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Blood pool agents (BPAs) are a class of magnetic resonance angiography contrast agents.[1][2] Blood pool agents (also known as intravascular contrast agents) are differentiated from other contrast agents due to their high molecular weight and higher relaxivities.[3] Their large size prevents diffusion through the vascular epithelium and leakage into the interstitial space, and because of this they stay in the vascular system for a longer time period. Most contrast agents, leave the vascular system within a few minutes, however blood pool agents remain in the circulation for up to an hour, extending the window available for imaging. Longer image acquisition times allow better signal-to-noise ratio and improved image resolution.

Roles of blood pool agents

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Due to their extended time in the circulatory system, blood pool agents can be used for delayed steady-state imaging, and additionally these results can be combined with first pass arterial imaging.[2][3]

Classes of blood pool agents

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Albumin-binding gadolinium complexes

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This class of BPAs is based on the noncovalent binding of low molecular weight Gd3+-based complexes to human serum albumin. The first commercial agent to be approved in this class is gadofosveset trisodium[4] (also known as Vasovist[5] or Ablavar,[6] and previously known as MS-325[7]). Many clinical and case studies documenting the use of this BPA have been published,[8][9][10][11][12][13][14] and its efficacy in enhancing blood vessels visibility has been demonstrated.[15] The manufacturer (Lantheus Medical) discontinued production in 2017 though, due to poor sales.[16]

Gadocoletic acid (Bracco SpA), also known as B-22956 and B22956/1, is a Gd-DTPA derivative that is currently in development, but has not yet been approved for clinical use.[17]

Gadobenic acid (MultiHance[18]) is sometimes categorized as a BPA; however, as it only binds weakly to albumin and because hepatobiliary uptake of this compound occurs, this contrast agent should not be classified as a BPA.

Polymeric gadolinium complexes

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Polymeric Gd3+ chelates are large in size, which prevents leakage into the interstitial space, and provides long imaging windows. Several polymeric gadolinium-based BPAs are currently in development but have not yet been approved for clinical use: Gadomelitol (Guerbet, France), also known as Vistarem and P792[19] Gadomer-17 (Schering AG, Berlin, Germany) also known as Gd-DTPA-17, SH L 643 A.[20]

