Single Session of MR Coronary Angiography and Myocardial Perfusion Imaging  Using a New Blood Pool Compound B-22956 (Gadoc...
POSITIVE NON DIAGNOSTIC POSITIVE NON DIAGNOSTIC Diagnostic Decision Tree  for Coronary Artery Disease ~ 4.4 m  procedures/...
Advantages of Cardiac MRI <ul><li>No radiation and minimal invasiveness (IV injection) </li></ul><ul><li>3-dimensional ana...
Challenges of Cardiac MRI <ul><li>Prone to cardiac and respiratory motions </li></ul><ul><li>Low signal-to-noise ratio </l...
New Experimental Contrast for  MR Coronary Angiography:  B-22956/1 <ul><li>Low molecular weight Gd chelate with very high ...
MPR Images (Siemens Symphony 1.5T) after 0.125 mmol/kg  Injection of  B-22956/1   [ Res. : 0.7    0.7    0.7 mm 3 ] 1 mi...
Res. :  1.0    1.0    2.0 (1.0)  mm 3 Volume Rendering 3D MR Coronary Angiography in Pigs  after  B-22956/1  (0.1 mmol/k...
B-22956/1   0.02 mmol/kg 2.7 s 6.4 s 9.1 s 16.4 s 20.0  s 23.6  s Conventional Gadolinium (FDA approved MRI contrast agent...
Materials and Methods <ul><li>Six Yucatan mini-swine (mean weight = 18 kg) </li></ul><ul><li>Coronary balloon angioplasty ...
Pig 2: LCx,  Mild Stenosis < 50% LCx LAD X-ray 50-70% Post-BH Post-NAV
Pig 2: RCA,  Moderate Stenosis 50-70% 50-70% X-ray Post-BH Post-NAV
Pig 1: RCA,  High Grade Stenosis > 95% RCA X-ray RCA Post-NAV
Pig 1: RCA,  Perfusion   High Grade Stenosis > 95% Low Perfusion in RCA Normal Perfusion in LAD LV RV LAD RCA
Results <ul><li>Breath-hold and high-resolution navigator-echo gated scans could repeat after the contrast injection </li>...
Conclusions <ul><li>Availability of  B-22956/1  will greatly facilitate the successful  development  of Magnetic Resonance...
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Single Session of MR Coronary Angiography and Myocardial Perfusion Imaging

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Jie Zheng, Debiao Li, Fabio Maggioni,
Dana Abendschein, Orlando Simonetti, Gerhard Laub,
J Paul Finn, Robert J Gropler, Friedrich M Cavagna

Published in: Health & Medicine, Business
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Single Session of MR Coronary Angiography and Myocardial Perfusion Imaging

