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MR Angiography with Gadofosveset Trisodium for Peripheral Vascular Disease: Phase II Trial¹

¹ From Department of Radiology, CHUM-Hospital St Luc, Montreal, Quebec, Canada (P.P.); Department of Radiology, Rush North Shore Medical Center, Skokie, Ill (M.A.E.); Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (R.A.B., E.K.Y.); EPIX Medical, Cambridge, Mass (R.M.W.); Berlex Laboratories, Montville, NJ (K.S.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, PHI Bldg, Rm 432, 51 N 39th St, Philadelphia, PA 19104 (E.R.M.). Received September 19, 2002; revision requested November 26; final revision received March 21, 2003; accepted April 14. Address correspondence to E.R.M. (e-mail: mohlere@uphs.upenn.edu).

PURPOSE: To evaluate the dose response and safety of gadofosveset trisodium–enhanced magnetic resonance (MR) angiography compared with nonenhanced two-dimensional time-of-flight MR angiography and with x-ray angiography as the standard.

MATERIALS AND METHODS: In this randomized, 20-center, double-blind study, 238 men and women who had peripheral vascular disease or were suspected of having it received intravenous injection of placebo or gadofosveset (0.005, 0.01, 0.03, 0.05, or 0.07 mmol per kilogram of body weight). MR angiographic images were evaluated by three blinded readers, and x-ray angiographic images were evaluated by two readers. Hypothesis testing for the presence of a dose response was based on a linear test for trend for increase in area under the receiver operating characteristic curve as a function of dose for each reader of MR angiographic images independently.

RESULTS: Gadofosveset administration resulted in a dose-dependent increase in diagnostic accuracy for detection of aortoiliac occlusive disease as reflected in the area under the receiver operating characteristic curve for each reader (P < .001). The plateau in effectiveness improvement began at the 0.03 mmol/kg dose. At doses of 0.03 mmol/kg and higher, gadofosveset-enhanced MR angiography provided an approximate 20% increase in accuracy over nonenhanced MR angiography for diagnosis of clinically significant aortoiliac occlusive disease. Gadofosveset exhibited a good safety profile in all dose groups. Three serious adverse events were possibly or probably related to gadofosveset administration. There were no dose-related trends in severe or serious adverse events in patients receiving gadofosveset.

CONCLUSION: A dose of 0.03 mmol/kg of gadofosveset was safe and effective for evaluation of aortoiliac occlusive disease with MR angiography.

© RSNA, 2003

Index terms: Angiography, contrast media, 92.12943, 98.12943 • Arteries, extremities, 92.72, 92.721, 98.72 • Magnetic resonance (MR), vascular studies, 92.12942, 98.12942

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