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Si G, Du Y, Tang P, Ma G, Jia Z, Zhou X, Mu D, Shen Y, Lu Y, Mao Y, Chen C, Li Y, Gu N. Unveiling the next generation of MRI contrast agents: current insights and perspectives on ferumoxytol-enhanced MRI. Natl Sci Rev 2024; 11:nwae057. [PMID: 38577664 PMCID: PMC10989670 DOI: 10.1093/nsr/nwae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Contrast-enhanced magnetic resonance imaging (CE-MRI) is a pivotal tool for global disease diagnosis and management. Since its clinical availability in 2009, the off-label use of ferumoxytol for ferumoxytol-enhanced MRI (FE-MRI) has significantly reshaped CE-MRI practices. Unlike MRI that is enhanced by gadolinium-based contrast agents, FE-MRI offers advantages such as reduced contrast agent dosage, extended imaging windows, no nephrotoxicity, higher MRI time efficiency and the capability for molecular imaging. As a leading superparamagnetic iron oxide contrast agent, ferumoxytol is heralded as the next generation of contrast agents. This review delineates the pivotal clinical applications and inherent technical superiority of FE-MRI, providing an avant-garde medical-engineering interdisciplinary lens, thus bridging the gap between clinical demands and engineering innovations. Concurrently, we spotlight the emerging imaging themes and new technical breakthroughs. Lastly, we share our own insights on the potential trajectory of FE-MRI, shedding light on its future within the medical imaging realm.
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Affiliation(s)
- Guangxiang Si
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Yue Du
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Peng Tang
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Gao Ma
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhaochen Jia
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai 200126, China
| | - Dan Mu
- Department of Radiology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yan Shen
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Yi Lu
- School of Mathematical Sciences, Capital Normal University, Beijing 100048, China
| | - Yu Mao
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine, Institute of Clinical Medicine, Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
| | - Chuan Chen
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Yan Li
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Ning Gu
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine, Institute of Clinical Medicine, Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
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Timms L, Zhou T, Qiao J, Gharagouzloo C, Mishra V, Lahoud RM, Chen JW, Harisinghani M, Sridhar S. Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI. Int J Biomed Imaging 2024; 2024:9763364. [PMID: 38644981 PMCID: PMC11032209 DOI: 10.1155/2024/9763364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Abstract
Background Ferumoxytol (Ferahame, AMAG Pharmaceuticals, Waltham, MA) is increasingly used off-label as an MR contrast agent due to its relaxivity and safety profiles. However, its potent T2∗ relaxivity limits achievable T1-weighted positive contrast and leads to artifacts in standard MRI protocols. Optimization of protocols for ferumoxytol deployment is necessary to realize its potential. Methods We present first-in-human clinical results of the Quantitative Ultrashort Time-to-Echo Contrast Enhanced (QUTE-CE) MRA technique using the superparamagnetic iron oxide nanoparticle agent ferumoxytol for vascular imaging of the head/brain in 15 subjects at 3.0T. The QUTE-CE MRA method was implemented on a 3T scanner using a stack-of-spirals 3D Ultrashort Time-to-Echo sequence. Time-of-flight MRA and standard TE T1-weighted (T1w) images were also collected. For comparison, gadolinium-enhanced blood pool phase images were obtained retrospectively from clinical practice. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and intraluminal signal heterogeneity (ISH) were assessed and compared across approaches with Welch's two-sided t-test. Results Fifteen volunteers (54 ± 17 years old, 9 women) participated. QUTE-CE MRA provided high-contrast snapshots of the arterial and venous networks with lower intraluminal heterogeneity. QUTE-CE demonstrated significantly higher SNR (1707 ± 226), blood-tissue CNR (1447 ± 189), and lower ISH (0.091 ± 0.031) compared to ferumoxytol T1-weighted (551 ± 171; 319 ± 144; 0.186 ± 0.066, respectively) and time-of-flight (343 ± 104; 269 ± 82; 0.190 ± 0.016, respectively), with p < 0.001 in each comparison. The high CNR increased the depth of vessel visualization. Vessel lumina were captured with lower heterogeneity. Conclusion Quantitative Ultrashort Time-to-Echo Contrast-Enhanced MR angiography provides approximately 5-fold superior contrast with fewer artifacts compared to other contrast-enhanced vascular imaging techniques using ferumoxytol or gadolinium, and to noncontrast time-of-flight MR angiography, for clinical vascular imaging. This trial is registered with NCT03266848.
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Affiliation(s)
- Liam Timms
- Department of Physics, Northeastern University, Boston, MA, USA
| | - Tianyi Zhou
- Department of Physics, Northeastern University, Boston, MA, USA
| | - Ju Qiao
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Codi Gharagouzloo
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Vishala Mishra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rita Maria Lahoud
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - John W. Chen
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Srinivas Sridhar
- Department of Physics, Northeastern University, Boston, MA, USA
- Department of Chemical Engineering, Northeastern University, Boston, MA, USA
- Department of Bioengineering, Northeastern University, Boston, MA, USA
- Theranano LLC, Newton, MA, USA
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Dasi A, Kring DN, Selvaraj B, Morgan P, Gerity C, Morgan EE, Krishnamurthy R, Krishnamurthy R. Brand ferumoxytol vs. generic ferumoxytol comparison across two dosing regimens: a cardiac MRI image quality study. Pediatr Radiol 2023; 53:2622-2632. [PMID: 37837456 DOI: 10.1007/s00247-023-05778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Ferumoxytol is becoming more widely used as an off-label blood-pool contrast agent for MR angiography (MRA) and four-dimensional (4D) flow imaging in pediatric cardiovascular disease. Brand and generic versions of ferumoxytol are available with no information on relative efficacy as a contrast agent and safety profiles. OBJECTIVE This study evaluates patient safety and image quality of comparable dosages of generic ferumoxytol (GF) versus brand ferumoxytol (BF) with the following hypotheses: (1) Reducing the contrast dosage from 3 to 2 mg/kg will not affect imaging quality and diagnostic accuracy of MRA and four-dimensional 4D flow. (2) GF and BF have similar image quality. (3) GF and BF have similar patient safety profiles. MATERIALS AND METHODS In an IRB-approved retrospective study, changes in vitals/clinical status between baseline, during infusion, and 30 min post-infusion were analyzed in 3 groups: group 1 (3 mg/kg BF, 216 patients, age: 19.29 ± 11.71 years ranging from 2 months to 62 years), group 2 (2 mg/kg BF, 47 patients, age: 15.35 ± 8.56 years ranging from 10 days to 41 years), and group 3 (2 mg/kg GF, 127 patients, age: 17.16 ± 12.18 years ranging from 6 days to 58 years). Both pediatric and adult patients with congenital heart disease (CHD) indications were included within the study. Adverse reactions were classified as mild, moderate, or severe. Quantitative analysis of MR image quality was performed with signal-to-noise ratio (SNR) on MRA and velocity-to-noise ratio (VNR) on 4D flow. Qualitative grading of imaging features was performed by 2 experienced observers. Two-way analysis of variance (ANOVA) and chi-square tests were used for comparison with a P value of ≤ 0.05 used for significance. RESULTS No statistical difference was found in clinical status and vital signs (P>0.05). No severe reactions were reported. 7.9% of GF patients experienced an adverse reaction compared to 2.3% with 3 mg/kg BF and 8.4% with 2 mg/kg BF. There was no statistical difference in SNR between the 3 groups (P>0.05). For 4D flow, 2 mg/kg GF demonstrated an increase in VNR compared to 2 mg/kg BF (P = 0.005). The qualitative scores for MRA and 4D flow were high (≥ 3) across all 3 groups. CONCLUSIONS No significant difference was identified between 2 mg/kg GF and BF in terms of safety profile and image quality. Given the small sample size of this study, further studies are required to confirm these results.
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Affiliation(s)
- Anoushka Dasi
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Donna N Kring
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bhavani Selvaraj
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Patricia Morgan
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher Gerity
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Eric E Morgan
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA.
- The Ohio State University, Columbus, OH, USA.
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Adams LC, Jayapal P, Ramasamy SK, Morakote W, Yeom K, Baratto L, Daldrup-Link HE. Ferumoxytol-Enhanced MRI in Children and Young Adults: State of the Art. AJR Am J Roentgenol 2023; 220:590-603. [PMID: 36197052 PMCID: PMC10038879 DOI: 10.2214/ajr.22.28453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ferumoxytol is an ultrasmall iron oxide nanoparticle that was originally approved by the FDA in 2009 for IV treatment of iron deficiency in adults with chronic kidney disease. Subsequently, its off-label use as an MRI contrast agent increased in clinical practice, particularly in pediatric patients in North America. Unlike conventional MRI contrast agents that are based on the rare earth metal gadolinium (gadolinium-based contrast agents), ferumoxytol is biodegradable and carries no potential risk of nephrogenic systemic fibrosis. At FDA-approved doses, ferumoxytol shows no long-term tissue retention in patients with intact iron metabolism. Ferumoxytol provides unique MRI properties, including long-lasting vascular retention (facilitating high-quality vascular imaging) and retention in reticuloendothelial system tissues, thereby supporting a variety of applications beyond those possible with gadolinium-based contrast agents (GBCAs). This Clinical Perspective describes clinical and early translational applications of ferumoxytol-enhanced MRI in children and young adults through off-label use in a variety of settings, including vascular, cardiac, and cancer imaging, drawing on the institutional experience of the authors. In addition, we describe current advances in pre-clinical and clinical research using ferumoxytol in cellular and molecular imaging as well as the use of ferumoxytol as a novel potential cancer therapeutic agent.
