative parenchyma measurements. Using higher boluses falsely lower perfusion values have to be considered due to signal saturation effects. Although gadofosveset yielded the lowest signal, the generated quantitative perfusion maps were of diagnostic quality.
authors.affiliation: From the *Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg; †Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich; and ‡Department of Diagnostic and Interventional Radiology Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Veldhoen
authors.forename: Markus
authors.initials: M
authors.lastname: Oechsner
authors.forename: Andre
authors.initials: A
authors.lastname: Fischer
authors.forename: Andreas Max
authors.initials: AM
authors.lastname: Weng
authors.forename: Andreas Steven
authors.initials: AS
authors.lastname: Kunz
authors.forename: Thorsten Alexander
authors.initials: TA
authors.lastname: Bley
authors.forename: Herbert
authors.initials: H
authors.lastname: Köstler
authors.forename: Christian Oliver
authors.initials: CO
authors.lastname: Ritter
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D019786:Gadolinium DTPA / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D064368:Healthy Volunteers; D006801:Humans; D008168:Lung / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D009942:Organometallic Compounds / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; D005682:Gadolinium; D019786:Gadolinium DTPA; C109932:gadofosveset trisodium