The Impact of Gadopiclenol Dose on Myocardial and Left Ventricular Blood Pool T1 Shortening Times in Cardiac Magnetic Resonance Imaging

Gadopiclenol is a gadolinium-based contrast agent (GBCA) with high relaxivity, allowing for lower millimolar gadolinium (Gd) dosage while maintaining diagnostic image quality. While its efficacy in central nervous system (CNS) and body MRI has been studied, its application in cardiac MRI (CMR) remains largely unexplored. This raises important questions, especially given the known risks of Gd exposure, including nephrogenic systemic fibrosis (NSF) and Gd deposition disease (GDD). Due to the ability of all GBCAs to release trace amounts of free Gd, patients undergoing multiple contrast-enhanced MRI studies may face cumulative exposure risks. Identifying the lowest effective dose of gadopiclenol for CMR is essential, particularly for patients vulnerable to these conditions. T1 mapping offers a reproducible technique for evaluating myocardial tissue characteristics and was employed in this study to identify whether gadopiclenol 0.06 mmol/kg is an acceptable dose in CMR.

This observational, retrospective, pre-post contrast cohort study included 110 subjects (mean age: 65 years; 50 females, 60 males) with known or suspected cardiovascular lesions who underwent standardized CMR using Modified Look-Locker Inversion Recovery (MOLLI) T1 mapping on a 1.5 Tesla General Electric scanner. Native T1 maps were acquired in a midventricular short-axis slice and repeated 10 minutes post-contrast. A 0.06 mmol/kg dose of gadopiclenol was administered in 95% of patients. Myocardial and LV blood pool T1 values were measured pre- and post-contrast.

The mean myocardial T1 shortening was 608 ± 49 ms, reflecting a 60% reduction from baseline. The mean LV blood pool T1 shortening was 1244 ± 90 ms, corresponding to an 82% reduction. Images were technically adequate in 40% of patients, while 60% were technically difficult to achieve. The most common reason for technical difficulty was respiratory artifact, most often due to inconsistent breath holding. For most patients, technical difficulty did not impact T1 values. No infusion reactions were reported.

These findings support gadopiclenol’s potential as a lower-dose alternative to traditional GBCAs in CMR. Future research should examine its accuracy in extracellular volume (ECV) fraction estimation, performance at higher field strengths, and clinical utility in broader populations, including those with renal impairment. A cost-benefit analysis comparing gadopiclenol with conventional agents is also warranted.