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Contrast Enhancement of Central Nervous System Lesions: Multicenter Intraindividual Crossover Comparative Study of Two MR Contrast Agents¹

¹ From the Neuroradiology and MR Research Laboratory, University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (K.R.M.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (J.A.M.); Neuroradiology Research, University of Florida, Gainesville, Fla (I.M.S.); Department of Radiology, Southern Illinois University School of Medicine, Springfield, Ill (M.J.K.); Department of Radiology, University of Miami School of Medicine, Miami, Fla (B.C.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.J.W.); Department of Radiology, Scott and White Memorial Hospital, Temple, Tex (V.M.R.); Department of Radiology, Ohio State University-University Hospitals, Columbus, Ohio (M.V.K.); Department of Neuroradiology, Centre Hospitalier et Universitaire de Neuroradiologie, Nancy, France (S.K.); Department of Radiology, University Hospital, Newark, NJ (L.J.W.); Department of Neuroradiology, San Raffaele Hospital, Milan, Italy (N.A.); German Cancer Research Institute, Heidelberg, Germany (M.E.); and Department of Neuroradiology, Sahlgrenska University Hospital, Gothenburg, Sweden (L.G.). Received July 28, 2005; revision requested September 30; revision received November 10; accepted December 8; final version accepted February 6, 2006. K.R.M. and V.M.R. received partial support and consulted for Bracco Diagnostics. L.J.W. received support from Berlex and Bracco Diagnostics. Address correspondence to K.R.M. (e-mail: kmarav{at}u.washington.edu).

View larger version (113K): [in a new window]   Figure 1a: Transverse T1-weighted SE MR images (467/8) in 77-year-old man with large intraventicular enhancing tumor extending into surrounding brain parenchyma after administration of 0.1 mmol/kg of (a) gadopentetate and (b) gadobenate. Whereas the lesion (arrows) is clearly visible with gadopentetate, markedly improved definition of lesion borders that better defines extension of tumor into the adjacent right thalamus, splenium, and lingual regions is achieved with gadobenate. Histologic evaluation of surgical specimen confirmed glioblastoma multiforme.

View larger version (121K): [in a new window]   Figure 1b: Transverse T1-weighted SE MR images (467/8) in 77-year-old man with large intraventicular enhancing tumor extending into surrounding brain parenchyma after administration of 0.1 mmol/kg of (a) gadopentetate and (b) gadobenate. Whereas the lesion (arrows) is clearly visible with gadopentetate, markedly improved definition of lesion borders that better defines extension of tumor into the adjacent right thalamus, splenium, and lingual regions is achieved with gadobenate. Histologic evaluation of surgical specimen confirmed glioblastoma multiforme.

View larger version (136K): [in a new window]   Figure 2a: (a) Transverse T1-weighted SE MR image (590/12) in 61-year-old man with metastatic lung cancer after administration of 0.1 mmol/kg of gadopentetate reveals multiple enhancing lesions in right cerebellum and posterior medulla. (b) Image acquired with identical parameters as in a after administration of 0.1 mmol/kg of gadobenate reveals improved contrast enhancement of lesions seen with gadopentetate and unequivocal detection of two additional metastatic lesions (arrows) in right cerebellar hemisphere.

View larger version (132K): [in a new window]   Figure 2b: (a) Transverse T1-weighted SE MR image (590/12) in 61-year-old man with metastatic lung cancer after administration of 0.1 mmol/kg of gadopentetate reveals multiple enhancing lesions in right cerebellum and posterior medulla. (b) Image acquired with identical parameters as in a after administration of 0.1 mmol/kg of gadobenate reveals improved contrast enhancement of lesions seen with gadopentetate and unequivocal detection of two additional metastatic lesions (arrows) in right cerebellar hemisphere.

View larger version (111K): [in a new window]   Figure 3a: (a) Transverse T1-weighted SE MR image (467/8) in 51-year-old woman with metastatic lung cancer after administration of 0.1 mmol/kg of gadopentetate shows two metastatic nodules in right frontal area. (b) Image acquired with identical parameters as in a after administration of 0.1 mmol/kg of gadobenate reveals meningeal carcinomatosis over right frontal lobe and two additional metastatic nodules in left frontal (upper arrow) and right occipital (lower arrow) areas.

View larger version (111K): [in a new window]   Figure 3b: (a) Transverse T1-weighted SE MR image (467/8) in 51-year-old woman with metastatic lung cancer after administration of 0.1 mmol/kg of gadopentetate shows two metastatic nodules in right frontal area. (b) Image acquired with identical parameters as in a after administration of 0.1 mmol/kg of gadobenate reveals meningeal carcinomatosis over right frontal lobe and two additional metastatic nodules in left frontal (upper arrow) and right occipital (lower arrow) areas.

View larger version (97K): [in a new window]   Figure 4a: (a) Transverse T1-weighted SE MR image (467/9) in 71-year-old woman with enhancing tumor in left posterior insular region after administration of 0.1 mmol/kg of gadopentetate shows mild relatively homogeneous enhancement of lesion (arrow). (b) Corresponding image after administration of 0.1 mmol/kg of gadobenate shows markedly greater contrast enhancement, which results in greater definition of lesion extent and improved definition of lesion internal morphologic features, and central area of diminished enhancement suggestive of central necrosis or hypovascularity. The characteristic features enabled diagnosis of glioblastoma multiforme, which was confirmed at histologic evaluation of surgical specimen.

View larger version (100K): [in a new window]   Figure 4b: (a) Transverse T1-weighted SE MR image (467/9) in 71-year-old woman with enhancing tumor in left posterior insular region after administration of 0.1 mmol/kg of gadopentetate shows mild relatively homogeneous enhancement of lesion (arrow). (b) Corresponding image after administration of 0.1 mmol/kg of gadobenate shows markedly greater contrast enhancement, which results in greater definition of lesion extent and improved definition of lesion internal morphologic features, and central area of diminished enhancement suggestive of central necrosis or hypovascularity. The characteristic features enabled diagnosis of glioblastoma multiforme, which was confirmed at histologic evaluation of surgical specimen.

View larger version (18K): [in a new window]   Figure 5: Bar graph shows increased mean SI enhancement with gadobenate (black bars) compared with gadopentetate (gray bars). Data were obtained from quantitative measurements of SI enhancement for all patients at ROIs positioned by three blinded readers. Degree of increased enhancement with gadobenate at a dose of 0.1 mmol/kg is approximately equal to that expected with a double dose of any standard extracellular gadolinium-based agent, including gadopentetate.