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Gadobenate Dimeglumine-Enhanced MRI of the Breast: Analysis of Dose Response and Comparison with Gadopentetate Dimeglumine

Michael V. Knopp1,2, Michael W. Bourne3, Francesco Sardanelli4, Martin N. Wasser5, Lorenzo Bonomo6, Carla Boetes7, Markus Müller-Schimpfle8, Margaret A. Hall-Craggs9, Bernd Hamm10, Antonio Orlacchio11, Carlo Bartolozzi12, Mareike Kessler13, Uwe Fischer14, Günther Schneider15, Matthijs Oudkerk16, William L. Teh17, Hans-Björn Gehl18, Isabella Salerio19, Gianpaolo Pirovano19, Anna La Noce19, Miles A. Kirchin19 and Alberto Spinazzi19

1 Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
3 Department of Diagnostic Radiology, University Hospital of Wales, Health Park, Cardiff CF4 4XN, United Kingdom.
4 Biomedical SpA., Servizio di Radiologia, Via Prà 1/b, 16157 Genova, Italy.
5 Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 AA Leiden, The Netherlands.
6 Istituto di Scienze Radiologiche e Formazione dell'Immagine, Ospedale SS. Annunziata, Via P. Valignani 66100, Chieti, Italy.
7 Department of Radiology, University Hospital Nijmegen-St. Radboud, 6500 HB Nijmegen, The Netherlands.
8 Eberhardt Karls-Universität, Radiologische Universitätsklinik, Abteilung für Radiologische Diagnostik, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
9 MRI Department, Middlesex Hospital, Mortimer St., London W1 N8AA, United Kingdom.
10 Medizinische Fakultät der Humboldt-Universität, Institut für Röntgendiagnostik Charité, Schumannstr. 20/21, D-10098 Berlin, Germany.
11 Radiologia e Diagnostica per Immagini, Ospedale Generale S. Giovanni Calibita, Fatebene Fratelli, Isola Tiberina 39, 00186 Rome, Italy.
12 Instituto di Radiologia, Ente Ospedaliero di Pisa, Via Roma 67, 56125 Pisa, Italy.
13 Institut für Radiologische Diagnostik, Ludwig-Maximilians-Universität, Klinikum Grosshadern, 81377 Munich, Germany.
14 Röntgendiagnostik I, Georg-August-Universität, Robert Koch Str. 40, D-37075 Göttingen, Germany.
15 Department of Diagnostic Radiology, University Hospital, 66421 Homburg/Saar, Germany.
16 State University Hospital, Hanzeplein 1, P. O. Box 30.001, 9700 RB Groningen, The Netherlands.
17 Department of Radiology, Northwick Park Hospital, Watford Rd., Harrow HA1 3UG, United Kingdom.
18 Institut für Radiologie Medizinischen, Universität Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
19 Worldwide Medical Affairs, Bracco Imaging SpA., Via E. Folli 50, 20134 Milano, Italy.



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  		Fig. 1. —Bar chart shows increase in global lesion detection score from unenhanced images to contrast-enhanced images, and from unenhanced images to combined (unenhanced, contrast-enhanced, and subtracted) images for two observers. Bars from left to right in each group indicate observer 1, contrast-enhanced images only; observer 2, contrast-enhanced images only; observer 1, combined images; and observer 2, combined images.

 


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  		Fig. 2. —Bar chart shows sensitivity for lesion detection per lesion for assessment of unenhanced (white), contrast-enhanced (gray), and combined (black) image sets for two observers. (Percentage values indicate increase of sensitivity for combined image assessment over unenhanced image assessment.)

 


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  		Fig. 3. —Bar chart shows numbers of false-positive interpretations for assessment of unenhanced (white), contrast-enhanced (gray), and combined (black) image sets for two observers.

 


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  		Fig. 4. —Bar chart shows sensitivity for lesion detection per breast for assessment of unenhanced (white), contrast-enhanced (gray), and combined (black) image sets for two observers. (Percentage values indicate increase of sensitivity for combined image assessment over unenhanced image assessment.)

