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Stefan O Schoenberg

Publications and source records attributed to Stefan O Schoenberg.

At least 19 recordsLinked to original sources

Thioguanin-induced nodular regenerative hyperplasia of the liver-ROC analysis of different MR techniques.

The aim of this study was to evaluate the diagnostic value of different magnetic resonance (MR) techniques for the diagnosis of nodular regenerative hyperplasia (NRH). Thirty-one patients with inflammatory bowel disease, who received 6-thioguanin, underwent liver biopsy and liver MRI on a 1.5-T MR system, with gadolinium and superparamagnetic iron oxide particles (SPIO). MR imaging (MRI) was evaluated independently as well as in consensus by two blinded readers, who received the following image sets: pre-contrast; pre-contrast and gadolinium-enhanced; pre-contrast and SPIO-enhanced and all images. The results were correlated with histopathology and diagnostic efficacy parameters were calculated. NRH was found in 13/31 patients. The set "all images" showed the highest sensitivity (84.6%), accuracy (77.4%) and negative predictive value (86.7%). However, results for gadolinium were only slightly inferior. The highest specificity (76.5%) was found for SPIO. The A(z) values of both readers were highest for gadolinium (mean A(z) = 0.824). It can be concluded that gadolinium-enhanced and SPIO-enhanced MRI enable an accurate diagnosis of NRH. Since gadolinium-enhanced MRI is very sensitive, it should be used for screening high-risk patients. SPIO-enhanced MRI is less sensitive, but more specific. The combination of both guarantees a high sensitivity and specificity and, therefore, is the diagnostic procedure of choice.

Adult↗

Multivariate network analysis of fiber tract integrity in Alzheimer's disease.

Axonal and dendritic integrity is affected early in Alzheimer's disease (AD). Studies using region of interest or voxel-based analysis of diffusion tensor imaging data found significant decline of fractional anisotropy, a marker of fiber tract integrity, in selected white matter areas. We applied a multivariate network analysis based on principal component analysis to fractional anisotropy maps derived from diffusion-weighted scans from 15 AD patients, and 14 elderly healthy controls. Fractional anisotropy maps were obtained from an EPI diffusion sequence using parallel imaging to reduce distortion artifacts. We used high-dimensional image warping to control for partial volume effects due to white matter atrophy in AD. We found a significant regional pattern of fiber changes (p < 0.01) indicating that the integrity of intracortical projecting fiber tracts (including corpus callosum, cingulum and fornix, and frontal, temporal and occipital lobe white matter areas) was reduced, whereas extracortical projecting fiber tracts, including the pyramidal and extrapyramidal systems and somatosensory projections, were relatively preserved in AD. Effects of a univariate analysis were almost entirely contained within the multivariate effect. Our findings illustrate the use of a multivariate approach to fractional anisotropy data that takes advantage of the highly organized structure of anisotropy maps, and is independent of multiple comparison correction and partial volume effects. In agreement with post-mortem evidence, our study demonstrates dissociation between intracortical and extracortical projecting fiber systems in AD in the living human brain.

Aged↗

Fiber connections between the cerebral cortex and the corpus callosum in Alzheimer's disease: a diffusion tensor imaging and voxel-based morphometry study.

Regional cortical atrophy in Alzheimer's disease (AD) most likely reflects the loss of cortical neurons. Several diffusion tensor imaging studies reported reduced fractional anisotropy (FA) in the corpus callosum in AD. The aim of this study was to investigate the association between reduced FA in the corpus callosum and gray matter atrophy in AD. Thirteen patients with AD with a mean (+/-standard deviation) age of 68.3 years (+/-11.5) and mean Mini Mental State Examination (MMSE) score of 21.8 (+/-4.8) were recruited. There were 13 control subjects with a mean age of 66.7 years (+/-6.4) and MMSE of 29.1 (+/-0.7). We used voxel-based morphometry of gray matter maps and region of interest-based analysis of FA in the corpus callosum. FA values of the anterior corpus callosum in AD patients were significantly correlated with gray matter volume in the prefrontal cortex and left parietal lobes. FA values of the posterior corpus callosum were significantly correlated with gray matter volume in the bilateral frontal, temporal, right parietal, and occipital lobes. In control subjects, no correlations were detected. Our findings suggest that decline of FA in the corpus callosum may be related to neuronal degeneration in corresponding cortical areas.

