title: Combined blood pool and extracellular contrast agents for pediatric and young adult cardiovascular magnetic resonance imaging.
abstract: BACKGROUND
  A comprehensive cardiac magnetic resonance (cardiac MR) study including both late gadolinium enhancement (LGE) and MR angiography may be indicated for patients with a history of acquired or congenital heart disease.
  
  
  OBJECTIVE
  To study the novel use of an extracellular agent for assessment of LGE combined with a blood pool contrast agent for detailed MR angiography evaluation to yield a comprehensive cardiac MR study in these patients.
  
  
  METHODS
  We reviewed clinical cardiac MR studies utilizing extracellular and blood pool contrast agents and noted demographics, clinical data and adverse events. We rated LGE image quality and MR angiography image quality for each vascular segment and calculated inter-rater variability. We also quantified contrast-to-noise ratio (CNR).
  
  
  RESULTS
  Thirty-three patients (mean age 13.9 ± 3 years) received an extracellular contrast agent (10 gadobenate dimeglumine, 23 gadopentetate dimeglumine) and blood pool contrast agent (33 gadofosveset trisodium). No adverse events were reported. MRI indications included Kawasaki disease (8), cardiomyopathy and coronary anatomy (15), repaired congenital heart disease (8), and other (2). Mean LGE quality was 2.6 ± 0.6 with 97% diagnostic imaging. LGE quality did not vary by type of contrast agent given (P = 0.07). Mean MR angiography quality score was 4.7 ± 0.6, with high inter-rater agreement (k = 0.6-0.8, P < 0.002). MR angiography quality did not vary by type of contrast agent used (P = 0.6).
  
  
  CONCLUSIONS
  Cardiac MR studies utilizing both extracellular and blood pool contrast agents are feasible and safe and provide excellent-quality LGE and MR angiography images. The use of two contrast agents allows for a comprehensive assessment of both myocardial viability and vascular anatomy during the same exam.
authors: Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 21, Chicago, IL, 60611, USA. jtjohnson@luriechildrens.org.|Department of Pediatrics, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA. jtjohnson@luriechildrens.org.
authors: Joyce T
authors: JT
authors: Johnson
authors: Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 21, Chicago, IL, 60611, USA.|Department of Pediatrics, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA.|Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors: Joshua D
authors: JD
authors: Robinson
authors: Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.|Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors: Jie
authors: J
authors: Deng
authors: Department of Pediatrics, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA.|Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.|Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors: Cynthia K
authors: CK
authors: Rigsby
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D009942:Organometallic Compounds; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; D005682:Gadolinium; D019786:Gadolinium DTPA; C109932:gadofosveset trisodium
keywords: Blood pool contrast agent; Cardiac magnetic resonance; Children; Heart; Late gadolinium enhancement; Magnetic resonance angiography