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Affiliation(s)
- Lisa C. Adams
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Praveen Jayapal
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Shakthi Kumaran Ramasamy
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Wipawee Morakote
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Kristen Yeom
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Heike E. Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
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Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121810. [PMID: 36553257 PMCID: PMC9777095 DOI: 10.3390/children9121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
Cardiac magnetic resonance imaging and angiography have a crucial role in the diagnostic evaluation and follow up of pediatric and adult patients with congenital heart disease. Although much of the information required of advanced imaging studies can be provided by standard gadolinium-enhanced magnetic resonance imaging, the limitations of precise bolus timing, long scan duration, complex imaging protocols, and the need to image small structures limit more widespread use of this modality. Recent experience with off-label diagnostic use of ferumoxytol has helped to mitigate some of these barriers. Approved by the U.S. FDA for intravenous treatment of anemia, ferumoxytol is an ultrasmall superparamagnetic iron oxide nanoparticle that has a long blood pool residence time and high relaxivity. Once metabolized by macrophages, the iron core is incorporated into the reticuloendothelial system. In this work, we aim to summarize the evolution of ferumoxytol-enhanced cardiovascular magnetic resonance imaging and angiography and highlight its many applications for congenital heart disease.
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Roy CW, Di Sopra L, Whitehead KK, Piccini D, Yerly J, Heerfordt J, Ghosh RM, Fogel MA, Stuber M. Free-running cardiac and respiratory motion-resolved 5D whole-heart coronary cardiovascular magnetic resonance angiography in pediatric cardiac patients using ferumoxytol. J Cardiovasc Magn Reson 2022; 24:39. [PMID: 35754040 PMCID: PMC9235103 DOI: 10.1186/s12968-022-00871-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary cardiovascular magnetic resonance angiography (CCMRA) of congenital heart disease (CHD) in pediatric patients requires accurate planning, adequate sequence parameter adjustments, lengthy scanning sessions, and significant involvement from highly trained personnel. Anesthesia and intubation are commonplace to minimize movements and control respiration in younger subjects. To address the above concerns and provide a single-click imaging solution, we applied our free-running framework for fully self-gated (SG) free-breathing 5D whole-heart CCMRA to CHD patients after ferumoxytol injection. We tested the hypothesis that spatial and motion resolution suffice to visualize coronary artery ostia in a cohort of CHD subjects, both for intubated and free-breathing acquisitions. METHODS In 18 pediatric CHD patients, non-electrocardiogram (ECG) triggered 5D free-running gradient echo CCMRA with whole-heart 1 mm3 isotropic spatial resolution was performed in seven minutes on a 1.5T CMR scanner. Eleven patients were anesthetized and intubated, while seven were breathing freely without anesthesia. All patients were slowly injected with ferumoxytol (4 mg/kg) over 15 minutes. Cardiac and respiratory motion-resolved 5D images were reconstructed with a fully SG approach. To evaluate the performance of motion resolution, visibility of coronary artery origins was assessed. Intubated and free-breathing patient sub-groups were compared for image quality using coronary artery length and conspicuity as well as lung-liver interface sharpness. RESULTS Data collection using the free-running framework was successful in all patients in less than 8 min; scan planning was very simple without the need for parameter adjustments, while no ECG lead placement and triggering was required. From the resulting SG 5D motion-resolved reconstructed images, coronary artery origins could be retrospectively extracted in 90% of the cases. These general findings applied to both intubated and free-breathing pediatric patients (no difference in terms of lung-liver interface sharpness), while image quality and coronary conspicuity between both cohorts was very similar. CONCLUSIONS A simple-to-use push-button framework for 5D whole-heart CCMRA was successfully employed in pediatric CHD patients with ferumoxytol injection. This approach, working without any external gating and for a wide range of heart rates and body sizes provided excellent definition of cardiac anatomy for both intubated and free-breathing patients.
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Affiliation(s)
- Christopher W. Roy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue de Bugnon 46, BH-8-84, 1011 Lausanne, Switzerland
| | - Lorenzo Di Sopra
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue de Bugnon 46, BH-8-84, 1011 Lausanne, Switzerland
| | - Kevin K. Whitehead
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Davide Piccini
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue de Bugnon 46, BH-8-84, 1011 Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue de Bugnon 46, BH-8-84, 1011 Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - John Heerfordt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue de Bugnon 46, BH-8-84, 1011 Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Reena M. Ghosh
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Mark A. Fogel
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue de Bugnon 46, BH-8-84, 1011 Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
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Harvell-Smith S, Tung LD, Thanh NTK. Magnetic particle imaging: tracer development and the biomedical applications of a radiation-free, sensitive, and quantitative imaging modality. NANOSCALE 2022; 14:3658-3697. [PMID: 35080544 DOI: 10.1039/d1nr05670k] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Magnetic particle imaging (MPI) is an emerging tracer-based modality that enables real-time three-dimensional imaging of the non-linear magnetisation produced by superparamagnetic iron oxide nanoparticles (SPIONs), in the presence of an external oscillating magnetic field. As a technique, it produces highly sensitive radiation-free tomographic images with absolute quantitation. Coupled with a high contrast, as well as zero signal attenuation at-depth, there are essentially no limitations to where that can be imaged within the body. These characteristics enable various biomedical applications of clinical interest. In the opening sections of this review, the principles of image generation are introduced, along with a detailed comparison of the fundamental properties of this technique with other common imaging modalities. The main feature is a presentation on the up-to-date literature for the development of SPIONs tailored for improved imaging performance, and developments in the current and promising biomedical applications of this emerging technique, with a specific focus on theranostics, cell tracking and perfusion imaging. Finally, we will discuss recent progress in the clinical translation of MPI. As signal detection in MPI is almost entirely dependent on the properties of the SPION employed, this work emphasises the importance of tailoring the synthetic process to produce SPIONs demonstrating specific properties and how this impacts imaging in particular applications and MPI's overall performance.
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Affiliation(s)
- Stanley Harvell-Smith
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT, UK.
- UCL Healthcare Biomagnetic and Nanomaterials Laboratories, University College London, 21 Albemarle Street, London W1S 4BS, UK
| | - Le Duc Tung
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT, UK.
- UCL Healthcare Biomagnetic and Nanomaterials Laboratories, University College London, 21 Albemarle Street, London W1S 4BS, UK
| | - Nguyen Thi Kim Thanh
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT, UK.
- UCL Healthcare Biomagnetic and Nanomaterials Laboratories, University College London, 21 Albemarle Street, London W1S 4BS, UK
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Huang Y, Hsu JC, Koo H, Cormode DP. Repurposing ferumoxytol: Diagnostic and therapeutic applications of an FDA-approved nanoparticle. Am J Cancer Res 2022; 12:796-816. [PMID: 34976214 PMCID: PMC8692919 DOI: 10.7150/thno.67375] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
Ferumoxytol is an intravenous iron oxide nanoparticle formulation that has been approved by the U.S. Food and Drug Administration (FDA) for treating anemia in patients with chronic kidney disease. In recent years, ferumoxytol has also been demonstrated to have potential for many additional biomedical applications due to its excellent inherent physical properties, such as superparamagnetism, biocatalytic activity, and immunomodulatory behavior. With good safety and clearance profiles, ferumoxytol has been extensively utilized in both preclinical and clinical studies. Here, we first introduce the medical needs and the value of current iron oxide nanoparticle formulations in the market. We then focus on ferumoxytol nanoparticles and their physicochemical, diagnostic, and therapeutic properties. We include examples describing their use in various biomedical applications, including magnetic resonance imaging (MRI), multimodality imaging, iron deficiency treatment, immunotherapy, microbial biofilm treatment and drug delivery. Finally, we provide a brief conclusion and offer our perspectives on the current limitations and emerging applications of ferumoxytol in biomedicine. Overall, this review provides a comprehensive summary of the developments of ferumoxytol as an agent with diagnostic, therapeutic, and theranostic functionalities.
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Ferumoxytol-enhanced ultrashort TE MRA and quantitative morphometry of the human kidney vasculature. Abdom Radiol (NY) 2021; 46:3288-3300. [PMID: 33666735 DOI: 10.1007/s00261-021-02984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the feasibility of Quantitative Ultrashort-Time-to-Echo Contrast-Enhanced (QUTE-CE) MRA using ferumoxytol as a contrast agent for abdominal angiography in the kidney. METHODS Four subjects underwent ferumoxytol-enhanced MRA with the 3D UTE Spiral VIBE WIP sequence at 3 T. Image quality metrics were quantified, specifically the blood Signal-to-Noise Ratio (SNR), blood-tissue Contrast-to-Noise Ratio (CNR) and Intraluminal Signal Heterogeneity (ISH) from both the aorta and inferior vena cava (IVC). Morphometric analysis of the vessels was performed using manual approach and semi-automatic approach using Vascular Modeling ToolKit (VMTK). Image quality and branching order were compared between QUTE-CE MRA and the Gadolinium (Gd) CEMRA reference image. RESULTS QUTE-CE MRA provides a bright blood snapshot that delineates arteries and veins equally in the same scan. The maximum SNR and CNR values were 3,282 ± 1,218 and 1,295 ± 580, respectively - significantly higher than available literature values using other CEMRA techniques. QUTE-CE MRA had lower ISH and depicted higher vessel branching order (7th vs 3rd) within the kidney compared to a standard dynamic clinical Gd CEMRA scan. Morphometric analysis yielded quantitative results for the total kidney volume, total cyst volume and for diameters of the branching arterial network down to the 7th branch. Vessel curvature was significantly increased (p < 0.001) in the presence of a renal cyst compared to equivalent vessels in normal kidney regions. CONCLUSION QUTE-CE MRA is feasible for kidney angiography, providing greater detail of kidney vasculature, enabling quantitative morphometric analysis of the abdominal and intra-renal vessels and yielding metrics relevant to vascular diseases while using a contrast agent ferumoxytol that is safe for CKD patients.