Aged↗

Functional renal MR imaging: an overview.

Due to its complementary information to standard morphological imaging, functional renal magnetic resonance imaging is a rapid growing field of radiology. This pictorial essay provides a comprehensive overview of state-of-the-art functional renal imaging techniques including renal magnetic resonance angiography, first pass renal perfusion, assessment of renal function, blood-oxygen level dependent imaging of the kidneys and diffusion-weighted imaging of the kidneys including diffusion-tensor imaging of the kidneys. Basic technical concepts for all sequences are laid out. As renal perfusion imaging becomes a clinical routine examination, particular attention is given to renal perfusion measurements and the potential postprocessing approaches. Advantages and drawbacks of the published methods are illustrated. Future applications of functional renal imaging are presented.

Contrast Media↗

Effects of injection rate and dose on image quality in time-resolved magnetic resonance angiography (MRA) by using 1.0M contrast agents.

In time-resolved MRA (TR MRA), injection parameters and contrast agent (CA) dose are important factors influencing image quality. In this study, three different injection schemes with different CA volumes were evaluated in 12 healthy volunteers. Injection rates between 0.2 and 0.8 ml/s were evaluated with CA volumes of 10 and 20 ml. To measure circulatory parameters, cine cardiac MRI was performed before each exam. Spatial resolution could be reduced to 2 x 1.4 x 2 mm3, temporal resolution was 2.25 s/frame. To exclude signal saturation at high CA concentrations, a phantom with fixed CA concentrations was placed in the field of view. SNR was measured, and the area under the curve of the arterial signal of the different injection schemes was calculated. Results showed the largest diagnostic window at a relatively slow injection rate of 0.4 ml/s and a CA volume of 10 ml. Circulatory parameters have an important impact on CA arrival, so delay times have to be set depending on these parameters.

Adult↗

MR imaging of the cervical spine: assessment of image quality with parallel imaging compared to non-accelerated MR measurements.

To compare the quality of cervical spine MR images obtained by parallel imaging [generalized autocalibrating partially parallel acquisition (GRAPPA)] with those of non-accelerated imaging, we conducted both phantom studies and examinations of ten volunteers at 1.5Tesla with a dedicated 12-element coil system and a head-spine-neck coil combination. Acquisitions included axial T2-weighted (T2w) images with both methods, and sagittal T2w and T1w images in vivo with the latter coil combination. Non-accelerated MRI with two averages and GRAPPA (acceleration factor 2) with two averages (GRAPPA/2AV, time reduction of approximately 50%) and four averages (GRAPPA/4AV) were compared. In the phantom, the signal-to-noise ratio of the GRAPPA/2AV was lower than that of the other two settings. In vivo, the image inhomogeneity (non-uniformity, NU) was significantly higher in T2w GRAPPA/2AV than in both other settings, and in T1w GRAPPA/2AV compared to GRAPPA/4AV. Subjectively, the delineation of anatomical structures was sufficient in all sequences. Only the spinal cord was considered to be better delineable on the non-accelerated T1w sequence compared to GRAPPA/2AV. In part, GRAPPA/4AV performed better than the other settings. The subjective image noise was lowest with GRAPPA/4AV. In cervical spine MRI, the examination time can be reduced by nearly 42% with GRAPPA, while preserving sufficient image quality.

Cervical Vertebrae↗

Pulmonary abnormalities in immunocompromised patients: comparative detection with parallel acquisition MR imaging and thin-section helical CT.

