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Better visualization and lesion enhancement in contrast-enhanced MRI of the brain with Gadovist® compared to gadoterate meglumine

There have been three intraindividual studies directly comparing Gadovist® and gadoterate meglumine for contrast-enhanced MRI of the central nervous system. In 2 out of 3 of these direct comparison trials,1-3 Gadovist® showed either:

  • Better visualization of enhancing brain lesions.1
  • Increased enhancement in MS lesions.3

Better visualization of enhancing brain lesions

Anzalone et al. compared Gadovist® and gadoterate meglumine to determine overall preference for one agent or the other in a clinical setting. The efficacy analysis for this multicenter, randomized, single-blind, intra-individually controlled, comparison study was based on 136 patients who underwent identical MRI examinations with Gadovist® and gadoterate meglumine. The order of contrast agents was randomized and the two exams were separated by at least 48 hours and up to 7 days. Three independent, off-site, blinded readers assessed their overall diagnostic preference based on a matched pairs approach.

Across the three blinded readers, and excluding assessments of “no preference”, Gadovist® was preferred 66% of the time (confidence interval 57% to 74%, p = 0.0007), demonstrating a statistically significant preference for Gadovist® (Table 1).

Table 1. Overall preference of Gadovist® versus gadoterate meglumine for intensity of lesion enhancement

* Three independent blinded readers assessed off-site their overall diagnostic preference (primary efficacy parameter) based on a matched pairs approach.

** Assessments in which a preference for either agent was expressed (P < 0.001). No preference recorded in a further 175.

In summary, Anzalone et al. reported that Gadovist® provided:

  • Better contrast enhancement of lesions than gadoterate meglumine (P < 0.001)
  • Higher lesion-to-brain signal (P < 0.001)
  • 9% difference in relative enhancement (P < 0.001)

Increased enhancement in MS lesions

In a separate comparison of these two agents, Saake et al. performed a multicenter, randomized, prospective intraindividual study comparing the contrast effects of Gadovist® and gadoterate meglumine for brain MRI in multiple sclerosis at 3 T. Seventy-four consecutive patients were enrolled in the study. If no enhancing lesion was present in the first MRI, then the second MRI was cancelled. Forty-five patients completed both MRI examinations using randomized contrast agent order. Quantitative (number and signal intensity of enhancing lesions) and qualitative parameters (time points of first and all lesions enhancing; subjective preference regarding contrast enhancement and lesion delineation; global preference) were evaluated in a blinded read.

In summary Saake et al. reported:

  • Significantly higher mean lesion enhancement for Gadovist® (p < 0.05 at time points 3, 6 and 9 minutes)
  • Subjective preference showed non-significant tendency in favour of Gadovist®

Conclusion

With its high relaxivity, Gadovist® leads to a higher signal intensity and contrast in CNS MRI than gadoterate meglumine. Higher relaxivity could result in:

  • Increased signal on T1-weighted images 4,5
  • Enhanced image quality5
  • Improved diagnostic confidence6,7

References

  1. Anzalone N, Scarabino T, Venturi C, et al. Cerebral neoplastic enhancing lesions: multicenter, randomized, crossover intraindividual comparison between gadobutrol (1.0M) and gadoterate meglumine (0.5M) at 0.1 mmol Gd/kg body weight in a clinical setting. Eur J Radiol. 2013;82(1):139–145.
  2. Saake M, Langner S, Schwenke C, et al. MRI in multiple sclerosis: an intra-individual, randomized and multicentric comparison of gadobutrol with gadoterate meglumine at 3 T. Eur Radiol. 2016;26(3):820–828.
  3. Maravilla KR, San-Juan D, Kim SJ, et al. Comparison of Gadoterate Meglumine and Gadobutrol in the MRI Diagnosis of Primary Brain Tumors: A Double-Blind Randomized Controlled Intraindividual Crossover Study (the REMIND Study). AJNR Am J Neuroradiol. 2017;38(9):1681–1688.
  4. Kanal E, Maravilla K, Rowley HA. Gadolinium contrast agents for CNS imaging: current concepts and clinical evidence. AJNR Am J Neuroradiol. 2014;35(12):2215–2226.
  5. Anzalone N, Essig M, Lee SK, et al. Optimizing contrast-enhanced magnetic resonance imaging characterization of brain metastases: relevance to stereotactic radiosurgery. Neurosurgery. 2013;72(5):691–701.
  6. Gutierrez JE, Rosenberg M, Seemann J, et al. Safety and Efficacy of Gadobutrol for Contrast-enhanced Magnetic Resonance Imaging of the Central Nervous System: Results from a Multicenter, Double-blind, Randomized, Comparator Study. Magn Reson Insights. 2015;8:1–10.
  7. Katakami N, Inaba Y, Sugata S, et al. Magnetic resonance evaluation of brain metastases from systemic malignances with two doses of gadobutrol 1.0 m compared with gadoteridol: a multicenter, phase ii/iii study in patients with known or suspected brain metastases. Invest Radiol. 2011;46(7):411 – 418.