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Ponrartana S, Moore MM, Chan SS, Victoria T, Dillman JR, Chavhan GB. Safety issues related to intravenous contrast agent use in magnetic resonance imaging. Pediatr Radiol 2021; 51:736-747. [PMID: 33871726 DOI: 10.1007/s00247-020-04896-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/12/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) have been used to improve image quality of MRI examinations for decades and have an excellent overall safety record. However, there are well-documented risks associated with GBCAs and our understanding and management of these risks continue to evolve. The purpose of this review is to discuss the safety of GBCAs used in MRI in adult and pediatric populations. We focus particular attention on acute adverse reactions, nephrogenic systemic fibrosis and gadolinium deposition. We also discuss the non-GBCA MRI contrast agent ferumoxytol, which is increasing in use and has its own risk profile. Finally, we identify special populations at higher risk of harm from GBCA administration.
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Affiliation(s)
- Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS# 81, Los Angeles, CA, 90064, USA. .,Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Michael M Moore
- Department of Radiology, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA
| | - Sherwin S Chan
- Department of Radiology, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Radiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Teresa Victoria
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan R Dillman
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Medical Imaging, University of Toronto, Toronto, ON, Canada
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Vascular applications of ferumoxytol-enhanced magnetic resonance imaging of the abdomen and pelvis. Abdom Radiol (NY) 2021; 46:2203-2218. [PMID: 33090256 DOI: 10.1007/s00261-020-02817-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 01/15/2023]
Abstract
Ferumoxytol is an injectable ultrasmall superparamagnetic iron oxide that has been gaining interest regarding its off-label use as an intravenous contrast agent in magnetic resonance imaging (MRI). Due to its large particle size, its use with MRI produces exquisite images of blood vessels with little background contamination or parenchymal enhancement of the abdominopelvic organs, except for the liver and spleen. Because ferumoxytol is neither an iodinated nor a gadolinium-based contrast agent, there are no restrictions for its use in patients with poor renal function. This article will highlight normal features in ferumoxytol-enhanced MRI in the abdomen and pelvis as well as its applications in evaluating vascular pathology, presurgical planning, and other problem solving.
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12
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Wilson S, Culp WTN, Wisner ER, Cissell DD, Finn JP, Zwingenberger AL. Ferumoxytol-enhanced magnetic resonance angiography provides comparable vascular conspicuity to CT angiography in dogs with intrahepatic portosystemic shunts. Vet Radiol Ultrasound 2021; 62:463-470. [PMID: 33634935 DOI: 10.1111/vru.12963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 11/26/2022] Open
Abstract
Computed tomography angiography (CTA) is currently the gold standard imaging modality for anatomically characterizing canine hepatic vascular anomalies; with conventional, gadolinium-enhanced MR angiography being less frequently utilized. However, both imaging modalities are limited by a brief, first pass peak of contrast medium in the vasculature that necessitates precisely timed image acquisition. A long-acting purely intravascular magnetic resonance imaging (MRI) contrast agent, ferumoxytol, offers the potential to reduce complexity of magnetic resonance angiography (MRA) protocol planning by ensuring diagnostic contrast medium concentration in all the vessels that are targeted for imaging. Aims of this prospective, pilot, methods comparison study were to develop an optimized MRA protocol using ferumoxytol in dogs with hepatic vascular anomalies, perform a dose escalation trial to compare image quality with four-dose regimens of ferumoxytol, and compare accuracy of vascular anatomic depiction based on the gold standard of CTA. Six dogs (10.7-36.1 kg) with portosystemic shunts (four intrahepatic left divisional shunts and two intrahepatic right divisional shunts) were recruited for inclusion in the study. A dose-escalation trial was performed to compare image quality at four incremental dose levels of ferumoxytol (1, 2, 3, and 4 mg/kg) and to compare the accuracy of vascular anatomic detection to CTA. Ferumoxytol contrast-enhanced MRA (CE-MRA) at 4 mg/kg provided similar conspicuity of normal and abnormal vasculature compared to CTA with a minimal decrease in spatial resolution. Findings indicated that ferumoxytol holds promise for comprehensive, single breath hold CE-MRA of all abdominal vessels in dogs with portosystemic shunts. Background information provided in this study can be used to support development of other future applications such as intracranial and cardiac MRA, real-time imaging, flow quantification, and potentially sedated MRI imaging.
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Affiliation(s)
- Sabrina Wilson
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California, USA
| | - William T N Culp
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California, USA
| | - Erik R Wisner
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California, USA
| | - Derek D Cissell
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California, USA
| | - J Paul Finn
- Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, School of Medicine, Davis, California, USA
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, University of California Davis, School of Veterinary Medicine, Davis, California, USA
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13
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Chandrasekharan P, Tay ZW, Zhou XY, Yu EY, Fung BK, Colson C, Fellows BD, Lu Y, Huynh Q, Saayujya C, Keselman P, Hensley D, Lu K, Orendorff R, Konkle J, Saritas EU, Zheng B, Goodwill P, Conolly S. Magnetic Particle Imaging for Vascular, Cellular and Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
MRI is a powerful diagnostic tool with excellent soft tissue contrast that uses nonionizing radiation. These advantages make MRI an appealing modality for imaging the pregnant patient; however, specific risks inherent to the magnetic resonance environment must be considered. MRI may be performed without and/or with intravenous contrast, which adds further fetal considerations. The risks of MRI with and without intravenous contrast are reviewed as they pertain to the pregnant or lactating patient and to the fetus and nursing infant. Relevant issues for gadolinium-based contrast agents and ultrasmall paramagnetic iron oxide particles are reviewed.
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Affiliation(s)
- Jason T Little
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Candice A Bookwalter
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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15
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Abdominal Applications of Pediatric Body MR Angiography: Tailored Optimization for Successful Outcome. AJR Am J Roentgenol 2020; 215:206-214. [PMID: 32374667 DOI: 10.2214/ajr.19.22289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to summarize current common techniques and indications for pediatric abdominopelvic MR angiography and strategies for optimizing them to achieve successful outcomes. We also discuss newer MR angiography techniques, including whole-body imaging and blood pool contrast agents, as well as various approaches to reducing the need for anesthesia in pediatric MRI. CONCLUSION. Pediatric body vascular imaging presents a unique set of challenges that require a tailored approach. Emerging pediatric abdominopelvic MR angiography techniques hold promise for continued improvement in pediatric body MR angiography.
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Strategies to Reduce the Use of Gadolinium-Based Contrast Agents for Abdominal MRI in Children. AJR Am J Roentgenol 2020; 214:1054-1064. [DOI: 10.2214/ajr.19.22232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Chandrasekharan P, Tay ZW, Hensley D, Zhou XY, Fung BKL, Colson C, Lu Y, Fellows BD, Huynh Q, Saayujya C, Yu E, Orendorff R, Zheng B, Goodwill P, Rinaldi C, Conolly S. Using magnetic particle imaging systems to localize and guide magnetic hyperthermia treatment: tracers, hardware, and future medical applications. Am J Cancer Res 2020; 10:2965-2981. [PMID: 32194849 PMCID: PMC7053197 DOI: 10.7150/thno.40858] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/27/2020] [Indexed: 01/07/2023] Open
Abstract
Magnetic fluid hyperthermia (MFH) treatment makes use of a suspension of superparamagnetic iron oxide nanoparticles, administered systemically or locally, in combination with an externally applied alternating magnetic field, to ablate target tissue by generating heat through a process called induction. The heat generated above the mammalian euthermic temperature of 37°C induces apoptotic cell death and/or enhances the susceptibility of the target tissue to other therapies such as radiation and chemotherapy. While most hyperthermia techniques currently in development are targeted towards cancer treatment, hyperthermia is also used to treat restenosis, to remove plaques, to ablate nerves and to alleviate pain by increasing regional blood flow. While RF hyperthermia can be directed invasively towards the site of treatment, non-invasive localization of heat through induction is challenging. In this review, we discuss recent progress in the field of RF magnetic fluid hyperthermia and introduce a new diagnostic imaging modality called magnetic particle imaging that allows for a focused theranostic approach encompassing treatment planning, treatment monitoring and spatially localized inductive heating.