PURPOSE: To compare parallel acquisition magnetic resonance (MR) imaging with thin-section helical computed tomography (CT) for depiction of pulmonary abnormalities suggestive of pneumonia in immunocompromised patients. MATERIALS AND METHODS: The institutional review board approved this study; prior consent was obtained. Thirty consecutive neutropenic patients (10 women, 20 men; mean age, 51 years +/- 15 [standard deviation]; range, 25-75 years) with fever of unknown origin or clinical signs and symptoms of lung infection were examined with breath-hold single-shot half-Fourier turbo spin-echo MR imaging. To reduce image blurring and increase MR signal in the lungs, the echo time was shortened with generalized autocalibrating partially parallel acquisition (GRAPPA). Patients underwent thoracic CT (four detector rows and 1-mm section thickness [4 x 1 mm]; pitch, 6) as reference standard. Pulmonary abnormalities (ill-defined nodules, ground-glass opacity areas, and consolidation), their location and distribution, and lesion characteristics were analyzed at MR imaging by three readers, blinded to results of CT, in consensus. Frequencies were calculated for each feature; paired Wilcoxon rank sum test was used to examine whether differences between CT and MR imaging features were statistically significant (alpha < .05). Bonferroni adjustments were performed. Overall sensitivity, specificity, and positive and negative predictive values were determined. RESULTS: Twenty-two patients had pulmonary abnormalities at CT. In 21 (95%) patients, pneumonia was correctly diagnosed with MR imaging. One false-negative finding occurred in a patient with ill-defined nodules smaller than 1 cm at CT. One false-positive finding with MR imaging was the result of blurring and respiratory artifacts (sensitivity, 95%; specificity, 88%; positive predictive value, 95%; negative predictive value, 88%). There was no significant difference in lesion location and distribution. CONCLUSION: With parallel imaging (GRAPPA technique) and fast MR imaging, detection of pulmonary abnormalities is almost as good as with CT. MR imaging has a slight disadvantage in its lower capability to assist in characterization of specific internal features, such as cavitations.

Adult↗

High-spatial-resolution multistation MR angiography with parallel imaging and blood pool contrast agent: initial experience.

The purpose of this study was to prospectively evaluate the diagnostic accuracy of reader detection of 75% or greater stenosis at high-spatial-resolution multistation magnetic resonance (MR) angiography performed with matrix coils and a blood pool contrast agent. Ten healthy volunteers and 10 patients were examined. All participants provided informed consent to participate in this institutional review board-approved study. For contrast agent-enhanced multistation MR angiography, an albumin-binding gadolinium chelate, gadofosveset trisodium, was used. Imaging was performed during the first-pass and steady-state phases of the contrast agent. Vessel conspicuity on the first-pass MR angiograms obtained in both volunteers and patients was rated as excellent for 93% of vessels. At steady-state imaging, vessel conspicuity was rated as excellent or good for 89% of vessels. Gadofosveset trisodium-enhanced MR angiography yielded sensitivities of 100% and 97% and specificities of 96% and 97% for detection of significant disease in the carotid and lower extremity arteries, respectively.

Adult↗

Autologous bone marrow stem cell mobilization induced by granulocyte colony-stimulating factor after subacute ST-segment elevation myocardial infarction undergoing late revascularization: final results from the G-CSF-STEMI (Granulocyte Colony-Stimulating Factor ST-Segment Elevation Myocardial Infarction) trial.

OBJECTIVES: The purpose of this investigator-driven, prospective, randomized, double-blinded, placebo-controlled phase II study was to compare the effects of granulocyte colony-stimulating factor (G-CSF) on the improvement of myocardial function in patients undergoing delayed percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Experimental and early clinical studies suggest that transplantation of stem cells improves cardiac regeneration and neovascularization after acute myocardial infarction. Most investigators have utilized either a direct injection or intracoronary infusion of bone marrow-derived cells, but early cytokine-mediated mobilization of stem cells has been reported to show similar improvement in cardiac function. METHODS: Forty-four patients with late revascularized subacute STEMI were treated either with G-CSF or placebo over 5 days after successful PCI. Primary end points were change of global and regional myocardial function from baseline (1 week after PCI) to 3 months after PCI assessed by magnetic resonance imaging (MRI). Secondary end points consisted of characterization of mobilized stem cell populations, assessment of safety parameters up to 12 months including 6-month angiography, as well as myocardial perfusion assessed by MRI. RESULTS: Global myocardial function from baseline (1 week after PCI) to 3 months improved in both groups, but G-CSF was not superior to placebo (Delta(ejection fraction) 6.2 +/- 9.0 vs. 5.3 +/- 9.8%, p = 0.77). A slight but non-significant improvement of regional function occurred in both groups. Granulocyte colony-stimulating factor resulted in mobilization of endothelial progenitor cell populations and was well tolerated with a similar rate of target lesion revascularization from in-stent restenosis. In both groups major adverse cardiovascular events occurred in a comparable frequency. Granulocyte colony-stimulating factor resulted in significant improvement of myocardial perfusion 1 week and 1 month after PCI. CONCLUSIONS: Granulocyte colony-stimulating factor treatment after PCI in subacute STEMI is feasible and relatively safe. However, patients do not benefit from G-CSF when PCI is performed late. Granulocyte colony-stimulating factor results in improved myocardial perfusion of the infarcted area, which may reflect enhanced neovascularization.