  1. 1. Single Session of MR Coronary Angiography and Myocardial Perfusion Imaging Using a New Blood Pool Compound B-22956 (Gadocoletic Acid): Initial Experience in a Porcine Model of Coronary Artery Disease Jie Zheng, Debiao Li, Fabio Maggioni, Dana Abendschein, Orlando Simonetti, Gerhard Laub, J Paul Finn, Robert J Gropler, Friedrich M Cavagna Zheng J et al, Investigative Radiology 2005;40:604-613
  2. 2. POSITIVE NON DIAGNOSTIC POSITIVE NON DIAGNOSTIC Diagnostic Decision Tree for Coronary Artery Disease ~ 4.4 m procedures/y Stress ECG Ultrasound $ 400.- rule out CAD medication Stress Perfusion Imaging Nuclear Medicine rule out CAD medication ~ 2.2 m procedures/y X-Ray Coronary Angiography or IVUS $ 300.- ~ 13 m procedures/y Radiation Invasive NEGATIVE NEGATIVE $ 700.- >$ 3,000.-
  3. 3. Advantages of Cardiac MRI <ul><li>No radiation and minimal invasiveness (IV injection) </li></ul><ul><li>3-dimensional anatomic images (3D coronary artery and myocardial imaging) </li></ul><ul><li>Comprehensive functional imaging - Myocardial mechanical work </li></ul><ul><li>- Myocardial perfusion </li></ul><ul><li>- Myocardial oxygenation </li></ul><ul><li>- Myocardial Viability </li></ul>
  4. 4. Challenges of Cardiac MRI <ul><li>Prone to cardiac and respiratory motions </li></ul><ul><li>Low signal-to-noise ratio </li></ul><ul><li>Low spatial resolution relative to motionless organs (brain, kidney, etc) </li></ul>Intravascular or blood-pool contrast agents can potentially overcome these limitations!
  5. 5. New Experimental Contrast for MR Coronary Angiography: B-22956/1 <ul><li>Low molecular weight Gd chelate with very high </li></ul><ul><li>affinity for serum proteins : </li></ul><ul><li>Apparent longitudinal relaxivity (0.5 mM in Seronorm ® ) : </li></ul><ul><li>Binding (0.5 mM) to HSA 0.6 mM 94 % (80 %)* </li></ul><ul><li>Binding (0.5 mM) to PSA 0.6 mM 90 % (56 %)* </li></ul><ul><li>Binding (0.5 mM) to MSA 0.6 mM 92 % (81 %)* </li></ul>* data in parenthesis are for MS-325, a protein binding contrast agent undergoing Clinical Trials and FDA approval r 1 27 mM -1 ·s -1 (35 mM -1 ·s -1 )*
  6. 6. MPR Images (Siemens Symphony 1.5T) after 0.125 mmol/kg Injection of B-22956/1 [ Res. : 0.7  0.7  0.7 mm 3 ] 1 min postcontrast 33 min postcontrast 17 min postcontrast RCA
  7. 7. Res. : 1.0  1.0  2.0 (1.0) mm 3 Volume Rendering 3D MR Coronary Angiography in Pigs after B-22956/1 (0.1 mmol/kg b.w.) RCA RCA LAD LCx
  8. 8. B-22956/1 0.02 mmol/kg 2.7 s 6.4 s 9.1 s 16.4 s 20.0 s 23.6 s Conventional Gadolinium (FDA approved MRI contrast agent) ® 0.04 mmol/kg 2.4 s 5.6 s 8.0 s 14.4 s 17.6 s 20.8 s Myocardial Perfusion Imaging in Pig @ 1.5T (IR-True FISP TR/TE/  : 3.5/1.8/70°)
  9. 9. Materials and Methods <ul><li>Six Yucatan mini-swine (mean weight = 18 kg) </li></ul><ul><li>Coronary balloon angioplasty injury and atherogenic diet feeding atherosclerotic plaques in 2 or 3 coronary arteries </li></ul><ul><li>X-ray angiography prior to MR scans </li></ul><ul><li>MR precontrast coronary imaging </li></ul><ul><li>Injection of 0.1 or 0.15 mmol/kg B-22956/1 (Bracco) </li></ul><ul><li>MR postcontrast scans (breath-holds (BH) and navigator-echo gated imaging (NAV)) </li></ul>
  10. 10. Pig 2: LCx, Mild Stenosis < 50% LCx LAD X-ray 50-70% Post-BH Post-NAV
  11. 11. Pig 2: RCA, Moderate Stenosis 50-70% 50-70% X-ray Post-BH Post-NAV
  12. 12. Pig 1: RCA, High Grade Stenosis > 95% RCA X-ray RCA Post-NAV
  13. 13. Pig 1: RCA, Perfusion High Grade Stenosis > 95% Low Perfusion in RCA Normal Perfusion in LAD LV RV LAD RCA
  14. 14. Results <ul><li>Breath-hold and high-resolution navigator-echo gated scans could repeat after the contrast injection </li></ul><ul><li>MR Coronary Angiography results qualitatively confirmed x-ray findings in terms of stenosis degree and locations </li></ul><ul><li>Functional assessment of myocardial perfusion simultaneously </li></ul>
  15. 15. Conclusions <ul><li>Availability of B-22956/1 will greatly facilitate the successful development of Magnetic Resonance Coronary Angiography and quantification of myocardial perfusion </li></ul><ul><li>Clinical Trials are warranted to further assess the potential of this contrast agent </li></ul>

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