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Affiliation(s)
- Prashant Chandrasekharan
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States,✉ Corresponding author: E-mail: ; Phone: +1 (510) 642 3420
| | - Zhi Wei Tay
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States
| | - Daniel Hensley
- Magnetic Insight, Inc., Alameda, CA 94501, United States
| | - Xinyi Y Zhou
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States
| | - Barry KL Fung
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States
| | - Caylin Colson
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States
| | - Yao Lu
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States
| | - Benjamin D Fellows
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States
| | - Quincy Huynh
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, United States
| | - Chinmoy Saayujya
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, United States
| | - Elaine Yu
- Magnetic Insight, Inc., Alameda, CA 94501, United States
| | - Ryan Orendorff
- Magnetic Insight, Inc., Alameda, CA 94501, United States
| | - Bo Zheng
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States
| | | | - Carlos Rinaldi
- University of Florida, J. Crayton Pruitt Family Department of Biomedical Engineering and Department of Chemical Engineering, FL, 32611 United States
| | - Steven Conolly
- University of California Berkeley, Department of Bioengineering, Berkeley, CA 94720, United States,Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, United States
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Samreen N, Bhatt AA, Glockner J, Lee CU. A Case of Ferumoxytol (Feraheme®) Prompting Critical Modification to Our Patient Prebreast Magnetic Resonance Imaging Questionnaire. J Clin Imaging Sci 2019; 9:6. [PMID: 31448157 PMCID: PMC6702869 DOI: 10.25259/jcis-9-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/07/2018] [Indexed: 11/04/2022] Open
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Shahrouki P, Moriarty JM, Khan SN, Bista B, Kee ST, DeRubertis BG, Yoshida T, Nguyen KL, Finn JP. High resolution, 3-dimensional Ferumoxytol-enhanced cardiovascular magnetic resonance venography in central venous occlusion. J Cardiovasc Magn Reson 2019; 21:17. [PMID: 30853026 PMCID: PMC6410526 DOI: 10.1186/s12968-019-0528-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/12/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although cardiovascular magnetic resonance venography (CMRV) is generally regarded as the technique of choice for imaging the central veins, conventional CMRV is not ideal. Gadolinium-based contrast agents (GBCA) are less suited to steady state venous imaging than to first pass arterial imaging and they may be contraindicated in patients with renal impairment where evaluation of venous anatomy is frequently required. We aim to evaluate the diagnostic performance of 3-dimensional (3D) ferumoxytol-enhanced CMRV (FE-CMRV) for suspected central venous occlusion in patients with renal failure and to assess its clinical impact on patient management. METHODS In this IRB-approved and HIPAA-compliant study, 52 consecutive adult patients (47 years, IQR 32-61; 29 male) with renal impairment and suspected venous occlusion underwent FE-CMRV, following infusion of ferumoxytol. Breath-held, high resolution, 3D steady state FE-CMRV was performed through the chest, abdomen and pelvis. Two blinded reviewers independently scored twenty-one named venous segments for quality and patency. Correlative catheter venography in 14 patients was used as the reference standard for diagnostic accuracy. Retrospective chart review was conducted to determine clinical impact of FE-CMRV. Interobserver agreement was determined using Gwet's AC1 statistic. RESULTS All patients underwent technically successful FE-CMRV without any adverse events. 99.5% (1033/1038) of venous segments were of diagnostic quality (score ≥ 2/4) with very good interobserver agreement (AC1 = 0.91). Interobserver agreement for venous occlusion was also very good (AC1 = 0.93). The overall accuracy of FE-CMRV compared to catheter venography was perfect (100.0%). No additional imaging was required prior to a clinical management decision in any of the 52 patients. Twenty-four successful and uncomplicated venous interventions were carried out following pre-procedural vascular mapping with FE-CMRV. CONCLUSIONS 3D FE-CMRV is a practical, accurate and robust technique for high-resolution mapping of central thoracic, abdominal and pelvic veins and can be used to inform image-guided therapy. It may play a pivotal role in the care of patients in whom conventional contrast agents may be contraindicated or ineffective.
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Affiliation(s)
- Puja Shahrouki
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - John M. Moriarty
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sarah N. Khan
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Biraj Bista
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Stephen T. Kee
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Brian G. DeRubertis
- Department of Surgery, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Takegawa Yoshida
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Kim-Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - J. Paul Finn
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
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20
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Zhou Z, Han F, Yoshida T, Nguyen KL, Finn JP, Hu P. Improved 4D cardiac functional assessment for pediatric patients using motion-weighted image reconstruction. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 31:747-756. [PMID: 30043124 DOI: 10.1007/s10334-018-0694-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Our aim was to develop and evaluate a motion-weighted reconstruction technique for improved cardiac function assessment in 4D magnetic resonance imaging (MRI). MATERIALS AND METHODS A flat-topped, two-sided Gaussian kernel was used to weigh k-space data in each target cardiac phase and adjacent two temporal phases during the proposed phase-by-phase reconstruction algorithm. The proposed method (Strategy 3) was used to reconstruct 18 cardiac phases based on data acquired using a previously proposed technique [4D multiphase steady-state imaging with contrast enhancement (MUSIC) technique and its self-gated extension using rotating Cartesian k-space (ROCK-MUSIC) from 12 pediatric patients. As a comparison, the same data set was reconstructed into nine phases using a phase-by-phase method (Strategy 1), 18 phases using view sharing (Strategy 4), and 18 phases using a temporal regularized method (Strategy 2). Regional image sharpness and left ventricle volumetric measurements were used to compare the four reconstructions quantitatively. RESULTS Strategies 1 and 4 generated significantly sharper images of static structures (P ≤ 0.018) than Strategies 2 and 3 but significantly more blurry (P ≤ 0.021) images of the heart. Left ventricular volumetric measurements from the nine-phase reconstruction (Strategy 1) correlated moderately (r < 0.8) with the 2D cine, whereas the remaining three techniques had a higher correlation (r > 0.9). The computational burden of Strategy 2 was six times that of Strategy 3. CONCLUSION The proposed method of motion-weighted reconstruction improves temporal resolution in 4D cardiac imaging with a clinically practical workflow.
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Affiliation(s)
- Ziwu Zhou
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Fei Han
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Takegawa Yoshida
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - John Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, CA, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, CA, USA.
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA, 90095, USA.
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21
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Abstract
BACKGROUND Ferumoxytol, an "off-label" contrast agent, allows for better cardiac MRI quality as compared with gadolinium-based contrast agents. However, hypotension has been reported with the use of ferumoxytol for indications other than cardiac MRI. The purpose of our investigation was to evaluate the safety of ferumoxytol in children undergoing general anaesthesia for cardiac MRI. METHODS Medical records of children undergoing general anaesthesia for cardiac MRI were reviewed. Baseline demographic and medical characteristics, as well as imaging and anaesthetic duration and technique, were collected. The incidence of hypotension or other adverse events', need for vasoactive support, or airway intervention throughout the anaesthetic, was recorded. RESULTS A total of 95 patients were identified, 61 received ferumoxytol and 34 received gadolinium. There were no significant differences between groups with respect to age, weight, or baseline blood pressure. The incidence of low blood pressure - systolic or mean - after contrast administration did not differ between groups, and there was no difference in sustained hypotension or use of vasopressors between groups. One patient who received ferumoxytol had possible anaphylaxis. The image acquisition time (45 versus 68 min, p=0.002) and anaesthesia duration (100 versus 132 min, p=0.02) were shorter in the ferumoxytol group. CONCLUSION Transient low blood pressure was common in children undergoing cardiac MRI with anaesthesia, but the incidence of hypotension did not differ between ferumoxytol and gadolinium groups. The use of ferumoxytol was associated with significantly shorter scan time and anaesthesia duration, as well as a decreased need for airway intervention.
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22
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Chandrasekharan P, Tay ZW, Zhou XY, Yu E, Orendorff R, Hensley D, Huynh Q, Fung KLB, VanHook CC, Goodwill P, Zheng B, Conolly S. A perspective on a rapid and radiation-free tracer imaging modality, magnetic particle imaging, with promise for clinical translation. Br J Radiol 2018; 91:20180326. [PMID: 29888968 DOI: 10.1259/bjr.20180326] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Magnetic particle imaging (MPI), introduced at the beginning of the twenty-first century, is emerging as a promising diagnostic tool in addition to the current repertoire of medical imaging modalities. Using superparamagnetic iron oxide nanoparticles (SPIOs), that are available for clinical use, MPI produces high contrast and highly sensitive tomographic images with absolute quantitation, no tissue attenuation at-depth, and there are no view limitations. The MPI signal is governed by the Brownian and Néel relaxation behavior of the particles. The relaxation time constants of these particles can be utilized to map information relating to the local microenvironment, such as viscosity and temperature. Proof-of-concept pre-clinical studies have shown favourable applications of MPI for better understanding the pathophysiology associated with vascular defects, tracking cell-based therapies and nanotheranostics. Functional imaging techniques using MPI will be useful for studying the pathology related to viscosity changes such as in vascular plaques and in determining cell viability of superparamagnetic iron oxide nanoparticle labeled cells. In this review article, an overview of MPI is provided with discussions mainly focusing on MPI tracers, applications of translational capabilities ranging from diagnostics to theranostics and finally outline a promising path towards clinical translation.
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Affiliation(s)
| | - Zhi Wei Tay
- 1 Department of Bioengineering, University of California , Berkeley, CA , USA
| | - Xinyi Yedda Zhou
- 1 Department of Bioengineering, University of California , Berkeley, CA , USA
| | - Elaine Yu
- 2 Magnetic Insight Inc , Alameda, CA , USA
| | | | | | - Quincy Huynh
- 1 Department of Bioengineering, University of California , Berkeley, CA , USA
| | - K L Barry Fung
- 1 Department of Bioengineering, University of California , Berkeley, CA , USA
| | | | | | - Bo Zheng
- 1 Department of Bioengineering, University of California , Berkeley, CA , USA
| | - Steven Conolly
- 1 Department of Bioengineering, University of California , Berkeley, CA , USA.,3 Department of Electrical Engineering and Computer Sciences, University of California , Berkeley, CA , USA
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Wang LJ, Prabhakar AM, Kwolek CJ. Current status of the treatment of infrarenal abdominal aortic aneurysms. Cardiovasc Diagn Ther 2018; 8:S191-S199. [PMID: 29850431 DOI: 10.21037/cdt.2017.10.01] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aortic aneurysms are the 13th leading cause of death in the United States. While aneurysms can occur along the entire length of the aorta, the infrarenal location is the most common. Targeted ultrasound screening has been found to be an effective and economical means of preventing aortic aneurysm rupture. The indication for repair includes either symptomatic aneurysms or aneurysms with a diameter greater than 5.4 cm. Treatment options for the repair of infrarenal aortic aneurysms are open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Currently, EVAR is the primary treatment method for the repair of infrarenal aortic aneurysms due to improved short-term morbidity and mortality outcomes. This article is intended to review the current status of the management of infrarenal abdominal aortic aneurysms (AAA).
