Dokument

Zusammenfassung:
In der vorliegenden Studie sollte das 0,5 molare MR-Kontrastmittel Gadobenat-Dimeglumin in halber Dosierung mit dem 1 molaren Gadobutrol in Standarddosierung bei der kontrastmittelverstärkten Magnetresonanzangiographie (CE-MRA) der unteren Extremität verglichen werden. Hierzu wurden jeweils 37 CE-MRAs mit 0,1 mmol/kg KG Gadobutrol und 0,05 mmol/kg KG Gadobenat-Dimeglumin bei 1,5 Tesla von der infrarenalen Aorta bis zu den Knöchelarterien retrospektiv untersucht. Zwei unabhängige, verblindete Untersucher beurteilten das Auftreten signifikanter (> 70%) und nicht-signifikanter (≤ 70%) Stenosen sowie die subjektive Bildqualität und die venöse Überlagerung der CE-MRAs. Von einem dritten Untersucher wurde die Signalintensität, das Signal-Rausch-Verhältnis (SNR) und das Kontrast-Rausch-Verhältnis (CNR) in den Segmenten von der infrarenalen Aorta bis zur A. poplitea bestimmt. Die Übereinstimmung zwischen den Untersuchern bei der Beurteilung arterieller Stenosen war sowohl für Gadobutrol (kappa = 0,547) als auch für Gadobenat-Dimeglumin (kappa = 0,524) deutlich. Bezüglich der subjektiven Bildqualität zeigte sich für Untersucher 1 kein signifikanter Unterschied (p = 0,21). Für Untersucher 2 ergab sich eine signifikant bessere Bildqualität mit Gadobenat-Dimeglumin (p < 0,05). Eine venöse Überlagerung trat mit beiden Kontrastmitteln ungefähr gleich häufig auf (p = 0,132 und p= 0,06). Eine hochgradige venöse Überlagerung im Bereich des Unterschenkels führte jedoch bei beiden Untersuchern mit Gadobutrol (in 1,4 und 2,6% der beurteilbaren Segmente) deutlich häufiger zu einer nicht-diagnostischen Bildqualität als mit Gadobenat-Dimeglumin (in 0,4 und 0,3 %). Hinsichtlich der Signalintensität (p = 0,28), SNR (p = 0,18) oder CNR (p = 0,18) bestand zwischen den beiden Kontrastmitteln kein signifikanter Unterschied. Durch die Verwendung von Gadobenat-Dimeglumin kann die Gadoliniumdosis bei der CE-MRA der unteren Extremität ohne Verlust an Bildqualität oder Signalintensität, SNR und CNR halbiert werden. Gadobenat-Dimeglumin sollte außerdem aufgrund der geringeren Rate an nicht-diagnostischer Bildqualität gegenüber Gadobutrol bevorzugt verwendet werden

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8. Abb. 11: Boxplotdiagramme für die Grade der subjektiven Bildqualität………………38
9. Abb. 12: Relative Häufigkeiten der venös überlagerten Gefäßsegmente im Bereich des Ober-und Unterschenkels……………………………………………………………...40
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