Dynamic Contrast Enhanced MRI of the Prostate: Comparison of Gadobutrol and Gd-DTPA

Abstract

Purpose: To evaluate the enhancement profile of the macrocyclic contrast medium (CM) gadobutrol in comparison to linear CM Gd-DTPA in DCE-MRI of the prostate.

Materials and Methods: In total 53 patients with prostata cancer (PCa) were included, who received a radical prostatectomy after multiparametric MRI of the prostate including DCE-MRI. Using circular regions of interests normal peripheral zone (PZ) and PCa foci > 5 mm in diameter (42 and 34 foci in Gd-DTPA and gadobutrol group, respectively) were analysed in DCE-MRI. Enhancement curves (Type I, II and III) and pharmacokinetic parameters were analyzed qualitatively and quantitatively and compared using mixed linear models (two sided p-values < 0.05 were regarded significant).

Results: There was no significant difference in frequencies of curve types I, II or III in the normal PZ (p = 0.63) or in PCa foci (p = 0.75). PCa with a Gleason score ≥ 7 had in comparison to Gleason ≤ 6 significantly more often a Wash-Out-curve (Type III) with both CM (p = 0.02). The relative peak enhancement was in the PZ (Gd-DTPA 1.4 a. u. [1.20; 1.59], gadobutrol 1.58 a. u. [1.37; 1.78]) and in PCa foci (Gd-DTPA 1.56 a. u. [1.41; 1.71], gadobutrol 1.76 a. u. [1.59; 1.94]) significantly higher with gadobutrol (p = 0.04). The pharmacokinetic parameters K^trans und k_ep were higher in PCa foci than in PZ (p < 0.0001 and p = 0.002, respectively) without significant difference of the parameter values between both CM (p = 0.65).

Conlusion: This study is the first systematic comparison of gadobutrol and Gd-DTPA in DCE-MRI of the prostate. The relative peak enhancement is higher using gadobutrol compared to Gd-DTPA in DCE-MRI. There was no statistically significant difference in curve types or the pharmacokinetic parameters in PCa or normal PZ between both CM.

Key Points:

• Gadobutrol yields a higher and faster peak enhancement in prostate cancer and in the normal peripheral zone compared to Gd-DTPA.

• There was no statistically significant difference observed in curve type frequencies and pharmacokinetic parameters between both CM.

• Gadobutrol as Gd-DTPA appear to be suitable for DCE-MRI of the prostate for prostate cancer detection.

Citation Format:

• Durmus T, Vollnberg B, Schwenke C et al. Dynamic Contrast Enhanced MRI of the Prostate: Comparison of Gadobutrol and Gd-DTPA. Fortschr Röntgenstr 2013; 862 – 868

Zusammenfassung

Ziel: Vergleich des makrozyklischen Kontrastmittels (KM) Gadobutrol und des linearen KM Gd-DTPA bezüglich des Signalintensitätsverlaufs in der dynamischen Kontrastmitteluntersuchung (DCE-MRI) der Prostata.

Material und Methoden: Es wurden insgesamt 53 Patienten mit Prostatakarzinom (PCa) eingeschlossen, welche nach einer multiparametrischen MRT der Prostata mit DCE-MRI prostatektomiert wurden. Jedes PCa > 5 mm (42 PCa in Gd-DTPA-Gruppe, 34 PCa in Gadobutrol-Gruppe) und die gesunde periphere Zone (PZ) wurden in der DCE-MRI qualitativ und quantitativ analysiert. Kurvenverläufe (TypI, II und III) und pharmakokinetische Parameter K^trans und k_ep wurden anhand gemischt linearer Modelle zwischen beiden Gruppen verglichen; zweiseitige p-Werte < 0,05 wurden als signifikant definiert.

Ergebnisse: Die Frequenz der Kurventypen I, II und III unterschied sich zwischen den KM weder in der PZ (p = 0,63) noch im PCa (p = 0,75) signifikant voneinander. PCa mit einem Gleason-Score ≥ 7 zeigten im Vergleich zu Gleason-Score ≤ 6 statistisch signifikant häufiger bei beiden KM eine Wash-out-Kurve (Typ III, p = 0,02). Das relative Signalintensitätsmaximum war in der PZ (Gd-DTPA 1,4 a. u. [1,20; 1,59], Gadobutrol 1,58 a. u. [1,37; 1,78]) und im PCa-Gewebe (Gd-DTPA 1,56 a. u. [1,41; 1,71], Gadobutrol 1,76 a. u. [1,59; 1,94]) für Gadobutrol signifikant höher (p = 0,04). Die pharmakokinetischen Parameter K^trans und k_ep waren im Tumorgewebe signifikant höher als in der PZ (K^transp< 0,0001; k_ep p = 0,002). Zwischen den KM fand sich kein signifikanter Unterschied bezüglich der pharmakokinetischen Parameter (p = 0,65)

Schlussfolgerung: Diese Arbeit ist der erste systematische Vergleich von Gadobutrol und Gd-DTPA in der DCE-MRI der Prostata. Hierbei konnte gezeigt werden, dass das maximale relative Enhancement mit Gadobutrol im Vergleich zu Gd-DTPA höher ist, wobei Kurventypen und pharmakokinetische Parameter K^trans und k_ep weder im PCa noch in der normalen PZ einen statistisch signifikanten Unterschied aufweisen.

Key words

prostate - MR-imaging - contrast agents - gadolinium - neoplasms

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