Reducing Gadolinium Based Contrast Agents In MRA v1
Research type
Research Study
Full title
Developing and Clinically Testing a Flow Phantom to Optimise Non-contrast Magnetic Resonance Angiography for Reducing the use of Gadolinium-based Contrast Agents
IRAS ID
307187
Contact name
Harry Poole
Contact email
Sponsor organisation
Royal Stoke University Hospital
Duration of Study in the UK
0 years, 10 months, 1 days
Research summary
Research Summary:
The use of gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI) has helped radiologists diagnose pathologies since their inception. One area in which GBCAs have been used is that of MR angiography (MRA) where the contrast helps to highlight the vessels of a patient. The Contrast Enhanced MRA (CE MRA) images help diagnose a range of conditions including aneurysms, malformations and atherosclerosis. Some of these conditions can prove fatal for patients if left undiagnosed.
In recent years however, GBCAs have been the subject of increasing safety concerns with links to gadolinium retention and Nephrogenic Systemic Fibrosis (NSF). Although gadolinium retention is a relatively new discovery, it is currently uncertain exactly what effect this has on patients. On the other hand, NSF is a known fatal disease and is directly linked to the use of GBCAs especially in patients with poor renal functions.
Most MRI centres use CE MRA by default as their tried and tested MRA technique. One of the biggest barriers in this project is to overcome clinicians’ reliance upon these images. This project aims to demonstrate that non-contrast alternatives have scope for improvement and can provide reliable high-quality images.
To do this the study will be split into three phases:
1) A novel custom built test object designed to mimic blood flow will be used to test and improve the non-contrast MRA images.
2) Volunteers will be recruited to assist with the verification of the test object results.
3) Patients that are undergoing CE MRA will be recruited and the non-contrast images performed alongside their clinical images.
In doing so, it will be possible to demonstrate the worth of the non-contrast techniques in a clinical context.
Summary of results:
From the 12 patients scanned, the results demonstrated that the new technique was comparable to the established technique for assessing the blood vessels to the kidneys without using contrast agents (dye used to highlight blood vessels). The new technique did demonstrate that it was possible to image the blood vessels to the kidneys without needing the patient to hold their breath or breath in a regular pattern. The established method remains heavily reliant upon the patient’s breathing cycle. Using the new technique will help those patients who have struggle with their breathing. The technique that used contrast agent scored best across all segments of the blood vessels to the kidneys and therefore cannot be replaced as the gold standard for this imaging application based on these results. Further work would be needed to improve the non-contrast imaging to match the image quality of the contrast technique.
REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
22/YH/0081
Date of REC Opinion
13 Apr 2022
REC opinion
Further Information Favourable Opinion