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Dose Optimization for Dynamic Time-Resolved Contrast-Enhanced 3D MR Angiography of Pulmonary Circulation

Stefan Sonnet1, Carlos Hernando Buitrago-Téllez1, Anja-Carina Schulte2, Georg Bongartz1 and Jens Bremerich1

1 Department of Radiology, University Hospitals Basel, Petersgraben 4, CH-4053 Basel, Switzerland.
2 Department of Radiology, Section of Medical Physics, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany.



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  		Fig. 1. —29-year-old healthy male volunteer. Contrast-enhanced 3D MR angiogram shows signal intensity measurements. Regions of interest are set in five different anatomic regions to measure signal intensities in 1, pulmonary trunk; 2, pulmonary parenchyma; 3, left atrium; 4, aorta; and 5, inferior vena cava. Repeated measurements in consecutive 3D slabs in identical locations provide time-course data of signal intensity changes.

 


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  		Fig. 2A. —Graphs show signal-intensity enhancement in arbitrary units ({Delta}SI) with 0.025 ({diamondsuit}), 0.05 ({blacksquare}), 0.1 ({blacktriangleup}), and 0.2 l (•) mmol/kg of gadoterate meglumine plotted over time. Graphs show main pulmonary artery (A).

 


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  		Fig. 2B. —Graphs show signal-intensity enhancement in arbitrary units ({Delta}SI) with 0.025 ({diamondsuit}), 0.05 ({blacksquare}), 0.1 ({blacktriangleup}), and 0.2 l (•) mmol/kg of gadoterate meglumine plotted over time. left atrium (B).

 


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  		Fig. 2C. —Graphs show signal-intensity enhancement in arbitrary units ({Delta}SI) with 0.025 ({diamondsuit}), 0.05 ({blacksquare}), 0.1 ({blacktriangleup}), and 0.2 l (•) mmol/kg of gadoterate meglumine plotted over time. aorta (C).

 


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  		Fig. 3A. —Visibility and delineation of pulmonary structures at various doses of contrast media. Light gray bars = 0.025 mmol/kg of gadoterate meglumine, dark gray bars = 0.05 mmol/kg of gadoterate meglumine, black bars = 0.1 mmol/kg of gadoterate meglumine, and white bars = 0.2 mmol/kg of gadoterate meglumine. Graph shows that image-quality score for right and left pulmonary arteries (r/l PA) was 4 or better, regardless of dose. Lobar (Lobar PA) and segmental arteries (Segm PA) were scored below 4 with 0.025 and 0.05 mmol/kg of gadoterate meglumine; significantly better score was achieved with 0.1 of mmol/kg. Dose increase to 0.2 of mmol/kg of gadoterate meglumine did not further improve score. Subsegmental arteries (Subsegm PA) were scored below 2 at all tested doses (p < 0.5).

 


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  		Fig. 3B. —Visibility and delineation of pulmonary structures at various doses of contrast media. Light gray bars = 0.025 mmol/kg of gadoterate meglumine, dark gray bars = 0.05 mmol/kg of gadoterate meglumine, black bars = 0.1 mmol/kg of gadoterate meglumine, and white bars = 0.2 mmol/kg of gadoterate meglumine. Graph shows that pulmonary parenchyma was visible, but score did not exceed 3 at all tested doses.

 


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  		Fig. 4A. —29-year-old healthy male volunteer. Contrast-enhanced maximum-intensity-projection 3D MR angiogram obtained with 0.1 mmol/kg of gadoterate meglumine during early pulmonary arterial phase shows clear depiction of pulmonary trunk and left and right (arrow) pulmonary arteries.

 


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  		Fig. 4B. —29-year-old healthy male volunteer. Contrast-enhanced maximum-intensity-projection 3D MR angiogram was obtained with 0.1 mmol/kg of gadoterate meglumine during late pulmonary arterial phase. Note pulmonary arteries up to segmental level and parenchymal blush (arrows).

 


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  		Fig. 4C. —29-year-old healthy male volunteer. Contrast-enhanced 3D MR angiogram obtained during pulmonary venous phase shows central pulmonary veins (arrows).

 


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  		Fig. 4D. —29-year-old healthy male volunteer. Contrast-enhanced 3D MR angiogram obtained during systemic arterial phase shows aorta (arrows) and proximal brachiocephalic arteries.

 

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