***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To evaluate the diagnostic efficacy of macrocyclic paramagnetic gadolinium ( Gd ) chelates gadoterate ( 0.5 mmol/mL ) and gadobutrol ( 1.0 mmol/mL ) for the diagnosis of clinical ly significant abdominal/lower limb arterial diseases at 3.0 T . MATERIAL S AND METHODS This study was conducted as a prospect i ve , single-center , r and omized , double-blind , intraindividual study comparing single dose ( 0.1 mmol/kg ) gadoterate enhanced-MRA ( magnetic resonance angiography ) with gadobutrol enhanced-MRA at 3.0 T for their diagnostic potential in patients with peripheral artery disease . A total of 20 patients were included in this trial . RESULTS Fourteen patients were eligible for the final efficacy analysis . The overall image quality ( excellent/more than adequate ) was better rated with gadoterate than with gadobutrol ( 100 % vs. 78.6 % , 100 % vs. 92.9 % , 100 % vs. 85.7 % , 100 % vs. 85.7 % for readers 1 , 2 , 3 , 4 , respectively ) . Diagnostic confidence was rated high/excellent in 100 % ( readers 1 , 2 , and 3 ) and 92.9 % ( reader 4 ) with gadoterate compared to 92.9 % ( readers 1 and 2 ) and 85.7 % ( readers 3 and 4 ) with gadobutrol .  Higher signal-to-noise ratio ( SNR ) and contrast-to-noise ratio ( CNR ) values were obtained for gadobutrol compared to gadoterate ( 26.1/23.4 , P = 0.01 , and 22.7/20.2 , P = 0.01 ) . For the secondary criteria , no differences between groups were reported . No adverse events were reported . CONCLUSION Gadobutrol yielded significantly higher SNR/CNR while gadoterate was better rated in terms of overall image quality and diagnostic confidence ( P > 0.05 ) Objective : To evaluate the diagnostic efficacy ( accuracy , sensitivity , specificity ) of 1.0 M gadobutrol versus 0.5 M gadopentetate for the classification of lesions as either benign or malignant in patients with known or suspected liver lesions . Methods and Material s : A multicenter , phase-III , r and omized , interindividually controlled comparison study with blinded reader evaluation was performed to investigate the diagnostic efficacy of a bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentetate at a dose of 0.1 mmol Gd/kg BW . The imaging protocol included a dynamic 3D-evaluation , static conventional , and fat saturated T1-weighted sequences . MR data sets were evaluated by 3 independent radiologists . The st and ard of reference was defined by an independent truth panel ( radiologist or hepatologist ) . The safety evaluation included adverse events , vital signs , and physical examination . Results : A total of 497 of 572 patients were eligible for the final efficacy analysis . Noninferiority of gadobutrol-enhanced magnetic resonance imaging ( MRI ) for the classification of liver lesions was demonstrated on the basis of diagnostic accuracy determined by the on-site investigators ( −0.098 , 0.021 ) as well as for the average reader of the blinded evaluation ( −0.096 , 0.014 ) ( 95 % confidence interval ) , compared with the predefined st and ard of reference . Very similar increases in sensitivity ( ranging from ∼10 % to ∼55 % ) and specificity ( ranging from ∼1%–∼18 % ) compared with precontrast MRI were also observed for the 2 contrast agent groups , with maximum differences of 4%.Very similar , low rates of adverse events were recorded for each of the 2 groups . No clinical ly relevant changes in vital signs or the results of the physical examination were observed in any patient . Conclusion : This study documents evidence for the noninferiority of a single i.v . bolus injection of 1.0 M gadobutrol ( 0.1 mmol/kg body weight ) to 0.5 M gadopentetate ( 0.1 mmol/kg body weight ) in the diagnostic assessment of liver lesions with contrast-enhanced MRI . The known excellent safety profile of gadobutrol was confirmed in this clinical trial and is similar to that of gadopentetate PURPOSE To prospect ively compare 0.5-M gadopentetate dimeglumine ( Gd-DTPA ) with 1.0-M gadobutrol