Gadolinium-based contrast dose regimens in MRI of the breast: Preliminary results of a systematic review

Background: Gadolinium-based contrast agents (GBCAs) are commonly used in magnetic resonance imaging (MRI) at a standard dose of 1.0 mmol/kg to enhance diagnostic accuracy (1). However, concerns about optimal dosing, and associated risks such as gadolinium retention in the brain tissue (2) and nephrogenic systemic fibrosis exist (3). This systematic review aims to provide an overview of the current evidence concerning sensitivity and specificity in clinical studies of breast MRI in women with biopsy-verified breast cancers, at different doses of GBCA, at different magnetic fields.
Methods: The study was designed in accordance with the PRISMA-P (4) guidelines to ensure systematic and transparent reporting of the methods employed in this review. Quantitative synthesis will be done to evaluate the diagnostic efficacy of different gadolinium dose regimens, using the receiver operating characteristic curve (ROC) and area under the curve (AUC) statistics to assess sensitivity and specificity throughout the articles.
Results: The search yielded 3392 articles. Title/abstract screening deemed 172 articles eligible for full text screening. Studies indicate that a reduced dose of GBCAs is not inferior to the standard dose in terms of sensitivity and specificity (5) (6) However, the outcome may vary depending on the specific agent used and the field strength implied.
Discussion: Large variation in GBCA dose regimens was identified, suggesting a potential for GBCA reduction whilst maintaining diagnostic accuracy. The results from this review will help guide clinical practice, support the development of standardized guidelines in breast MRI imaging, while addressing the safety concerns associated with GBCAs.