MultiHance® (gadobenate dimeglumine)

 

Whenever you need high relaxivity and liver specificity in MRI.

 

MultiHance® (gadobenate dimeglumine) is a gadolinium-based contrast agent (GBCA) currently approved in the European Union, Norway, and Iceland for use in diagnostic magnetic resonance imaging (MRI) of the liver in adult and in pediatric patients older than two years of age.1

The active ingredient of MultiHance® (gadobenate dimeglumine, or Gd-BOPTA) possesses an aromatic (benzyloxymethyl) group on the contrast-effective molecule.

gadobemate dimeglumine molecule

Thanks to its chemical structure, Gd-BOPTA is actively transported into functioning hepatocytes and up to 4% of the injected dose is excreted via the hepatobiliary route into the bile and, ultimately, the faeces.2, 3, 4

 

In view of its pharmacokinetics, MultiHance® can be used both for dynamic and delayed, liver-specific imaging in adult and pediatric patients.

Evidence shows that:

 

  • Dynamic imaging is not affected by short-term dyspnea and respiratory motion artifacts 5, 6, 7,
     
  • Delayed, liver-specific imaging offers extended opportunities for the assessment of focal liver lesions, with further increase in sensitivity and specificity for detection and characterization of liver disease over and above those provided by dynamic imaging when images are acquired 40-120 minutes after injection of the agent. 8, 9, 10, 11

 

Therefore, MultiHance® should be used when diagnostic information is essential and not available with unenhanced MRI and when delayed phase imaging is required.

 

The aromatic group on Gd-BOPTA also provides increased r1-relaxivity relative to that of the macrocyclic GBCAs12, 13, 14, 15 and hence greater signal intensity (SI) enhancement on T1-weighted images16. This is why MultiHance® allows both dynamic and delayed, organ-specific imaging of the liver at a dose as low as 0.05 mmol/kg.

 

Therefore, the recommended dose of MultiHance® in adult patients and children is 0.05 mmol/kg body weight (0.1 mL/kg of the 0.5 M solution). The lowest dose that provides sufficient enhancement for diagnostic purposes should be used. The dose should be calculated based on the patient's body weight, and should not exceed the recommended dose per kilogram of body weight.1

 

The safety of MultiHance® has been established in numerous clinical investigations and during extensive clinical use with 35 million doses administered worldwide since its launch.17, 18, 19, 20

The safety of MultiHance® has also been studied in children and in special populations, such as children and patients with impairment of renal and/or liver function. 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32

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DISCLAIMER

 

For any product or type of product, whether a drug or device, referenced in this website, physicians should carefully review the product's package insert, instructions for use, or user manual prior to patient administration to ensure proper utilization of the product. The local Summaries of Product Characteristics of the main Bracco Imaging products are available on line.

 

Gadolinium retention

After administration of gadobenic acid, gadolinium can be retained in the brain and in other tissues of the body (bones, liver, kidneys, skin) and can cause dose-dependent increases in T1-weighted signal intensity in the brain, particularly in the dentate nucleus, globus pallidus, and thalamus. Clinical consequences are unknown. The possible diagnostic advantages of using MultiHance in patients who will require repeated scans should be weighed against the potential for deposition of gadolinium in the brain and other tissues.

 

Impaired renal function

Prior to administration of MultiHance, it is recommended that all patients are screened for renal dysfunction by obtaining laboratory tests. There have been reports of nephrogenic systemic fibrosis (NSF) associated with use of some gadolinium containing contrast agents in patients with acute or chronic severe renal impairment (GFR<30ml/min/1.73m2).
Patients undergoing liver transplantation are at particular risk since the incidence of acute renal failure is high in this group. As there is a possibility that NSF may occur with MultiHance, it should therefore be avoided in patients with severe renal impairment and in patients in the perioperative liver transplantation period unless the diagnostic information is essential and not available with non-contrast enhanced MRI.
Haemodialysis shortly after MultiHance administration may be useful at removing MultiHance from the body. There is no evidence to support the initiation of haemodialysis for prevention or treatment of NSF in patients not already undergoing haemodialysis.

 

Elderly

As the renal clearance of gadobenate dimeglumine may be impaired in the elderly, it is particularly important to screen patients aged 65 years and older for renal dysfunction.