for contrast-enhanced magnetic resonance angiography ( CE-MRA ) of the blood supplying arteries of the spinal cord in patients referred for open surgical repair of a thoracoabdominal aortic aneurysm ( TAAA ) . MATERIAL S AND METHODS A total of 11 patients with a TAAA underwent two three-dimensional CE-MRA exams of the aorta , segmental arteries ( SAs ) , artery of Adamkiewicz ( AKA ) , and anterior spinal artery ( ASA ) . Imaging was performed on two separate occasions using Gd-DTPA and gadobutrol as contrast agents at 0.3 mmol/kg . Images were evaluated by measuring signal-to-noise ( SNR ) and contrast-to-noise ( CNR ) ratios and were judged for different image quality criteria by two blinded observers . RESULTS In all patients both CE-MRA exams were of sufficient image quality to detect the AKA and ASA . No significant differences in SNR and CNR were observed between the two contrast agents . According to the observers , no significant differences in subjective image quality were found . CONCLUSIONS Using both contrast agents it was possible to visualize the ultrasmall spinal cord arteries in all cases . The use of the 1.0-M contrast agent did not improve image quality of CE-MRA images of the blood supplying arteries of the spinal cord compared to the 0.5-M contrast agent The purpose of this phase III clinical trial was to compare two different extracellular contrast agents , 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine , for magnetic resonance imaging ( MRI ) in patients with known or suspected focal renal lesions . Using a multicenter , single-blind , interindividual , r and omized study design , both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy , sensitivity , and specificity to correctly classify focal lesions of the kidney . To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading . The average diagnostic accuracy across the three blinded readers ( ‘ average reader ’ ) was 83.7 % for gadobutrol and 87.3 % for gadopentate dimeglumine . The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0 % for gadobutrol and 6.9 % for gadopentate dimeglumine . Sensitivity of the average reader was 85.2 % for gadobutrol and 88.7 % for gadopentate dimeglumine . Specificity of the average reader was 82.1 % for gadobutrol and 86.1 % for gadopentate dimeglumine . In conclusion , this study documents evidence for the noninferiority of a single i.v . bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI PURPOSE To perform a quantitative and qualitative comparison of gadobutrol and gadoterate in three-station contrast enhanced magnetic resonance angiography ( CE-MRA ) of the lower limbs . MATERIAL S AND METHODS In this prospect i ve r and omized controlled trial , 52 patients with leg ischemia were r and omly assigned to one of two groups receiving either gadobutrol ( 1.0 mmol Gd/mL , 15 mL ) or gadoterate ( 0.5 mmol Gd/mL , 30 mL ) . Three-station 3D CE-MRAs from the pelvis to the ankles were performed with moving-table technique on a 1.5 T MR scanner . Injection time was identical in both groups . Signal-to-noise ( SNR ) and contrast-to-noise ratios ( CNR ) were calculated for 816 arteries . Contrast quality in 1196 vessel segments was evaluated separately by two blinded readers on a three-point scale . RESULTS Mean SNR ( 61.8 + /- 7.8 for gadobutrol vs. 61.9 + /- 9.1 for gadoterate , P = 0.257 ) , CNR ( 52.8 + /- 9.1 vs. 52.8 + /- 10.7 , P = 0.154 ) , and qualitative ranking ( 1.41 vs. 1.44 , P = 0.21 ) for all vessels did not differ significantly between the two patient groups . The overall quality was good in 90.4 % with gadoterate and 94.2 % with gadobutrol ( P = 0.462 ) . CONCLUSION High-concentration gadobutrol allows neither a higher CNR nor any qualitative advantage over the ordinary unspecific Gd agent gadoterate when the same Gd load and injection times are used in multistation CE-MRA of the peripheral arteries OBJECTIVE The purpose of this study was to compare a macrocyclic 1.0 M contrast agent with a linear ionic 