Hd. Nguyen et al., MR EVALUATION OF ACOUSTIC SCHWANNOMA WITH FRACTIONAL CONTRAST DOSES, Journal of computer assisted tomography, 19(1), 1995, pp. 23-27
Objective: To investigate the utility of lower contrast medium doses f
or the detection and conspicuity of acoustic schwannomas. Materials an
d Methods: The L/B (L, lesion; B, background) ratios or lesion contras
t of 17 pathologically proven acoustic schwannomas studied with a stan
dard dose (0.1 mmol/kg) of gadopentetate dimeglumine was measured. In
addition, 22 patients with acoustic schwannomas were studied prospecti
vely with fractional doses using the incremental dose technique. Each
patient received an initial bolus injection of one-eighth the standard
dose (0.0125 mmol/ kg) followed by an injection of one-eighth, one-fo
urth, and one-half the standard dose at 5 min intervals to achieve a c
umulative dose of one-fourth, one-half and full dose, respectively. Im
aging was performed immediately after each injection. Results: Standar
d dose-The L/B ratios of pathologically proven acoustic schwannomas to
mastoid air cells ranged from 14.8 to 41.2 (mean +/- SEM, 28.0 +/- 1.
95), which were approximately 17 times more than those of intraparench
ymal lesions. Fractional cumulative dose-Qualitative visual analysis d
emonstrated that all acoustic schwannomas showed apparent enhancement
at one-fourth dose. Intense enhancement was noted at one-half and full
dose. Quantitative analysis demonstrated the mean L/B ratios between
the acoustic schwannomas and mastoid air cells of the precontrast and
one-eighth, one-fourth, one-half, and full dose studies were 8.33 +/-
0.52, 11.21 +/- 0.75, 13.02 +/- 0.83, 15.38 +/- 0.98, and 18.03 +/- 1.
36, respectively. Conclusion: The L/B ratios or lesion contrast of aco
ustic schwannomas at various fractional contrast medium doses was sign
ificantly higher compared with that of intraparenchymal lesions. Thus,
the standard contrast medium dose may not be necessary for detection
of acoustic schwannomas, and a fractional dose may be sufficient. Alth
ough the optimal fractional dose remains to be determined, one-half of
the standard dose (0.05 mmol/kg) appears to be sufficient because of
intense enhancement at this dose.