Dose Reduction with Gadopiclenol: Implications for DSC Perfusion Imaging

Gadopiclenol (Vueway) has a substantially higher T1 relaxivity than other gadolinium-based contrast agents, including gadobenate dimeglumine (MultiHance), allowing a 50% dose reduction with noninferiority in detection of enhancing lesions on T1-weighted imaging. However, such reduced dosing may have unintended consequences for DSC perfusion imaging. In this retrospective analysis of 30 patients imaged using package-insert dosing of both MultiHance and Vueway (on separate occasions), DSC signal transients were compared between these agents. There was a statistically significant reduction in % signal change and area under the contrast concentration-time curve for Vueway relative to MultiHance. When the signal was normalized for contrast dose, this difference was statistically eliminated. The results demonstrate that package-insert dosing of Vueway produces substantially weaker signal transients for DSC perfusion imaging, in proportion to the one-half gadolinium dose regimen. Potential impact on perfusion metrics, with concerns including SNR and leakage correction, warrants further study.