0.5 M contrast agent at equimolar dosage in regard to image quality and number of vessel segments visualized at abdominal dynamic contrast-enhanced 3D MR angiography . SUBJECTS AND METHODS In an intraindividual comparative study , 15 patients ( six women , nine men ; mean age , 53 + /- 12.1 years ; range , 25 - 72 years ) underwent 32 1.5-T whole-body contrast-enhanced 3D MR angiographic examinations  performed with parallel imaging technique . At r and om and in separate sessions , each patient was examined after IV injection of 0.1 mmol/kg body weight 1.0 M macrocyclic gadobutrol and 0.5 M linear ionic gadopentetate dimeglumine . Three-dimensional data sets were acquired in the arterial , portal venous , and venous phases with identical imaging protocol s. Quantitative analysis included contrast measurements of vessels compared with adjacent background tissue ( Student 's t test ) . Qualitative analysis was performed independently by two radiologists with regard to visualization of arterial and venous vessel segments and overall image quality ( Wilcoxon 's test ) . RESULTS Visualization of individual vessel segments was rated significantly better after administration of 1.0 M macrocyclic gadobutrol compared with 0.5 M linear ionic gadopentetate dimeglumine ( p < 0.001 ) . Overall image quality was superior with 1.0 M macrocyclic gadobutrol , but the difference was not significant . Vessel-to- background contrast after injection of 1.0 M macrocyclic gadobutrol was significantly higher ( arterial phase , 0.90 , p = 0.02 ; portal venous phase , 0.78 , p = 0.0002 ; venous phase , 0.74 , p = 0.0002 ) compared with 0.5 M linear ionic gadopentetate dimeglumine ( arterial phase , 0.89 ; portal venous phase , 0.73 ; venous phase , 0.67 ) . CONCLUSION At abdominal contrast-enhanced 3D MR angiography , depiction of small abdominal vessels was significantly better and vessel-to-tissue contrast significantly higher with 1.0 M macrocyclic gadobutrol than with an equimolar dose of 0.5 M linear ionic gadopentetate dimeglumine OBJECTIVE Two macrocyclic extracellular contrast agents , one-molar neutral gadobutrol and ionic gadoterate meglumine , were compared to determine the overall preference for one or the other in a clinical setting . MATERIAL S AND METHODS Multicenter , r and omized , single-blind , intra-individually controlled , comparison study with a corresponding blinded read . Efficacy analysis was based on 136 patients who underwent identical MRI examinations : group A first received 1.0 M gadobutrol followed by 0.5 M gadoterate meglumine 48 h to 7 days later ; group B had a reversed administration order . Three independent blinded readers assessed off-site their overall diagnostic preference ( primary efficacy parameter ) based on a matched pairs approach . RESULTS Superiority of gadobutrol over gadoterate meglumine was demonstrated for the qualitative assessment of overall preference across all readers by a statistically significant difference between both contrast agents for this primary endpoint . Preferences in lesion enhancement ( secondary endpoint ) were also found significantly in favor of gadobutrol . For preference in lesion delineation from surrounding tissue/edema and for internal structure only a trend towards a higher proportion for gadobutrol was found ( except for internal structure reported by one reader , which showed a result of statistical significance ) . Lesion contrast and relative lesion enhancement ( quantitative parameters ) were statistically significantly higher for gadobutrol compared to gadoterate meglumine . CONCLUSION Contrast-enhanced MRI of neoplastic brain lesions at a dose of 0.1 mmol Gd/kg body weight , assessed in a st and ardized off-site blinded reading , results in 
    Output:
    
Conclusion Imaging differences between 0.5 M and 1.0 M GBCAs were essentially observed under non-equimolar delivery rates .
However , they did not result into greater diagnostic efficacy when performed under equimolar conditions