Angioplasty, Balloon, Coronary↗

Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT.

The diagnostic accuracy of screening for bone metastases was evaluated using whole-body magnetic resonance imaging (WB-MRI) compared with combined fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) (FDG-PET-CT). In a prospective, blinded study, 30 consecutive patients (18 female, 12 male; 24-76 years) with different oncological diseases and suspected skeletal metastases underwent FDG-PET-CT as well as WB-MRI with the use of parallel imaging (PAT). With a 32-channel scanner, coronal imaging of the entire body and sagittal imaging of the complete spine was performed using T1-weighted and short tau inversion recovery (STIR) sequences in combination. PET-CT was conducted using a low-dose CT for attenuation correction, a PET-emission scan and diagnostic contrast-enhanced CT scan covering the thorax, abdomen and pelvis. Two radiologists read the MRI scans, another radiologist in combination with a nuclear medicine physician read the PET-CT scans, each in consensus. The standard of reference was constituted by radiological follow-up within at least 6 months. In 28 patients, 102 malignant and 25 benign bone lesions were detected and confirmed. WB-MRI showed a sensitivity of 94% (96/102), PET-CT exams achieved 78% (79/102; P<0.001). Specificities were 76% (19/25) for WB-MRI and 80% (20/25) for PET-CT (P>0.05). Diagnostic accuracy was 91% (115/127) and 78% (99/127; P<0.001), respectively. Cut-off size for the detection of malignant bone lesions was 2 mm for WB-MRI and 5 mm for PET-CT. WB-MRI revealed ten additional bone metastases due to the larger field of view. In conclusion, WB-MRI and FDG-PET-CT are robust imaging modalities for a systemic screening for metastatic bone disease. PAT allows WB-MRI bone marrow screening at high spatial resolution and with a diagnostic accuracy superior to PET-CT.

Adult↗

MRA of abdominal vessels: technical advances.

Magnetic resonance angiography (MRA) in general and MRA of the abdominal vessels in particular have undergone substantial improvements in the past 5 years triggered by the introduction and application of parallel imaging (PI), new sequence techniques such as centric k-space trajectories and undersampling, dedicated contrast agents and clinical high-field scanners. All of these techniques have the potential to improve image quality and resolution or decrease the image acquisition time. However, each of them has its own specific advantages and drawbacks. This review describes the main technical innovations and focuses on the impact these developments may have on abdominal MRA. Special consideration is given to the interaction of these various technical advances. The clinical value of advanced MRA techniques is discussed and illustrated by characteristic cases.

Abdomen↗

Cardiac magnetic resonance perfusion imaging for the functional assessment of coronary artery disease: a comparison with coronary angiography and fractional flow reserve.

AIMS: Cardiac magnetic resonance perfusion imaging (CMRI) is a promising technique for non-invasive measurement of myocardial perfusion reserve. Fractional flow reserve (FFR) is an established invasive method for functional assessment of coronary artery disease (CAD). To prospectively assess the diagnostic value of CMRI for the detection of haemodynamically significant coronary lesions, compared with coronary angiography (CA) and FFR. METHODS AND RESULTS: Forty-three patients with suspected or known CAD underwent CA, CMRI, and FFR measurement. First pass magnetic resonance perfusion examination was performed during hyperaemia (140 microg/kg/min adenosine over 6 min) and at rest. One hundred and twenty-nine perfusion territories were assessed by semi-quantitative evaluation of signal intensity-time curves using the myocardial perfusion reserve index (MPRI) [upslope(stress(corrected))/upslope(rest(corrected))]. Perfusion territories were categorized as normal (coronary stenosis < or = 50%), intermediate (stenosis > 50% and FFR > 0.75), or severe (stenosis > 50% and FFR < or = 0.75 or total occlusion). MPRI values (+/-SD) were significantly different between the three categories [normal, 2.2 +/- 0.5 vs. intermediate, 1.8 +/- 0.5 (P = 0.005) and intermediate vs. severe, 1.2 +/- 0.3 (P < 0.001)]. An MPRI cut-off value of 1.5 (derived from receiver operating characteristics analysis) distinguished haemodynamically relevant (severe) from non-relevant (normal and intermediate) stenoses with a sensitivity of 88% (CI 74-100%) and a specificity of 90% (CI 84-96%). CONCLUSION: In contrast to earlier studies that compared CMRI with morphological examination (CA) alone, the present study compared CMRI with CA plus a standard invasive functional assessment (FFR) and demonstrated that CMRI is able to distinguish haemodynamically relevant from non-relevant coronary lesions with a high sensitivity and specificity and may therefore contribute to clinical decision-making.