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Affiliation(s)
- Linda J Wang
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand M Prabhakar
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Kwolek
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kim J, Kim E, Euceda LR, Meyer DE, Langseth K, Bathen TF, Moestue SA, Huuse EM. Multiparametric characterization of response to anti-angiogenic therapy using USPIO contrast-enhanced MRI in combination with dynamic contrast-enhanced MRI. J Magn Reson Imaging 2017; 47:1589-1600. [DOI: 10.1002/jmri.25898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/03/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jana Kim
- Department of Circulation and Medical Imaging; NTNU - Norwegian University of Science and Technology; Trondheim Norway
- Department of Radiology and Nuclear Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Eugene Kim
- Department of Circulation and Medical Imaging; NTNU - Norwegian University of Science and Technology; Trondheim Norway
- Department of Radiology and Nuclear Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Leslie R. Euceda
- Department of Circulation and Medical Imaging; NTNU - Norwegian University of Science and Technology; Trondheim Norway
| | - Dan E. Meyer
- Biosciences Technology Organization, GE Global Research Center; Niskayuna NY United States
| | | | - Tone F. Bathen
- Department of Circulation and Medical Imaging; NTNU - Norwegian University of Science and Technology; Trondheim Norway
| | - Siver A. Moestue
- Department of Circulation and Medical Imaging; NTNU - Norwegian University of Science and Technology; Trondheim Norway
- Department of Laboratory Medicine, Women's and Children's Health; NTNU - Norwegian University of Science and Technology; Trondheim Norway
| | - Else Marie Huuse
- Department of Circulation and Medical Imaging; NTNU - Norwegian University of Science and Technology; Trondheim Norway
- Department of Radiology and Nuclear Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
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26
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Zucker EJ, Cheng JY, Haldipur A, Carl M, Vasanawala SS. Free-breathing pediatric chest MRI: Performance of self-navigated golden-angle ordered conical ultrashort echo time acquisition. J Magn Reson Imaging 2017; 47:200-209. [PMID: 28570032 DOI: 10.1002/jmri.25776] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/09/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess the feasibility and performance of conical k-space trajectory free-breathing ultrashort echo time (UTE) chest magnetic resonance imaging (MRI) versus four-dimensional (4D) flow and effects of 50% data subsampling and soft-gated motion correction. MATERIALS AND METHODS Thirty-two consecutive children who underwent both 4D flow and UTE ferumoxytol-enhanced chest MR (mean age: 5.4 years, range: 6 days to 15.7 years) in one 3T exam were recruited. From UTE k-space data, three image sets were reconstructed: 1) one with all data, 2) one using the first 50% of data, and 3) a final set with soft-gating motion correction, leveraging the signal magnitude immediately after each excitation. Two radiologists in blinded fashion independently scored image quality of anatomical landmarks on a 5-point scale. Ratings were compared using Wilcoxon rank-sum, Wilcoxon signed-ranks, and Kruskal-Wallis tests. Interobserver agreement was assessed with the intraclass correlation coefficient (ICC). RESULTS For fully sampled UTE, mean scores for all structures were ≥4 (good-excellent). Full UTE surpassed 4D flow for lungs and airways (P < 0.001), with similar pulmonary artery (PA) quality (P = 0.62). 50% subsampling only slightly degraded all landmarks (P < 0.001), as did motion correction. Subsegmental PA visualization was possible in >93% scans for all techniques (P = 0.27). Interobserver agreement was excellent for combined scores (ICC = 0.83). CONCLUSION High-quality free-breathing conical UTE chest MR is feasible, surpassing 4D flow for lungs and airways, with equivalent PA visualization. Data subsampling only mildly degraded images, favoring lesser scan times. Soft-gating motion correction overall did not improve image quality. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:200-209.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Joseph Y Cheng
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Anshul Haldipur
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Michael Carl
- Applied Science Laboratory, GE Healthcare, San Diego, California, USA
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27
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Gale EM, Caravan P, Rao AG, McDonald RJ, Winfeld M, Fleck RJ, Gee MS. Gadolinium-based contrast agents in pediatric magnetic resonance imaging. Pediatr Radiol 2017; 47:507-521. [PMID: 28409250 DOI: 10.1007/s00247-017-3806-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/16/2016] [Accepted: 02/10/2017] [Indexed: 12/17/2022]
Abstract
Gadolinium-based contrast agents can increase the accuracy and expediency of an MRI examination. However the benefits of a contrast-enhanced scan must be carefully weighed against the well-documented risks associated with administration of exogenous contrast media. The purpose of this review is to discuss commercially available gadolinium-based contrast agents (GBCAs) in the context of pediatric radiology. We discuss the chemistry, regulatory status, safety and clinical applications, with particular emphasis on imaging of the blood vessels, heart, hepatobiliary tree and central nervous system. We also discuss non-GBCA MRI contrast agents that are less frequently used or not commercially available.
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Affiliation(s)
- Eric M Gale
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Caravan
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anil G Rao
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Robert J McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew Winfeld
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert J Fleck
- Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, MassGeneral Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.
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28
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Toth GB, Varallyay CG, Horvath A, Bashir MR, Choyke PL, Daldrup-Link HE, Dosa E, Finn JP, Gahramanov S, Harisinghani M, Macdougall I, Neuwelt A, Vasanawala SS, Ambady P, Barajas R, Cetas JS, Ciporen J, DeLoughery TJ, Doolittle ND, Fu R, Grinstead J, Guimaraes AR, Hamilton BE, Li X, McConnell HL, Muldoon LL, Nesbit G, Netto JP, Petterson D, Rooney WD, Schwartz D, Szidonya L, Neuwelt EA. Current and potential imaging applications of ferumoxytol for magnetic resonance imaging. Kidney Int 2017; 92:47-66. [PMID: 28434822 DOI: 10.1016/j.kint.2016.12.037] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/17/2016] [Accepted: 12/06/2016] [Indexed: 01/18/2023]
Abstract
Contrast-enhanced magnetic resonance imaging is a commonly used diagnostic tool. Compared with standard gadolinium-based contrast agents, ferumoxytol (Feraheme, AMAG Pharmaceuticals, Waltham, MA), used as an alternative contrast medium, is feasible in patients with impaired renal function. Other attractive imaging features of i.v. ferumoxytol include a prolonged blood pool phase and delayed intracellular uptake. With its unique pharmacologic, metabolic, and imaging properties, ferumoxytol may play a crucial role in future magnetic resonance imaging of the central nervous system, various organs outside the central nervous system, and the cardiovascular system. Preclinical and clinical studies have demonstrated the overall safety and effectiveness of this novel contrast agent, with rarely occurring anaphylactoid reactions. The purpose of this review is to describe the general and organ-specific properties of ferumoxytol, as well as the advantages and potential pitfalls associated with its use in magnetic resonance imaging. To more fully demonstrate the applications of ferumoxytol throughout the body, an imaging atlas was created and is available online as supplementary material.
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Affiliation(s)
- Gerda B Toth
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Csanad G Varallyay
- Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrea Horvath
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, 3808, Durham, North Carolina, USA; Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Section of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, California, USA
| | - Edit Dosa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - John Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Seymur Gahramanov
- Department of Neurosurgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Mukesh Harisinghani
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Iain Macdougall
- Department of Renal Medicine, King's College Hospital, London, UK
| | - Alexander Neuwelt
- Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado, USA
| | | | - Prakash Ambady
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ramon Barajas
- Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Justin S Cetas
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas J DeLoughery
- Department of Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nancy D Doolittle
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Bronwyn E Hamilton
- Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Xin Li
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Heather L McConnell
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Leslie L Muldoon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Gary Nesbit
- Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Joao P Netto
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA; Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - David Petterson
- Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Schwartz
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Laszlo Szidonya
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA; Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA; Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
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Thakor AS, Chung J, Patel P, Chan A, Ahmed A, McNeil G, Liu DM, Forster B, Klass D. Use of blood pool agents with steady-state MRI to assess the vascular system. J Magn Reson Imaging 2017; 45:1559-1572. [PMID: 28422344 DOI: 10.1002/jmri.25636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/02/2016] [Indexed: 12/19/2022] Open
Abstract
Over the past two decades there have been significant advances in the use of magnetic resonance imaging (MRI) to assess the vascular system. New imaging sequences and improvements in magnet design have enabled the creation of higher spatial resolution images. MRI is now a viable alternative imaging modality when compared to both invasive angiography and computed tomographic angiography. The use of blood pool agents has further facilitated the use of MR angiography (MRA); their high molecular weight allows for lower doses of contrast medium administration while their prolonged presence in the blood stream allows for repeated high-quality volumetric imaging of both the arterial and venous circulation. As such, MRA is now no longer constrained by the tight windows for first-pass arterial and venous enhancement, which has resulted in the ability to assess and diagnose a large range of vascular pathologies in both arterial and venous systems. The intent of this review is to highlight MRI findings in common vascular pathologies including peripheral arterial disease (PAD), abnormalities of the abdominal aortic branches, postendovascular aortic aneurysm repair (EVAR) endoleak assessment, popliteal artery entrapment syndrome (PAES), deep venous thrombosis (DVT), vascular thoracic outlet syndrome (TOS), and vascular malformations. In addition, the latest MRI techniques currently used to optimally assess each of these pathologies will be discussed. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;45:1559-1572.
