CNS Perfusion Imaging: The Role of High-Dose Contrast-Enhanced MRI

Sunday, 29 Sep 2002 14:46:57 GMT

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Beyond their use in perfusion imaging, high-dose gadolinium techniques offer several advantages. One is an improvement in tissue contrast when imaging small or multiple metastases, or in magnetic resonance angiography (MRA) of the brain, neck, or aortic arch. ⁶ Further, the use of elevated doses of gadolinium can improve the efficiency of scan protocols. For example, when evaluating a patient with suspected stroke, it is possible to conduct both perfusion and angiographic studies quickly, in addition to obtaining parenchymal images.

In some cases, high-dose gadolinium can improve detection rates and hasten oncologic studies. ⁷ The benefits of such an approach are particularly apparent in patients who are difficult to image. A good example is a child with a primary CNS tumor who is being evaluated for subarachnoid metastases (so-called drop metastases). An increase in the gadolinium dose of 50% to 100% enables the entire exam to be done at one time, without the need for reinjection or repeat anesthesia. Increasing the contrast dose may also be necessary when repeating an exam, for example, when evaluating the results of an intervention. Such modest increases in gadolinium dose are well tolerated and adverse reactions are rare. ⁸

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CNS Perfusion Imaging: The Role of High-Dose Contrast-Enhanced MRI