Aged↗

Dual breath-hold magnetic resonance cine evaluation of global and regional cardiac function.

The purpose of our study was to evaluate the accuracy of a multislice cine magnetic resonance imaging (MRI) technique with parallel imaging in regard to global and regional left ventricular function. Forty-two individuals underwent cine MRI on a 1.5-tesla scanner. Cine MRI used a steady-state free precession technique and was performed as a single-slice technique (nonTSENSE cine) and an accelerated multislice technique (TSENSE cine) with five slices per breath-hold. End diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) were evaluated for all data sets and in regard to regional wall motion and regional wall motion analysis, and quantitative regional wall thickness and systolic thickening were also assessed. EDV, ESV, and EF based on TSENSE cine showed excellent correlation to the nonTSENSE cine approach (all r(2)=0.99, P<0.001). While EDV evaluations showed a small underestimation for TSENSE cine, ESV and EF showed accurate results compared with nonTSENSE cine. Both readers showed good agreement (kappa=0.72) in regional wall motion assessment comparing both techniques. Data acquisition for the multislice approach was significantly shorter ( approximately 75%) that in single-slice cine. We conclude that accurate evaluation of regional wall motion and left ventricular EF is possible using accelerated multislice cine MR with high spatial and temporal resolution.

Adolescent↗

Whole-body MRI and PET-CT in the management of cancer patients.

Mortality rate, prognosis, and treatment outcome of cancer patients depend strongly on the detection of malignancy at an early stage and efficient monitoring of the disease. Multimodality diagnostic approaches are now widely applied for tumor detection, staging, and follow-up. However, the introduction of whole-body imaging modalities into clinical practice has substantially expanded diagnostic options. PET-CT has increased diagnostic accuracy by providing "anatometabolic" information by fusing tumor glucose-uptake measures from the PET examination and accurate delineation of anatomical structures given by spiral CT. Since PET-CT is associated with high doses of ionizing radiation, it is used in mainly tumor staging and screening within the scope of tertiary prevention. Here promising results have been reported for various tumor entities. MRI provides excellent tissue contrast, detailed morphological information and lack of ionizing radiation. MRI has been employed for the assessment of focal pathologies in specific anatomical regions. Whole-body MRI scanners using multiple receiver channels with parallel acquisition techniques now allow tumor screening from head to toe within substantially shorter examination times and without compromises in image resolution. We report our experience with these two novel techniques and discuss their benefits and drawbacks in terms of systemic tumor screening.

Early Diagnosis↗

Cardiac CINE MR imaging with a 32-channel cardiac coil and parallel imaging: impact of acceleration factors on image quality and volumetric accuracy.

PURPOSE: To assess the impact of parallel imaging algorithms on image quality and volumetric accuracy of CINE magnetic resonance imaging (MRI) with high temporal and spatial resolution using a new 32-channel dedicated cardiac phased array coil. MATERIALS AND METHODS: Fourteen individuals underwent steady-state free precession (SSFP) CINE MRI using a 32-element phased-array coil and parallel imaging acceleration using spatiotemporal sensitivity encoding (TSENSE). Acquisition acceleration ranged from R = 2 to 7. In conjunction with data extracted from phantom measurements, contrast-to-noise ratio (CNR) performance was evaluated for each acceleration factor and subjective image quality was evaluated by two independent readers. In addition, volumetric assessment was performed for each acceleration factor based on a single breath-hold multi-slice data acquisition. Results were compared to nonTSENSE measurements. RESULTS: CNR for non-accelerated CINE (R = 1) was 45.7 +/- 12.8 and showed a constant decrease with increase in acceleration of 51% at R = 4 and 86% at R = 7. CNR losses accompanied reductions in subjective image quality. Volumetric evaluation was accurate for R <or= 4, with significant underestimation of ejection fraction (EF) at higher accelerations. CONCLUSION: This study shows that one-dimensional acceleration factors up to R = 4 allow accurate SSFP CINE MRI even though CNR is significantly reduced. This allows for a marked reduction in scan time and allows for multi-slice CINE imaging with high spatial and temporal resolution.