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Affiliation(s)
- Avnesh S Thakor
- Department of Radiology, Lucile Packard and Stanford Hospital, Stanford University, Palo Alto, California, USA
| | - John Chung
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Premal Patel
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Chan
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amdad Ahmed
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graeme McNeil
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Liu
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Forster
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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30
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Hassan N, Boville B, Reischmann D, Ndika A, Sterken D, Kovey K. Intravenous Ferumoxytol in Pediatric Patients With Iron Deficiency Anemia. Ann Pharmacother 2017. [DOI: 10.1177/1060028017699429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Iron deficiency anemia (IDA) is common in children. Limited data exist on the efficacy and safety of ferumoxytol in children. Objective: To assess the efficacy of 10 mg/kg dose given over 15-60 minutes in correcting IDA and report any adverse drug reactions (ADRs). Methods: We conducted a retrospective review of all patients who received ferumoxytol infusions for the management of IDA by the Pediatric Blood Management Program between October 2010 and March 2015. Results: A total of 110 infusions were given to 54 patients. Compared with baseline preinfusion hemoglobin (Hb; 9.2 ± 1.9 g/dL), a significant rise was seen at 1 week and 4 weeks postinfusion (11.5 ± 1.5 and 11.8 ± 1.7 g/dL, respectively, P < 0.001). Also, a significant rise in serum ferritin at 1 week and 4 weeks postinfusion was seen (51 ± 71 vs 192 ± 148 and 89 ± 135 ng/mL, P < 0.001 and <0.035, respectively). Patients who concomitantly received erythropoietin had a significantly larger Hb rise from baseline than those who did not at 4 weeks (2.7 ± 2.2 vs 1.6 ± 1.1 g/dL, P < 0.017). ADRs included pruritus (n = 1), urticaria (n = 1), and multisymptom episodes (n = 3) that included shortness of breath, chest tightness, back pain, and epigastric cramping that responded to therapy with IV diphenhydramine and methylprednisolone. Conclusion: Ferumoxytol was effective in treating IDA in our small study. Slow infusion rate and close monitoring allowed early detection of the infrequent ADRs.
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Affiliation(s)
- Nabil Hassan
- Children’s Hospital of Illinois at OSF St Frances, Peoria, IL, USA
| | - Brian Boville
- Helen Devos Children’s Hospital, Grand Rapids, MI, USA
| | | | - Akunne Ndika
- Grand Rapids Medical Education Partners, MI, USA
| | - David Sterken
- Helen Devos Children’s Hospital, Grand Rapids, MI, USA
| | - Karen Kovey
- Parkview Regional Medical Center, Fort Wayne, IN, USA
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31
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Keselman P, Yu EY, Zhou XY, Goodwill PW, Chandrasekharan P, Ferguson RM, Khandhar AP, Kemp SJ, Krishnan KM, Zheng B, Conolly SM. Tracking short-term biodistribution and long-term clearance of SPIO tracers in magnetic particle imaging. Phys Med Biol 2017; 62:3440-3453. [PMID: 28177301 DOI: 10.1088/1361-6560/aa5f48] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Magnetic particle imaging (MPI) is an emerging tracer-based medical imaging modality that images non-radioactive, kidney-safe superparamagnetic iron oxide (SPIO) tracers. MPI offers quantitative, high-contrast and high-SNR images, so MPI has exceptional promise for applications such as cell tracking, angiography, brain perfusion, cancer detection, traumatic brain injury and pulmonary imaging. In assessing MPI's utility for applications mentioned above, it is important to be able to assess tracer short-term biodistribution as well as long-term clearance from the body. Here, we describe the biodistribution and clearance for two commonly used tracers in MPI: Ferucarbotran (Meito Sangyo Co., Japan) and LS-oo8 (LodeSpin Labs, Seattle, WA). We successfully demonstrate that 3D MPI is able to quantitatively assess short-term biodistribution, as well as long-term tracking and clearance of these tracers in vivo.
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Affiliation(s)
- Paul Keselman
- Department of Bioengineering, University of California Berkeley, Berkeley CA 94720, United States of America
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32
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Finn JP, Nguyen KL, Hu P. Ferumoxytol vs. Gadolinium agents for contrast-enhanced MRI: Thoughts on evolving indications, risks, and benefits. J Magn Reson Imaging 2017; 46:919-923. [PMID: 28160356 PMCID: PMC10156572 DOI: 10.1002/jmri.25580] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/21/2016] [Indexed: 12/27/2022] Open
Affiliation(s)
- J Paul Finn
- Department of Radiological Sciences, UCLA, Los Angeles, California, USA.,Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.,Department of Biomedical Physics, UCLA, Los Angeles, California, USA
| | - Kim-Lien Nguyen
- Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, UCLA, Los Angeles, California, USA.,Department of Biomedical Physics, UCLA, Los Angeles, California, USA
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33
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Zhou Z, Han F, Rapacchi S, Nguyen KL, Brunengraber DZ, Kim GHJ, Finn JP, Hu P. Accelerated ferumoxytol-enhanced 4D multiphase, steady-state imaging with contrast enhancement (MUSIC) cardiovascular MRI: validation in pediatric congenital heart disease. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3663. [PMID: 27862507 PMCID: PMC5298926 DOI: 10.1002/nbm.3663] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 05/09/2023]
Abstract
The purpose of this work was to validate a parallel imaging (PI) and compressed sensing (CS) combined reconstruction method for a recently proposed 4D non-breath-held, multiphase, steady-state imaging technique (MUSIC) cardiovascular MRI in a cohort of pediatric congenital heart disease patients. We implemented a graphics processing unit accelerated CS-PI combined reconstruction method and applied it in 13 pediatric patients who underwent cardiovascular MRI after ferumoxytol administration. Conventional breath-held contrast-enhanced magnetic resonance angiography (CE-MRA) was first performed during the first pass of ferumoxytol injection, followed by the original MUSIC and the proposed CS-PI MUSIC during the steady-state distribution phase of ferumoxytol. Qualities of acquired images were then evaluated using a four-point scale. Left ventricular volumes and ejection fractions calculated from the original MUSIC and the CS-PI MUSIC were also compared with conventional multi-slice 2D cardiac cine MRI. The proposed CS-PI MUSIC reduced the imaging time of the MUSIC acquisition to 4.6 ± 0.4 min from 8.9 ± 1.2 min. Computationally intensive image reconstruction was completed within 5 min without interruption of sequential clinical scans. The proposed method (mean 3.3-4.0) provided image quality comparable to that of the original MUSIC (3.2-4.0) (all P ≥ 0.42), and better than conventional breath-held first-pass CE-MRA (1.1-3.3) for 13 anatomical structures (all P ≤ 0.0014) with good inter-observer agreement (κ > 0.46). The calculated ventricular volumes and ejection fractions from both original MUSIC (r > 0.90) and CS-PI MUSIC (r > 0.85) correlated well with 2D cine imaging. In conclusion, PI and CS were successfully incorporated into the 4D MUSIC acquisition to further reduce scan time by approximately 50% while maintaining highly comparable image quality in a clinically practical reconstruction time.
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Affiliation(s)
- Ziwu Zhou
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Fei Han
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Daniel Z Brunengraber
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Grace-Hyun J. Kim
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - J. Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, CA, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, CA, USA
- Correspondence to: Peng Hu, PhD, Department of Radiological Sciences, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095.
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Schwein A, Chinnadurai P, Shah DJ, Lumsden AB, Bechara CF, Bismuth J. Feasibility of three-dimensional magnetic resonance angiography-fluoroscopy image fusion technique in guiding complex endovascular aortic procedures in patients with renal insufficiency. J Vasc Surg 2016; 65:1440-1452. [PMID: 28017584 DOI: 10.1016/j.jvs.2016.10.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Three-dimensional image fusion of preoperative computed tomography (CT) angiography with fluoroscopy using intraoperative noncontrast cone-beam CT (CBCT) has been shown to improve endovascular procedures by reducing procedure length, radiation dose, and contrast media volume. However, patients with a contraindication to CT angiography (renal insufficiency, iodinated contrast allergy) may not benefit from this image fusion technique. The primary objective of this study was to evaluate the feasibility of magnetic resonance angiography (MRA) and fluoroscopy image fusion using noncontrast CBCT as a guidance tool during complex endovascular aortic procedures, especially in patients with renal insufficiency. METHODS All endovascular aortic procedures done under MRA image fusion guidance at a single-center were retrospectively reviewed. The patients had moderate to severe renal insufficiency and underwent diagnostic contrast-enhanced magnetic resonance imaging after gadolinium or ferumoxytol injection. Relevant vascular landmarks electronically marked in MRA images were overlaid on real-time two-dimensional fluoroscopy for image guidance, after image fusion with noncontrast intraoperative CBCT. Technical success, time for image registration, procedure time, fluoroscopy time, number of digital subtraction angiography (DSA) acquisitions before stent deployment or vessel catheterization, and renal function before and after the procedure were recorded. The image fusion accuracy was qualitatively evaluated on a binary scale by three physicians after review of image data showing virtual landmarks from MRA on fluoroscopy. RESULTS Between November 2012 and March 2016, 10 patients underwent endovascular procedures for aortoiliac aneurysmal disease or aortic dissection using MRA image fusion guidance. All procedures were technically successful. A paired t-test analysis showed no difference between preimaging and postoperative renal function (P = .6). The mean time required for MRA-CBCT image fusion was 4:09 ± 01:31 min:sec. Total fluoroscopy time was 20.1 ± 6.9 minutes. Five of 10 patients (50%) underwent stent graft deployment without any predeployment DSA acquisition. Three of six vessels (50%) were cannulated under image fusion guidance without any precannulation DSA runs, and the remaining vessels were cannulated after one planning DSA acquisition. Qualitative evaluation showed 14 of 22 virtual landmarks (63.6%) from MRA overlaid on fluoroscopy were completely accurate, without the need for adjustment. Five of eight incorrect virtual landmarks (iliac and visceral arteries) resulted from vessel deformation caused by endovascular devices. CONCLUSIONS Ferumoxytol or gadolinium-enhanced MRA imaging and image fusion with fluoroscopy using noncontrast CBCT is feasible and allows patients with renal insufficiency to benefit from optimal guidance during complex endovascular aortic procedures, while preserving their residual renal function.
