Choosing the appropriate contrast agent for breast MRI  

The significantly increased value of the higher-relaxivity MR contrast agent MultiHance relative to Magnevist for the detection and characterization of breast cancer on MRI has previously been demonstrated by Pediconi et al. in two single-center intra-individual crossover studies (1, 2) and most recently by Martincich et al. in a much larger multi-center crossover study involving 151 patients who each received identical 0.1 mmol/kg bodyweight doses of each agent in two otherwise identical breast MRI examinations (3). In this latter study, three blinded readers each showed that MultiHance provides significantly superior contrast enhancement, is associated with roughly half the number of cancer misdiagnoses, and leads to significantly improved detection of malignant breast lesions and significantly improved sensitivity, specificity and accuracy for the diagnosis of breast cancer than Magnevist.

Recently published additional analysis from this study has compared MultiHance-enhanced breast MRI intra-individually with Magnevist-enhanced breast MRI and either conventional mammography, whole-breast ultrasound, or both, and found significantly greater cancer detection rates on MultiHance-enhanced MRI compared with mammography (Δ15.8-17.5%; p<0.0001), ultrasound (Δ18.3-20.0%; p<0.0001), and mammography and/or ultrasound (Δ8.6-10.7%; p≤0.0105) but not for comparisons of Magnevist-enhanced MRI with conventional techniques (p>0.05). Three blinded readers also noted lower false positive detection rates on MultiHance-enhanced MRI than on conventional imaging (4.0-5.5% vs. 11.1% at mammography; 6.3-8.4% vs. 15.5% at ultrasound). Significantly improved cancer detection on MRI was noted in heterogeneously dense breast (91.2-97.3% on MultiHance-enhanced MRI vs. 77.2-84.9% on Magnevist-enhanced MRI vs. 71.9-84.9% with conventional techniques) and for invasive cancers (93.2-96.2% for IDC on MultiHance-enhanced MRI vs. 79.7-88.5% on Magnevist-enhanced MRI vs. 77.0-84.4% with conventional techniques). Overall diagnostic performance for the detection of cancer was superior on MultiHance-enhanced MRI than on conventional imaging or Magnevist-enhanced MRI which was again ascribed to the better visualization of characteristic malignant features with Multihance.

1.      Pediconi F, Catalano C, Occhiato R, et al. Breast lesion detection and characterization at contrast-enhanced MR mammography: gadobenate dimeglumine versus gadopentetate dimeglumine. Radiology 2005; 237:45-56.

2.      Pediconi F, Catalano C, Padula S, et al. Contrast-Enhanced MR Mammography: Improved lesion detection and differentiation with gadobenate dimeglumine. AJR Am J Roentgenol. 2008; 191:1339-1346.

3.      Martincich L, Faivre-Pierret M, Zechmann CM, et al. Multicenter, Double-Blind, Randomized, Intraindividual Crossover Comparison of Gadobenate Dimeglumine and Gadopentetate Dimeglumine for Breast MR Imaging (DETECT Trial). Radiology. 2011; 258:396-408.

4.      Gilbert FJ, van den Bosch HCM, Petrillo A, et al.  Comparison of gadobenate dimeglumine-enhanced breast MRI and gadopentetate dimeglumine-enhanced breast MRI with mammography and ultrasound for the detection of breast cancer. J Magn Reson Imaging 2013. Article first published online: 4 NOV 2013. DOI: 10.1002/jmri.24434