 


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  		Fig. 5. —Bar chart shows specificity for lesion detection per breast for assessment of unenhanced (white), contrast-enhanced (gray), and combined (black) image sets for two observers.

 


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  		Fig. 6A. —58-year-old woman with multicentric invasive ductal carcinoma. Unenhanced MRI reveals two suspicious lesions (arrows) in right breast.

 


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  		Fig. 6B. —58-year-old woman with multicentric invasive ductal carcinoma. Contrast-enhanced MRI acquired immediately after injection of 0.1 mmol/kg of gadobenate dimeglumine reveals enhancement of lesions.

 


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  		Fig. 6C. —58-year-old woman with multicentric invasive ductal carcinoma. Subtracted MRI more clearly delineates lesions. Lesion in right lower medial quadrant seems to infiltrate skin.

 


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  		Fig. 6D. —58-year-old woman with multicentric invasive ductal carcinoma. Maximum-intensity-projection reconstruction in craniocaudal plane shows markedly increased vascularization of affected breast.

 


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  		Fig. 7A. —58-year-old woman with invasive ductal carcinoma. Unenhanced MRI of breasts reveals three solid-appearing areas (arrows) of low signal intensity.

 


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  		Fig. 7B. —58-year-old woman with invasive ductal carcinoma. Contrast-enhanced MRI acquired immediately after injection of 0.2 mmol/kg of gadobenate dimeglumine shows strong enhancement of one lesion (arrow) but only moderate increases in signal intensity of other two lesions.

 


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  		Fig. 7C. —58-year-old woman with invasive ductal carcinoma. Each lesion is delineated more clearly on subtracted images. Area of diffuse enhancement (arrow) is also apparent. Circles indicate regions of interest.

 


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  		Fig. 7D. —58-year-old woman with invasive ductal carcinoma. Signal intensity-time curve of strongly enhancing lesion (marked on C) reveals peak of enhancement immediately after injection (0 min) of gadobenate dimeglumine followed by rapid washout, indicative of malignancy. Areas showing moderate increases of signal intensity correspond to benign areas of adenosis.

 


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  		Fig. 8A. —71-year-old woman with multicentric invasive ductal carcinoma. Contrast-enhanced MRI of right breast acquired immediately after injection of 0.1 mmol/kg of gadobenate dimeglumine reveals 1.1-cm lesion (arrow) at border between right lower inner and outer quadrants.

 


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  		Fig. 8B. —71-year-old woman with multicentric invasive ductal carcinoma. Subtracted MRI improves lesion delineation and conspicuity and reveals second smaller (0.3 cm) lesion (arrow) in right upper inner quadrant.

 


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  		Fig. 8C. —71-year-old woman with multicentric invasive ductal carcinoma. Signal intensity-time curve of larger lesion reveals peak of enhancement immediately after gadobenate dimeglumine injection (0 min) followed by rapid washout. Similar signal intensity-time curve was noted for smaller lesion (not shown).

 


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  		Fig. 8D. —71-year-old woman with multicentric invasive ductal carcinoma. Maximum-intensity-projection reconstructions in craniocaudal (D), lateral (E), and anteroposterior (F) planes reveal size and location of lesions (arrowheads) and increased breast vascularization.

 


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  		Fig. 8E. —71-year-old woman with multicentric invasive ductal carcinoma. Maximum-intensity-projection reconstructions in craniocaudal (D), lateral (E), and anteroposterior (F) planes reveal size and location of lesions (arrowheads) and increased breast vascularization.

 


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  		Fig. 8F. —71-year-old woman with multicentric invasive ductal carcinoma. Maximum-intensity-projection reconstructions in craniocaudal (D), lateral (E), and anteroposterior (F) planes reveal size and location of lesions (arrowheads) and increased breast vascularization.

 


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  		Fig. 9. —Bar chart shows percentage of increase in quantitative signal intensity enhancement of malignant lesions from unenhanced to contrast-enhanced images. White bars indicate observer 1, black bars indicate observer 2.

 

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