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Shahrouki P, Khan SN, Yoshida T, Iskander PJ, Ghahremani S, Finn JP. High-resolution three‑dimensional contrast‑enhanced magnetic resonance venography in children: comparison of gadofosveset trisodium with ferumoxytol. Pediatr Radiol 2022; 52:501-512. [PMID: 34936018 PMCID: PMC8857136 DOI: 10.1007/s00247-021-05225-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/08/2021] [Accepted: 10/12/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gadofosveset is a gadolinium-based blood pool contrast agent that was approved by the United States Food and Drug Administration in 2008. Its unanticipated withdrawal from production in 2016 created a void in the blood pool agent inventory and highlighted the need for an alternative agent with comparable imaging properties. OBJECTIVE The purpose of our study is to compare the diagnostic image quality, vascular contrast-to-noise ratio (CNR) and temporal signal characteristics of gadofosveset trisodium and ferumoxytol at similar molar doses for high-resolution, three-dimensional (3-D) magnetic resonance (MR) venography in children. MATERIALS AND METHODS The medical records and imaging data sets of patients who underwent high-resolution 3-D gadofosveset-enhanced MR venography (GE-MRV) or ferumoxytol-enhanced MR venography (FE-MRV) were retrospectively reviewed. Two groups of 20 pediatric patients (age- and weight-matched with one patient common to both groups; age range: 2 days-15 years) who underwent high-resolution 3-D GE-MRV or FE-MRV at similar molar doses were identified and analyzed. Qualitative analysis of image quality and vessel definition was performed by two blinded pediatric radiologists. Interobserver agreement was assessed with the AC1 (first-order agreement coefficient) statistic. Signal-to-noise ratio (SNR) and CNR of the inferior vena cava and aorta were measured in the steady-state venous phase. Medical records were retrospectively reviewed for any adverse reactions associated with either contrast agent. RESULTS Measured SNR and CNR of the inferior vena cava were higher for FE-MRV than GE-MRV (P = 0.034 and P < 0.001, respectively). The overall image quality score and individual vessel scores of FE-MRV were equal to or greater than GE-MRV (P = 0.084), with good interobserver agreement (AC1 = 0.657). The venous signal on FE-MRV was stable over the longest interval measured (1 h, 13 min and 46 s), whereas venous signal on GE-MRV showed more variability and earlier loss of signal. No adverse reactions were noted in any patient with either contrast agent. CONCLUSION Ferumoxytol produces more uniform and stable enhancement throughout the entire venous circulation in children than gadofosveset, offering a wider time window for optimal image acquisition. FE-MRV offers a near-ideal approach to high-resolution venography in children at all levels of anatomical complexity.
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Affiliation(s)
- Puja Shahrouki
- grid.19006.3e0000 0000 9632 6718Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206 USA
| | - Sarah N. Khan
- grid.19006.3e0000 0000 9632 6718Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206 USA
| | - Takegawa Yoshida
- grid.19006.3e0000 0000 9632 6718Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206 USA
| | - Paul J. Iskander
- grid.19006.3e0000 0000 9632 6718Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206 USA ,grid.19006.3e0000 0000 9632 6718Division of Pediatric Radiology, Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA USA ,grid.239546.f0000 0001 2153 6013Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Shahnaz Ghahremani
- grid.19006.3e0000 0000 9632 6718Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206 USA ,grid.19006.3e0000 0000 9632 6718Division of Pediatric Radiology, Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA USA
| | - J. Paul Finn
- grid.19006.3e0000 0000 9632 6718Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206 USA
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Lam CZ, Pagano JJ, Gill N, Vidarsson L, de la Mora R, Seed M, Grosse-Wortmann L, Yoo SJ. Dual phase infusion with bolus tracking: technical innovation for cardiac and respiratory navigated magnetic resonance angiography using extracellular contrast. Pediatr Radiol 2019; 49:399-406. [PMID: 30443668 DOI: 10.1007/s00247-018-4293-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
This technical innovation paper describes a technique for performing cardiac-gated, respiratory-navigated cardiovascular magnetic resonance angiography using an extracellular gadolinium-based contrast agent at 1.5 Tesla (T) with a dual phase bolus injection and slow infusion technique.
