Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonanceReport as inadecuate

Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance - Download this document for free, or read online. Document in PDF available to download.

Journal of Cardiovascular Magnetic Resonance

, 13:28

First Online: 24 May 2011Received: 15 December 2009Accepted: 24 May 2011


BackgroundThe dual-bolus protocol enables accurate quantification of myocardial blood flow MBF by first-pass perfusion cardiovascular magnetic resonance CMR. However, despite the advantages and increasing demand for the dual-bolus method for accurate quantification of MBF, thus far, it has not been widely used in the field of quantitative perfusion CMR. The main reasons for this are that the setup for the dual-bolus method is complex and requires a state-of-the-art injector and there is also a lack of post processing software. As a solution to one of these problems, we have devised a universal dual-bolus injection scheme for use in a clinical setting. The purpose of this study is to show the setup and feasibility of the universal dual-bolus injection scheme.

MethodsThe universal dual-bolus injection scheme was tested using multiple combinations of different contrast agents, contrast agent dose, power injectors, perfusion sequences, and CMR scanners. This included 3 different contrast agents Gd-DO3A-butrol, Gd-DTPA and Gd-DOTA, 4 different doses 0.025 mmol-kg, 0.05 mmol-kg, 0.075 mmol-kg and 0.1 mmol-kg, 2 different types of injectors with and without -pause- function, 5 different sequences turbo field echo TFE, balanced TFE, k-space and time k-t accelerated TFE, k-t accelerated balanced TFE, turbo fast low-angle shot and 3 different CMR scanners from 2 different manufacturers. The relation between the time width of dilute contrast agent bolus curve and cardiac output was obtained to determine the optimal predefined pause duration between dilute and neat contrast agent injection.

Results161 dual-bolus perfusion scans were performed. Three non-injector-related technical errors were observed 1.9%. No injector-related errors were observed. The dual-bolus scheme worked well in all the combinations of parameters if the optimal predefined pause was used. Linear regression analysis showed that the optimal duration for the predefined pause is 25s to separate the dilute and neat contrast agent bolus curves if 0.1 mmol-kg dose of Gd-DO3A-butrol is used.

ConclusionThe universal dual-bolus injection scheme does not require sophisticated double-head power injector function and is a feasible technique to obtain reasonable arterial input function curves for absolute MBF quantification.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-28 contains supplementary material, which is available to authorized users.

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Author: Masaki Ishida - Andreas Schuster - Geraint Morton - Amedeo Chiribiri - Shazia Hussain - Matthias Paul - Nico Merkle - Henni


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