Summary: In a randomised comparison for dynamic contrast-enhanced MRI of pituitary macroadenomas, gadobutrol was non-inferior to meglumine gadoterate for the key perfusion parameter Ktrans, but produced a significantly higher Kep, a difference radiologists should recognise to avoid misreading tumour vascularity.
PICO Summary
| Element | Detail |
|---|---|
| Population | 60 patients with pituitary macroadenomas (mean age 59.7; 40 men); prospective, randomised. |
| Intervention | Gadobutrol (macrocyclic, non-ionic) for DCE-MRI perfusion measurement. |
| Comparison | Meglumine gadoterate (macrocyclic, ionic). |
| Outcome | Gadobutrol non-inferior for Ktrans. Kep significantly higher with gadobutrol (p=0.001) regardless of tumour status. Ktrans, Ve, Vp, and pre/post-contrast T1 signal did not differ. Perfusion parameters did not distinguish tumour functional status. |
Expert Commentary
This is a technical radiology comparison of marginal day-to-day relevance to most endocrinologists, but it is worth getting right, because the earlier framing of gadobutrol outperforming its comparator misstates what the study found. On the principal perfusion measure, Ktrans, the two macrocyclic agents were equivalent, and most parameters, Ve, Vp, and signal intensities, did not differ. The single real difference was a higher Kep with gadobutrol, which the authors explicitly present not as superiority but as a systematic variation to be aware of, lest it be mistaken for genuinely different tumour vascular dynamics. That is a caution, not a win. The study is also modest at sixty patients, and notably the perfusion parameters did not actually discriminate functioning from non-functioning tumours, so the clinical payoff of DCE perfusion here is itself uncertain. Can I use this with my patients? Only very indirectly. It does not change how I manage a pituitary adenoma. Its practical message is for the radiology protocol: keep the contrast agent consistent across serial scans so that a Kep difference between agents is not misread as tumour change. I would defer to neuroradiology on agent choice.
References
Hwang K, Bae YJ, Kim CY, et al. Comparison of gadobutrol and meglumine gadoterate for dynamic contrast-enhanced MRI of pituitary macroadenomas. Sci Rep. 2025;15(1):26419. doi:10.1038/s41598-025-10702-x