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Affiliation(s)
- Christopher Z Lam
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Joseph J Pagano
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Navjot Gill
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Logi Vidarsson
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Regina de la Mora
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Tandon A, Hashemi S, Parks WJ, Kelleman MS, Sallee D, Slesnick TC. Improved high-resolution pediatric vascular cardiovascular magnetic resonance with gadofosveset-enhanced 3D respiratory navigated, inversion recovery prepared gradient echo readout imaging compared to 3D balanced steady-state free precession readout imaging. J Cardiovasc Magn Reson 2016; 18:74. [PMID: 27802802 PMCID: PMC5090984 DOI: 10.1186/s12968-016-0296-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/14/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Improved delineation of vascular structures is a common indication for cardiovascular magnetic resonance (CMR) in children and requires high spatial resolution. Currently, pre-contrast 3D, respiratory navigated, T2-prepared, fat saturated imaging with a bSSFP readout (3D bSSFP) is commonly used; however, these images can be limited by blood pool inhomogeneity and exaggeration of metal artifact. We compared image quality of pediatric vasculature obtained using standard 3D bSSFP to 3D, respiratory navigated, inversion recovery prepared imaging with a gradient echo readout (3D IR GRE) performed after administration of gadofosveset trisodium (GT), a blood pool contrast agent. METHODS For both sequences, VCG triggering was used with acquisition during a quiescent period of the cardiac cycle. 3D bSSFP imaging was performed pre-contrast, and 3D IR GRE imaging was performed 5 min after GT administration. We devised a vascular imaging quality score (VIQS) with subscores for coronary arteries, pulmonary arteries and veins, blood pool homogeneity, and metal artifact. Scoring was performed on axial reconstructions of isotropic datasets by two independent readers and differences were adjudicated. Signal- and contrast-to-noise (SNR and CNR) calculations were performed on each dataset. RESULTS Thirty-five patients had both 3D bSSFP and 3D IR GRE imaging performed. 3D IR GRE imaging showed improved overall vascular imaging compared to 3D bSSFP when comparing all-patient VIQS scores (n = 35, median 14 (IQR 11-15), vs 6 (4-10), p < 0.0001), and when analyzing the subset of patients with intrathoracic metal (n = 17, 16 (14-17) vs. 5 (2-9), p < 0.0001). 3D IR GRE showed significantly improved VIQS subscores for imaging the RCA, pulmonary arteries, pulmonary veins, and blood pool homogeneity. In addition, 3D IR GRE imaging showed reduced variability in both all-patient and metal VIQS scores compared to 3D bSSFP (p < 0.05). SNR and CNR were higher with 3D IR GRE in the left ventricle and left atrium, but not the pulmonary arteries. CONCLUSIONS Respiratory navigated 3D IR GRE imaging after GT administration provides improved vascular CMR in pediatric patients compared to pre-contrast 3D bSSFP imaging, as well as improved imaging in patients with intrathoracic metal. It is an excellent alternative in this challenging patient population when high spatial resolution vascular imaging is needed.