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Affiliation(s)
- Adeline Schwein
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Ponraj Chinnadurai
- Advanced Therapies, Siemens Medical Solutions USA Inc, Hoffman Estates, Ill
| | - Dipan J Shah
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Alan B Lumsden
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Carlos F Bechara
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Jean Bismuth
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
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35
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Combined blood pool and extracellular contrast agents for pediatric and young adult cardiovascular magnetic resonance imaging. Pediatr Radiol 2016; 46:1822-1830. [PMID: 27576457 DOI: 10.1007/s00247-016-3694-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/19/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND A comprehensive cardiac magnetic resonance (cardiac MR) study including both late gadolinium enhancement (LGE) and MR angiography may be indicated for patients with a history of acquired or congenital heart disease. OBJECTIVE To study the novel use of an extracellular agent for assessment of LGE combined with a blood pool contrast agent for detailed MR angiography evaluation to yield a comprehensive cardiac MR study in these patients. MATERIALS AND METHODS We reviewed clinical cardiac MR studies utilizing extracellular and blood pool contrast agents and noted demographics, clinical data and adverse events. We rated LGE image quality and MR angiography image quality for each vascular segment and calculated inter-rater variability. We also quantified contrast-to-noise ratio (CNR). RESULTS Thirty-three patients (mean age 13.9 ± 3 years) received an extracellular contrast agent (10 gadobenate dimeglumine, 23 gadopentetate dimeglumine) and blood pool contrast agent (33 gadofosveset trisodium). No adverse events were reported. MRI indications included Kawasaki disease (8), cardiomyopathy and coronary anatomy (15), repaired congenital heart disease (8), and other (2). Mean LGE quality was 2.6 ± 0.6 with 97% diagnostic imaging. LGE quality did not vary by type of contrast agent given (P = 0.07). Mean MR angiography quality score was 4.7 ± 0.6, with high inter-rater agreement (k = 0.6-0.8, P < 0.002). MR angiography quality did not vary by type of contrast agent used (P = 0.6). CONCLUSION Cardiac MR studies utilizing both extracellular and blood pool contrast agents are feasible and safe and provide excellent-quality LGE and MR angiography images. The use of two contrast agents allows for a comprehensive assessment of both myocardial viability and vascular anatomy during the same exam.
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36
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Zucker EJ, Ganguli S, Ghoshhajra BB, Gupta R, Prabhakar AM. Imaging of venous compression syndromes. Cardiovasc Diagn Ther 2016; 6:519-532. [PMID: 28123973 DOI: 10.21037/cdt.2016.11.19] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Venous compression syndromes are a unique group of disorders characterized by anatomical extrinsic venous compression, typically in young and otherwise healthy individuals. While uncommon, they may cause serious complications including pain, swelling, deep venous thrombosis (DVT), pulmonary embolism, and post-thrombotic syndrome. The major disease entities are May-Thurner syndrome (MTS), variant iliac vein compression syndrome (IVCS), venous thoracic outlet syndrome (VTOS)/Paget-Schroetter syndrome, nutcracker syndrome (NCS), and popliteal venous compression (PVC). In this article, we review the key clinical features, multimodality imaging findings, and treatment options of these disorders. Emphasis is placed on the growing role of noninvasive imaging options such as magnetic resonance venography (MRV) in facilitating early and accurate diagnosis and tailored intervention.
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Affiliation(s)
- Evan J Zucker
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;; Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Rajiv Gupta
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;; Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Anand M Prabhakar
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Can Ferumoxytol be Used as a Contrast Agent to Differentiate Between Acute and Chronic Inflammatory Kidney Disease?: Feasibility Study in a Rat Model. Invest Radiol 2016; 51:100-5. [PMID: 26352750 DOI: 10.1097/rli.0000000000000209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Ferumoxytol, an intravenous iron supplement, can be used in off-label mode as a contrast agent in magnetic resonance imaging. The aim of this study was to assess whether ferumoxytol can be used as a marker of inflammation in animal models of acute and chronic inflammatory kidney diseases. MATERIAL AND METHODS The institutional animal care committee approved this study. A total of 18 rats were examined: 6 healthy Sprague Dawley rats as a control group; 6 rats with polycystic kidney disease (PKD) as a model for chronic inflammatory disease; Thy-1, an antibody triggering glomerulonephritis, was injected in 6 rats as a model for acute inflammation. Each rat was examined directly before and 24 hours after intravenous administration of ferumoxytol at a dose of 30 mg Fe/kg body weight. T2* times of renal tissue were approximated using a multiecho sequence. Changes in relative T2* times and T2 signal intensity after ferumoxytol injection were calculated. RESULTS Statistically significant differences between the 3 groups were found: the T2* times of both, Thy-1 and PKD rats were statistically significant different compared with the control group (T2* time ratio after/before: Thy-1, 0.21; PKD, 0.19, control, 0.28; P = 0.002). The highest T2 signal loss in the renal cortex was observed in the Thy-1 rats (T2 signal intensity ratio after/before: Thy-1, 0.49; PKD, 0.79; control, 0.78; P = 0.0005). CONCLUSIONS Ferumoxytol-enhanced magnetic resonance imaging allows detection and differentiation of acute and chronic inflammatory kidney disease based on different patterns of parenchymal ferumoxytol depositions. Ferumoxytol thus might help to differentiate between different types of inflammation in various kidney diseases.
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Luhar A, Khan S, Finn JP, Ghahremani S, Griggs R, Zaritsky J, Salusky I, Hall TR. Contrast-enhanced magnetic resonance venography in pediatric patients with chronic kidney disease: initial experience with ferumoxytol. Pediatr Radiol 2016; 46:1332-40. [PMID: 27059620 DOI: 10.1007/s00247-016-3605-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 01/13/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) particle that is FDA-approved for parenteral treatment of iron deficiency anemia in adults with chronic kidney disease. Because of the association between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with severe chronic kidney disease, we sought to evaluate the diagnostic role of ferumoxytol-enhanced MR venography in children with chronic kidney disease. Twenty children underwent 22 high-resolution ferumoxytol-enhanced MR venography examinations at 3.0 T. High-resolution 3-D contrast-enhanced imaging was performed at a minimum of 3 time points following injection of ferumoxytol at a total dose of 4 mg/kg. Two blinded pediatric radiologists independently scored six named veins on ferumoxytol-enhanced MR venography examinations according to a three-point subjective score, where a score ≥2 was considered diagnostic. Additionally, all relevant venous structures in the included field of view were analyzed for occlusive or non-occlusive thrombosis, compression and presence of collaterals. All patients underwent ferumoxytol-enhanced MR venography successfully and without adverse event. The overall scores of the reviewing radiologists for all venous structures were 2.7-2.9. In all cases, the reviewers were confident basing their diagnoses on the ferumoxytol-enhanced MR venography findings. In 12 of 22 examinations, findings on follow-up imaging or invasive procedures were available to correlate with the findings on ferumoxytol-enhanced MR venography. There was complete concordance between the findings from follow-up imaging and invasive procedures with findings from ferumoxytol-enhanced MR venography. Ferumoxytol holds promise as a powerful alternative to gadolinium-based contrast agents for reliable, high-resolution MR venography in children with chronic kidney disease.
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Affiliation(s)
- Aarti Luhar
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sarah Khan
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - J Paul Finn
- Department of Radiology and Medicine, David Geffen School of Medicine at University of California at Los Angeles, Peter V. Ueberroth Bldg., Suite 3371, 10945 Le Conte Ave., Los Angeles, CA, 90095, USA.
| | - Shahnaz Ghahremani
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rachel Griggs
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Joshua Zaritsky
- Department of Pediatrics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Isidro Salusky
- Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Theodore R Hall
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Acute effects of ferumoxytol on regulation of renal hemodynamics and oxygenation. Sci Rep 2016; 6:29965. [PMID: 27436132 PMCID: PMC4951703 DOI: 10.1038/srep29965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023] Open
Abstract
The superparamagnetic iron oxide nanoparticle ferumoxytol is increasingly used as intravascular contrast agent in magnetic resonance imaging (MRI). This study details the impact of ferumoxytol on regulation of renal hemodynamics and oxygenation. In 10 anesthetized rats, a single intravenous injection of isotonic saline (used as volume control) was followed by three consecutive injections of ferumoxytol to achieve cumulative doses of 6, 10, and 41 mg Fe/kg body mass. Arterial blood pressure, renal blood flow, renal cortical and medullary perfusion and oxygen tension were continuously measured. Regulation of renal hemodynamics and oxygenation was characterized by dedicated interventions: brief periods of suprarenal aortic occlusion, hypoxia, and hyperoxia. None of the three doses of ferumoxytol resulted in significant changes in any of the measured parameters as compared to saline. Ferumoxytol did not significantly alter regulation of renal hemodynamics and oxygenation as studied by aortic occlusion and hypoxia. The only significant effect of ferumoxytol at the highest dose was a blunting of the hyperoxia-induced increase in arterial pressure. Taken together, ferumoxytol has only marginal effects on the regulation of renal hemodynamics and oxygenation. This makes ferumoxytol a prime candidate as contrast agent for renal MRI including the assessment of renal blood volume fraction.