Adult↗

High-resolution renal MRA: comparison of image quality and vessel depiction with different parallel imaging acceleration factors.

PURPOSE: To investigate the image quality and vessel depiction of renal MRA with integrated parallel imaging techniques (iPAT) using acceleration factors of 2 and 3. MATERIALS AND METHODS: In this prospective study renal MRA was performed on 14 and 12 patients with acceleration factors of 3 and 2, respectively. For the MRA a 3D-GRE sequence with an acquired spatial resolution of 0.9 x 0.8 x 1.0 mm(3) was applied (TR/TE = 3.79 msec/1.39 msec, FOV = 400 mm x 320 mm, acquired matrix = 512 x 384, flip angle = 25 degrees) on a 32-channel 1.5T MR scanner. The acquisition time was 26 seconds with iPAT 2, and 19 seconds with iPAT3. All parameters other than acquisition time and acceleration factor were kept constant. To assess the signal-to-noise ratio (SNR) we performed repetitive phantom measurements using iPAT 2 and 3. The images were rated by two radiologists in terms of noise, artifacts, and the quality of vessel depiction for the proximal, segmental, and subsegmental renal artery. A Mann-Whitney U-test and kappa-test were used for statistical analysis. RESULTS: SNR decreased significantly with iPAT 3 in the phantom measurements. The two readers found no difference in noise, but significantly fewer artifacts with iPAT 3. The depiction of segmental vessels was significantly better for both readers with iPAT 3, and the subsegmental vessels were rated significantly better by one reader. iPAT 3 also resulted in a better interreader agreement. CONCLUSION: The use of iPAT 3 for renal MRA enables a better depiction of the distal parts of the renal artery. The decrease in SNR is not diagnostically impairing.

Adult↗

Renal perfusion: comparison of saturation-recovery TurboFLASH measurements at 1.5T with saturation-recovery TurboFLASH and time-resolved echo-shared angiographic technique (TREAT) at 3.0T.

PURPOSE: To investigate the dependence of semiquantitative renal perfusion parameters on the acquisition technique and field strength used. MATERIALS AND METHODS: After intravenous injection of 7-mL Gd-chelates, high-temporal-resolution turbo fast low-angle shot (TurboFLASH) renal perfusion measurements were performed on eight healthy volunteers at 1.5T and another eight healthy volunteers at 3.0T. Another eight healthy volunteers were examined at 3.0T using time-resolved echo-shared angiographic technique (TREAT) after bolus administration of 7-mL Gd-chelates with a temporal resolution of 1.4 seconds. Analysis of the first-pass perfusion data yielded the following semiquantitative renal perfusion indices: mean transit time (MTT), time to peak (TTP), maximal upslope (MUS), and maximal signal intensity (MSI). RESULTS: MTT and TTP did not show significant differences between the different techniques. MSI and MUS were significantly (P < or = 0.002) higher with TREAT (591.1 a.u./second and 103.5 a.u./second) than with TurboFLASH at both field strengths (1.5T: 400.5 a.u./second and 65.4 a.u./second; 3.0T: 362.2 a.u./second and 68.7 a.u./second). CONCLUSION: Semiquantitative renal perfusion measurements are feasible with time-resolved echo-shared sequences and TurboFLASH techniques. While MTT and TTP appear to be independent of the technique and field strength applied, MUS and MSI are higher with TREAT.

Adult↗

Vasovist-enhanced MR angiography.

Vasovist (MS-325) is the first intravascular contrast agent approved for use with magnetic resonance angiography in the European Union. Vasovist reversibly binds to albumin, providing extended intravascular enhancement compared to existing extracellular magnetic resonance contrast agents. Prior to approval, Vasovist underwent extensive testing to evaluate the safety and efficacy of the drug; the clinical trials program included blinded, placebo-controlled dose ranging, efficacy in a variety of vascular beds (AIOD, renal, pedal), examination of potential drug interaction with warfarin and comparison with XRA. The clinical trials show that Vasovist-enhanced MR angiography is safe and well-tolerated in patients with vascular disease, effective for the detection of vascular stenosis and aneurysms, significantly more accurate (both more sensitive and specific) than non-contrast MR angiography for the diagnosis of vascular stenoses, and similar to conventional angiography for the overall characterization of vascular disease, without the need for catheterization.

Contrast Media↗