MR perfusion imaging: Half-dose gadolinium is half the quality

Area of Science:

• Neuroradiology
• Neuroimaging
• Stroke Imaging

Background:

• Acute ischemic stroke patients with large vessel occlusion (AIS-LVO) require rapid neuroimaging for thrombectomy.
• Cerebral magnetic resonance perfusion (MRP) is crucial for identifying salvageable brain tissue (penumbra).
• Assessing the feasibility of reducing gadolinium contrast dose in MRP is important for optimizing imaging protocols.

Purpose of the Study:

• To evaluate if a reduced (half-dose) gadolinium contrast agent administration provides sufficient magnetic resonance perfusion (MRP) image quality in AIS-LVO patients.
• To compare the image quality of half-dose MRP with standard full-dose MRP in this patient population.

Main Methods:

• A prospective observational study included AIS-LVO patients undergoing MRP with a half-dose of gadolinium (0.1 ml/kg).
• MRP images were compared to a historical cohort of patients who received a full-dose (0.2 ml/kg) of gadolinium.
• Image quality was rated as poor, borderline, or good to determine thrombectomy eligibility.

Main Results:

• Fifty-four half-dose and 127 full-dose MRP studies were analyzed.
• Half-dose MRP scans were significantly more likely to be rated as poor quality (40.7%) compared to full-dose scans (6.3%) (p < 0.001).
• Good quality MRP was achieved in 40.7% of half-dose scans versus 66.9% of full-dose scans.

Conclusions:

• Half-dose gadolinium administration for MRP in AIS-LVO patients frequently results in poor image quality.
• Reduced image quality from half-dose gadolinium may compromise accurate stroke patient triage for thrombectomy.
• Standard full-dose gadolinium is likely necessary for adequate MRP assessment in AIS-LVO.