References

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  1. ^ "MR Contrast Agents". 2014. Archived from the original on 2019-12-02. Retrieved 2014-11-16.
  2. ^ a b "Blood Pool Agents". Archived from the original on March 13, 2018.
  3. ^ a b Geraldes, Carlos F. G. C.; Laurent, Sophie (2009). "Classification and basic properties of contrast agents for magnetic resonance imaging". Contrast Media & Molecular Imaging. 4 (1). Wiley: 1–23. doi:10.1002/cmmi.265. ISSN 1555-4309. PMID 19156706.
  4. ^ "Ablavar (gadofosveset trisodium) injection". Food and Drug Administration. Archived from the original on 2017-02-22. Retrieved 2019-12-16.
  5. ^ "DailyMed". dailymed.nlm.nih.gov. Archived from the original on 2018-10-03. Retrieved 2024-07-26.
  6. ^ "Ablavar". Archived from the original on 2012-01-27. Retrieved 2012-03-08.
  7. ^ "MRI Database : MS-325". www.mr-tip.com. Archived from the original on 2018-08-29. Retrieved 2024-07-26.
  8. ^ Wolf, Florian; Plank, Christina; Beitzke, Dietrich; Popovic, Martin; Domenig, Christoph M.; Weber, Michael; Loewe, Christian (2011). "Prospective Evaluation of High-Resolution MRI Using Gadofosveset for Stent-Graft Planning: Comparison With CT Angiography in 30 Patients". American Journal of Roentgenology. 197 (5). American Roentgen Ray Society: 1251–1257. doi:10.2214/ajr.10.6268. ISSN 0361-803X. PMID 22021522.
  9. ^ Partovi; Aschwanden; Staub; Rasmus; Zipp; Rengier; Jacobi; Hügli; Bilecen (2011-07-01). "Gadofosveset enhanced MR phlebography for detecting pelvic and deep vein leg thrombosis". VASA. Zeitschrift für Gefässkrankheiten. 40 (4). Hogrefe Publishing Group: 315–319. doi:10.1024/0301-1526/a000121. ISSN 0301-1526. PMID 21780056.
  10. ^ Haneder, Stefan; Attenberger, Ulrike I.; Biffar, Andreas; Dietrich, Olaf; Fink, Christian; Schoenberg, Stefan O.; Michaely, Henrik J. (2011). "Gadofosveset". Investigative Radiology. 46 (11). Ovid Technologies (Wolters Kluwer Health): 678–685. doi:10.1097/rli.0b013e31822428ad. ISSN 0020-9996. PMID 21709565.
  11. ^ Pfeil, Alexander; Betge, Stefan; Poehlmann, Guenther; Boettcher, Joachim; Drescher, Robert; Malich, Ansgar; Wolf, Gunter; Mentzel, Hans-Joachim; Hansch, Andreas (2012). "Magnetic resonance VIBE venography using the blood pool contrast agent gadofosveset trisodium—An interrater reliability study". European Journal of Radiology. 81 (3). Elsevier BV: 547–552. doi:10.1016/j.ejrad.2011.01.102. ISSN 0720-048X. PMID 21349675.
  12. ^ Pedersen, Steen F; Thrysøe, Samuel A; Paaske, William P; Thim, Troels; Falk, Erling; Ringgaard, Steffen; Kim, Won Y (2011). "CMR Assessment of endothelial damage and angiogenesis in porcine coronary arteries using gadofosveset". Journal of Cardiovascular Magnetic Resonance. 13 (1). Elsevier BV: 10. doi:10.1186/1532-429x-13-10. ISSN 1097-6647. PMC 3036628. PMID 21269470.
  13. ^ Yamashita, Tomohiro; Takahara, Taro; Kwee, Thomas C.; Kawada, Shuichi; Horie, Tomohiko; Inomoto, Chie; Hashida, Kazunobu; Yamamuro, Hiroshi; Myojin, Kazunori; Luijten, Peter R.; Imai, Yutaka (2011). "Diffusion magnetic resonance imaging with gadofosveset trisodium as a negative contrast agent for lymph node metastases assessment". Japanese Journal of Radiology. 29 (1). Springer Science and Business Media LLC: 25–32. doi:10.1007/s11604-010-0513-2. ISSN 1867-1071. PMID 21264658.
  14. ^ Lambregts, Doenja M.J.; Beets, Geerard L.; Maas, Monique; Kessels, Alfons G.H.; Bakers, Frans C.H.; Cappendijk, Vincent C.; Engelen, Sanne M.E.; Lahaye, Max J.; de Bruïne, Adriaan P.; Lammering, Guido; Leiner, Tim; Verwoerd, Jan L.; Wildberger, Joachim E.; Beets-Tan, Regina G.H. (2011). "Accuracy of Gadofosveset-enhanced MRI for Nodal Staging and Restaging in Rectal Cancer". Annals of Surgery. 253 (3). Ovid Technologies (Wolters Kluwer Health): 539–545. doi:10.1097/sla.0b013e31820b01f1. ISSN 0003-4932. PMID 21239980.
  15. ^ McGregor, Robert; Vymazal, Josef; Martinez-Lopez, Manuel; Neuwirth, Jiri; Salgado, Perla; Beregi, Jean-Paul; Peduto, Anthony; de la Pena-Almaguer, Erasmo; Slater, Greg J.; Shamsi, Kohkan; Parsons, Edward C. (2008). "A multi-center, comparative, phase 3 study to determine the efficacy of gadofosveset-enhanced magnetic resonance angiography for evaluation of renal artery disease". European Journal of Radiology. 65 (2). Elsevier BV: 316–325. doi:10.1016/j.ejrad.2007.03.018. ISSN 0720-048X. PMID 17499952.
  16. ^ Bell, Daniel; Morgan, Matt. "Gadofosveset trisodium". Radiopaedia. radiopaedia.org. Archived from the original on 2018-08-29. Retrieved 2018-08-28.
  17. ^ "Gadocoletic acid". bloodpoolagents.us. Archived from the original on January 28, 2012.
  18. ^ "MultiHance" (PDF). Food and Drug Administration. Archived (PDF) from the original on 2017-05-09. Retrieved 2019-12-16.
  19. ^ "Gadomelitol". bloodpoolagents.us. Archived from the original on January 28, 2012.
  20. ^ "Gadomer 17". bloodpoolagents.us. Archived from the original on January 28, 2012.
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