PMID- 27716273 OWN - NLM STAT- MEDLINE DCOM- 20171212 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 18 IP - 1 DP - 2016 Oct 5 TI - A clinical combined gadobutrol bolus and slow infusion protocol enabling angiography, inversion recovery whole heart, and late gadolinium enhancement imaging in a single study. PG - 66 LID - 66 AB - BACKGROUND: The use of gadolinium contrast agents in cardiovascular magnetic resonance is well-established and serves to improve both vascular imaging as well as enable late gadolinium enhancement (LGE) imaging for tissue characterization. Currently, gadofosveset trisodium, an intravascular contrast agent, combined with a three-dimensional inversion recovery balanced steady state free precession (3D IR bSSFP) sequence, is commonly used in pediatric cardiac imaging and yields excellent vascular imaging, but cannot be used for late gadolinium enhancement. Gadofosveset use remains limited in clinical practice, and manufacture was recently halted, thus an alternative is needed to allow 3D IR bSSFP and LGE in the same study. METHODS: Here we propose a protocol to give a bolus of 0.1 mL/kg = 0.1 mmol/kg gadobutrol (GADAVIST/GADOVIST) for time-resolved magnetic resonance angiography (MRA). Subsequently, 0.1 mmol/kg is diluted up to 5 or 7.5 mL with saline and then loaded into intravenous tubing connected to the patient. A 0.5 mL short bolus is infused, then a slow infusion is given at 0.02 or 0.03 mL/s. Image navigated (iNAV) 3D IR bSSFP imaging is initiated 45-60 s after the initiation of the infusion, with a total image acquisition time of ~5 min. If necessary, LGE imaging using phase sensitive inversion recovery reconstruction (PSIR) is performed at 10 min after the infusion is initiated. RESULTS: We have successfully performed the above protocol with good image quality on 10 patients with both time-resolved MRA and 3D IR bSSFP iNAV imaging. Our initial attempts to use pencil beam respiratory navigation failed due to signal labeling in the liver by the navigator. We have also performed 2D PSIR LGE successfully, with both LGE positive and LGE negative results. CONCLUSION: A bolus of gadobutrol, followed later by a slow infusion, allows time-resolved MRA, 3D IR bSSFP using the iNAV navigation technique, and LGE imaging, all in a single study with a single contrast agent. FAU - Tandon, Animesh AU - Tandon A AUID- ORCID: 0000-0001-9769-8801 AD - Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, Texas, USA. Animesh.Tandon@UTSouthwestern.edu. AD - Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, Texas, USA. Animesh.Tandon@UTSouthwestern.edu. AD - Pediatric Cardiology, Children's Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235, Texas, USA. Animesh.Tandon@UTSouthwestern.edu. FAU - James, Lorraine AU - James L AD - Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, Texas, USA. AD - Pediatric Cardiology, Children's Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235, Texas, USA. FAU - Henningsson, Markus AU - Henningsson M AD - Department of Imaging and Biomedical Engineering, King's College London, London, UK. FAU - Botnar, Rene M AU - Botnar RM AD - Department of Imaging and Biomedical Engineering, King's College London, London, UK. AD - Pontificia Universidad Catolica de Chile, Escuela de Ingenieria, Santiago, Chile. FAU - Potersnak, Amanda AU - Potersnak A AD - Pediatric Cardiology, Children's Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235, Texas, USA. FAU - Greil, Gerald F AU - Greil GF AD - Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, Texas, USA. AD - Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, Texas, USA. AD - Pediatric Cardiology, Children's Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235, Texas, USA. FAU - Hussain, Tarique AU - Hussain T AD - Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, Texas, USA. AD - Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390, Texas, USA. AD - Pediatric Cardiology, Children's Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235, Texas, USA. LA - eng GR - RG/12/1/29262/BHF_/British Heart Foundation/United Kingdom GR - UL1 TR001425/TR/NCATS NIH HHS/United States PT - Journal Article DEP - 20161005 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 1BJ477IO2L (gadobutrol) SB - IM MH - Contrast Media/*administration & dosage MH - Coronary Angiography/*methods MH - Heart/*diagnostic imaging/physiopathology MH - Heart Defects, Congenital/*diagnostic imaging/physiopathology MH - Humans MH - Image Interpretation, Computer-Assisted MH - Imaging, Three-Dimensional MH - Infusions, Intravenous MH - Injections, Intravenous MH - Magnetic Resonance Angiography/*methods MH - Magnetic Resonance Imaging, Cine/*methods MH - Organometallic Compounds/*administration & dosage MH - Predictive Value of Tests MH - Retrospective Studies MH - Time Factors PMC - PMC5052797 OTO - NOTNLM OT - Congenital heart disease OT - Gadobutrol OT - Late gadolinium enhancement OT - Steady state magnetic resonance angiography OT - Time-resolved magnetic resonance angiography EDAT- 2016/10/08 06:00 MHDA- 2017/12/13 06:00 PMCR- 2016/10/05 CRDT- 2016/10/08 06:00 PHST- 2016/08/02 00:00 [received] PHST- 2016/09/24 00:00 [accepted] PHST- 2016/10/08 06:00 [entrez] PHST- 2016/10/08 06:00 [pubmed] PHST- 2017/12/13 06:00 [medline] PHST- 2016/10/05 00:00 [pmc-release] AID - S1097-6647(23)01007-4 [pii] AID - 285 [pii] AID - 10.1186/s12968-016-0285-7 [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2016 Oct 5;18(1):66. doi: 10.1186/s12968-016-0285-7.