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Affiliation(s)
- Animesh Tandon
- Departments of Pediatrics, Radiology, and Biomedical Engineering, University of Texas Southwestern Medical School, Dallas, TX USA
- Children’s Medical Center Dallas, Dallas, TX USA
| | | | - W. James Parks
- Children’s Healthcare of Atlanta, Atlanta, GA USA
- Emory University School of Medicine, Atlanta, GA USA
| | | | - Denver Sallee
- Children’s Healthcare of Atlanta, Atlanta, GA USA
- Emory University School of Medicine, Atlanta, GA USA
| | - Timothy C. Slesnick
- Children’s Healthcare of Atlanta, Atlanta, GA USA
- Emory University School of Medicine, Atlanta, GA USA
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Safety of Blood Pool Contrast Agent Administration in Children and Young Adults. AJR Am J Roentgenol 2015; 205:1114-20. [DOI: 10.2214/ajr.14.13991] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Seeger A, Krumm P, Hornung A, Schäfer JF, Kramer U, Sieverding L. 3-D cardiac MRI in free-breathing newborns and infants: when is respiratory gating necessary? Pediatr Radiol 2015; 45:1448-54. [PMID: 25903840 DOI: 10.1007/s00247-015-3346-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Newborns and small infants have shallow breathing. OBJECTIVE To suggest criteria for when respiratory gating is necessary during cardiac MRI in newborns and infants. MATERIALS AND METHODS One-hundred ten data sets of newborns and infants with (n = 92, mean age: 1.9 ± 1.7 [SD] years) and without (n = 18, mean age: 1.6 ± 1.8 [SD] years) navigator gating were analysed retrospectively. The respiratory motion of the right hemidiaphragm was recorded and correlated to age, weight, body surface area and qualitative image quality on a 4-point score. Quantitative image quality assessment was performed (sharpness of the delineation of the ventricular septal wall) as well as a matched-pair comparison between navigator-gated and non-gated data sets. RESULTS No significant differences were found in overall image quality or in the sharpness of the ventricular septal wall between gated and non-gated scans. A navigator acceptance of >80% was frequently found in patients ages <12 months, body surface area <0.40 m(2), body weight <10 kg and a size of <80 cm. CONCLUSION Sequences without respiratory gating may be used in newborns and small infants, in particular if age <12 months, body surface area <0.40 m(2), body weight <10 kg and height <80 cm.
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Affiliation(s)
- Achim Seeger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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Advances in cardiac magnetic resonance imaging of congenital heart disease. Pediatr Radiol 2015; 45:5-19. [PMID: 25552386 DOI: 10.1007/s00247-014-3067-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/21/2014] [Indexed: 01/09/2023]
Abstract
Due to advances in cardiac surgery, survival of patients with congenital heart disease has increased considerably during the past decades. Many of these patients require repeated cardiovascular magnetic resonance imaging to assess cardiac anatomy and function. In the past decade, technological advances have enabled faster and more robust cardiovascular magnetic resonance with improved image quality and spatial as well as temporal resolution. This review aims to provide an overview of advances in cardiovascular magnetic resonance hardware and acquisition techniques relevant to both pediatric and adult patients with congenital heart disease and discusses the techniques used to assess function, anatomy, flow and tissue characterization.
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Farmakis SG, Khanna G. Extracardiac applications of MR blood pool contrast agent in children. Pediatr Radiol 2014; 44:1598-609; quiz 1595-7. [PMID: 25408135 DOI: 10.1007/s00247-014-3167-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/30/2014] [Accepted: 08/20/2014] [Indexed: 11/26/2022]
Abstract
Magnetic resonance (MR) angiography has significantly reduced the need for diagnostic conventional angiography and is preferred over CT angiography in children because of its lack of ionizing radiation. The availability of gadofosveset trisodium (the only clinically approved blood pool MR contrast agent) has led to an increase in applications of MR for vascular imaging and an improvement in diagnostic quality of MR angiography. Gadofosveset is a gadolinium-based contrast agent that binds reversibly to albumin, resulting in increased paramagnetic effect and longer intravascular residence. This allows for high-resolution arterial and venous MR angiography, assessment of flow characteristics of vascular malformations, dynamic vascular imaging, and multi-station imaging with a single low-dose gadolinium contrast injection. The purpose of this pictorial essay is to facilitate understanding of the kinetics and safety profile of gadofosveset trisodium, discuss technical aspects of imaging, and illustrate advantages and extracardiac applications in pediatric body imaging.
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Affiliation(s)
- Shannon G Farmakis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO, 63110, USA
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