The Optimization of Dynamic and Blood-pool Magnetic Resonance Angiography Imaging with Gadofosveset in Peripheral Vascular Disease

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Abstract

Abstract
The introduction of contrast agents has further expanded the use of magnetic resonance imaging (MRI), allowing for enhanced acquisition under safer conditions relative to previous imaging techniques. Gadofosveset trisodium is the first blood-pool agent approved for use in contrast-enhanced magnetic resonance angiography (MRA). Its efficacy in first-pass (dynamic) imaging has been shown to be comparable to that of other gadoliniumbased contrast agents. With the additional steady-state (equilibrium) phase, it is possible to obtain detailed images with high contrast and high spatial resolution of vascular beds for the characterization of vascular disease, particularly peripheral vascular disease (PVD). Persistence of the contrast agent in the blood plasma is a significant advantage, removing the time constraints of first-pass imaging and providing the option of repeat image acquisition through an extended diagnostic time-frame. Importantly, adopting gadofosveset in clinical practice is easy as it requires minimal adjustments to the standard protocols commonly used with conventional gadolinium-based agents.

Keywords
Gadofosveset trisodium, peripheral vascular disease, blood-pool agent, magnetic resonance angiography, steady-state imaging

Disclosure: Winfried A Willinek, MD, is a speaker for Lantheus Medical Imaging.
Received: November 12, 2009 Accepted: March 10, 2010 Citation: US Radiology, 2010;2(1):16├óÔé¼ÔÇ£20
Correspondence: Winfried A Willinek, MD, Department of Radiology, University of Bonn, Sigmund-Freund-Str. 25, D-53105 Bonn, Germany. E: winfried.willinek@ukb.uni-bonn.de

Support: This article was independently developed, designed, and laid out by Touch Briefings, and supported by Lantheus Medical Imaging. The views expressed are those of the authors and not necessarily those of Lantheus Medical Imaging.

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Until recently, the assessment of vasculature via imaging was conventionally performed using X-ray angiography (XRA). The mandatory arterial catheterization of XRA led to the development of the non-invasive imaging techniques of X-ray computed tomography (CT) and magnetic resonance imaging (MRI). While both of these approaches allow for increased enhancement using exogenous contrast agents, the former is associated with radiation exposure, while no such risk exists with the latter. Indeed, recent years have seen a gradual expansion in the use of the safe and widely available MRI technique. Moreover, the development of magnetic resonance angiography (MRA) has enabled the imaging of vascular beds, enhancing the ability to characterize vasculature, especially in peripheral vascular disease (PVD), thereby improving the management of patients with vascular disease.

Radiologists and surgeons place different emphases on an MRA scan of known or suspected PVD owing to the foci of their respective fields. For the radiologist, it is important to avoid errors with timing and movement, while also improving spatial resolution to yield the best possible image, combining high sensitivity, specificity, and diagnostic accuracy for particular lesions. For the surgeon, the image obtained of the vasculature needs to be diagnostically helpful such that the appropriate intervention can be planned and applied: the extent and severity of overall disease, as well as the potential locations for either stents or grafts, must be clarified. Improvements in such areas of imaging have been achievable with the introduction of a blood-pool contrast agent, where the additional steady-state or equilibrium phase beyond the firstpass or dynamic (arterial) phase provides detailed information, including high-resolution depiction, delineation, and characterization of stenoses and vessel pathology. This article will provide insight into the use of gadofosveset trisodium (Ablavar├óÔÇŞ╦İ, Lantheus Medical Imaging, North Billerica, MA, US), the first gadolinium-based MRI contrast agent designed and approved to image the blood pool, with a particular focus on literature- and experience-based practicalities and technicalities in patients with suspected or known PVD.

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