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Finn JP, Nguyen KL, Han F, Zhou Z, Salusky I, Ayad I, Hu P. Cardiovascular MRI with ferumoxytol. Clin Radiol 2016; 71:796-806. [PMID: 27221526 DOI: 10.1016/j.crad.2016.03.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/28/2022]
Abstract
The practice of contrast-enhanced magnetic resonance angiography (CEMRA) has changed significantly in the span of a decade. Concerns regarding gadolinium (Gd)-associated nephrogenic systemic fibrosis in those with severely impaired renal function spurred developments in low-dose CEMRA and non-contrast MRA as well as efforts to seek alternative MR contrast agents. Originally developed for MR imaging use, ferumoxytol (an ultra-small superparamagnetic iron oxide nanoparticle), is currently approved by the US Food and Drug Administration for the treatment of iron deficiency anaemia in adults with renal disease. Since its clinical availability in 2009, there has been rising interest in the scientific and clinical use of ferumoxytol as an MR contrast agent. The unique physicochemical and pharmacokinetic properties of ferumoxytol, including its long intravascular half-life and high r1 relaxivity, support a spectrum of MRI applications beyond the scope of Gd-based contrast agents. Moreover, whereas Gd is not found in biological systems, iron is essential for normal metabolism, and nutritional iron deficiency poses major public health challenges worldwide. Once the carbohydrate shell of ferumoxytol is degraded, the elemental iron at its core is incorporated into the reticuloendothelial system. These considerations position ferumoxytol as a potential game changer in the field of CEMRA and MRI. In this paper, we aim to summarise our experience with the cardiovascular applications of ferumoxytol and provide a brief synopsis of ongoing investigations on ferumoxytol-enhanced MR applications.
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Affiliation(s)
- J P Finn
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - K-L Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - F Han
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Z Zhou
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Salusky
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ayad
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - P Hu
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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MR Angiography of Renal Transplant Vasculature with Ferumoxytol:: Comparison of High-Resolution Steady-State and First-Pass Acquisitions. Acad Radiol 2016; 23:368-73. [PMID: 26707344 DOI: 10.1016/j.acra.2015.10.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 01/18/2023]
Abstract
RATIONALE AND OBJECTIVES This work aimed to quantify the differences in signal-to-noise ratio (SNR) and vessel sharpness between steady-state and first-pass magnetic resonance angiography (MRA) with ferumoxytol in renal transplant recipients. MATERIALS AND METHODS We performed a retrospective study of adult patients who underwent steady-state and first-pass MRA with ferumoxytol to evaluate renal transplant vasculature. SNR was calculated in the external iliac artery, and vessel sharpness was calculated in the external iliac and renal transplant arteries for both acquisitions. Data were compared using Student's t test. RESULTS Fifteen patients were included (mean age 56.9 years, 10 males). The mean SNR of the external iliac artery was 42.2 (SD, 11.9) for the first-pass MRA and 41.8 (SD, 9.7) for the steady-state MRA (p = 0.92). The mean vessel sharpness was significantly higher for the steady-state MRA compared to first-pass MRA for both external iliac (1.24 vs. 0.80 mm(-1), p < 0.01) and renal transplant arteries (1.26 vs. 0.79 mm(-1), p < 0.01). CONCLUSION Steady-state MRA using ferumoxytol improves vessel sharpness while maintaining equivalent SNR compared to conventional first-pass MRA in renal transplant patients.
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Vasanawala SS, Nguyen KL, Hope MD, Bridges MD, Hope TA, Reeder SB, Bashir MR. Safety and technique of ferumoxytol administration for MRI. Magn Reson Med 2016; 75:2107-11. [PMID: 26890830 DOI: 10.1002/mrm.26151] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/10/2016] [Accepted: 01/15/2016] [Indexed: 12/12/2022]
Abstract
Ferumoxytol is an ultrasmall superparamagnetic iron oxide agent marketed for the treatment of anemia. There has been increasing interest in its properties as an MRI contrast agent as well as greater awareness of its adverse event profile. This mini-review summarizes the current state of knowledge of the risks of ferumoxytol and methods of administration.
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Affiliation(s)
| | - Kim-Lien Nguyen
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Michael D Hope
- Department of Radiology, University of California, San Francisco
| | | | - Thomas A Hope
- Department of Radiology, University of California, San Francisco
| | - Scott B Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, and Emergency Medicine, University of Wisconsin, Madison, WI
| | - Mustafa R Bashir
- Center for Advanced Magnetic Resonance Development and Department of Radiology, Duke University, Durham, NC
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Hanneman K, Kino A, Cheng JY, Alley MT, Vasanawala SS. Assessment of the precision and reproducibility of ventricular volume, function, and mass measurements with ferumoxytol-enhanced 4D flow MRI. J Magn Reson Imaging 2016; 44:383-92. [PMID: 26871420 DOI: 10.1002/jmri.25180] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/19/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare the precision and interobserver agreement of ventricular volume, function, and mass quantification by 3D time-resolved (4D) flow MRI relative to cine steady-state free precession (SSFP). MATERIALS AND METHODS With Institutional Research Board approval, informed consent, and HIPAA compliance, 22 consecutive patients with congenital heart disease (CHD) (10 males, 6.4 ± 4.8 years) referred for 3T ferumoxytol-enhanced cardiac MRI were prospectively recruited. Complete ventricular coverage with standard 2D short-axis cine SSFP and whole chest coverage with axial 4D flow were obtained. Two blinded radiologists independently segmented images for left ventricular (LV) and right ventricular (RV) myocardium at end systole (ES) and end diastole (ED). Statistical analysis included linear regression, analysis of variance (ANOVA), Bland-Altman (BA) analysis, and intraclass correlation (ICC). RESULTS Significant positive correlations were found between 4D flow and SSFP for ventricular volumes (r = 0.808-0.972, P < 0.001), ejection fraction (EF) (r = 0.900-928, P < 0.001), and mass (r = 0.884-0.934, P < 0.001). BA relative limits of agreement for both ventricles were between -52% to 34% for volumes, -29% to 27% for EF, and -41% to 48% for mass, with wider limits of agreement for the RV compared to the LV. There was no significant difference between techniques with respect to mean square difference of ED-ES mass for either LV (F = 2.05, P = 0.159) or RV (F = 0.625, P = 0.434). Interobserver agreement was moderate to good with both 4D flow (ICC 0.523-0.993) and SSFP (ICC 0.619-0.982), with overlapping confidence intervals. CONCLUSION Quantification of ventricular volume, function, and mass can be accomplished with 4D flow MRI with precision and interobserver agreement comparable to that of cine SSFP. J. Magn. Reson. Imaging 2016;44:383-392.
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Affiliation(s)
- Kate Hanneman
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Aya Kino
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Joseph Y Cheng
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marcus T Alley
- Department of Radiology, Stanford University, Stanford, California, USA
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Trotier AJ, Lefrançois W, Van Renterghem K, Franconi JM, Thiaudière E, Miraux S. Positive contrast high-resolution 3D-cine imaging of the cardiovascular system in small animals using a UTE sequence and iron nanoparticles at 4.7, 7 and 9.4 T. J Cardiovasc Magn Reson 2015; 17:53. [PMID: 26149628 PMCID: PMC4493959 DOI: 10.1186/s12968-015-0167-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/24/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To show that 3D sequences with ultra-short echo times (UTEs) can generate a positive contrast whatever the magnetic field (4.7, 7 or 9.4 T) and whatever Ultra Small Particles of Iron Oxide (USPIO) concentration injected and to use it for 3D time-resolved imaging of the murine cardiovascular system with high spatial and temporal resolutions. METHODS Three different concentrations (50, 200 and 500 μmol Fe/kg) of USPIO were injected in mice and static images of the middle part of the animals were acquired at 4.7, 7 and 9.4 T pre and post-contrast with UTE (TE/TR = 0.05/4.5 ms) sequences. Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) of blood and static tissus were evaluated before and after contrast agent injection. 3D-cine images (TE/TR = 0.05/3.5 ms, scan time < 12 min) at 156 μm isotropic resolution of the mouse cardiopulmonary system were acquired prospectively with the UTE sequence for the three magnetic fields and with an USPIO dose of 200 μmol Fe/kg. SNR, CNR and signal homogeneity of blood were measured. High spatial (104 μm) or temporal (3.5 ms) resolution 3D-cine imaging (scan time < 35 min) isotropic resolution were also performed at 7 T with a new sequence encoding scheme. RESULTS UTE imaging generated positive contrast and higher SNR and CNR whatever the magnetic field and the USPIO concentration used compared to pre-contrast images. Time-resolved 3D acquisition enables high blood SNR (66.6 ± 4.5 at 7 T) and CNR (33.2 ± 4.2 at 7 T) without flow or motion artefact. Coronary arteries and aortic valve were visible on images acquired at 104 μm resolution. CONCLUSIONS We have demonstrated that by combining the injection of iron nanoparticles with 3D-cine UTE sequences, it was possible to generate a strong positive contrast between blood and surrounding tissues. These properties were exploited to produce images of the cardiovascular system in small animals at high magnetic fields with a high spatial and temporal resolution. This approach might be useful to measure the functional cardiac parameters or to assess anatomical modifications to the blood vessels in cardio-vascular disease models.
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Affiliation(s)
- Aurélien J Trotier
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS/Université de Bordeaux, 146 rue Léo Saignat, Cedex 33076, Bordeaux, France.
| | - William Lefrançois
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS/Université de Bordeaux, 146 rue Léo Saignat, Cedex 33076, Bordeaux, France.
| | - Kris Van Renterghem
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS/Université de Bordeaux, 146 rue Léo Saignat, Cedex 33076, Bordeaux, France.
| | - Jean-Michel Franconi
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS/Université de Bordeaux, 146 rue Léo Saignat, Cedex 33076, Bordeaux, France.
| | - Eric Thiaudière
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS/Université de Bordeaux, 146 rue Léo Saignat, Cedex 33076, Bordeaux, France.
| | - Sylvain Miraux
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS/Université de Bordeaux, 146 rue Léo Saignat, Cedex 33076, Bordeaux, France.
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Abstract
OBJECTIVE Ferumoxytol is increasingly reported as an alternative to gadolinium-based contrast agents for MR angiography (MRA), particularly for patients with renal failure. This article summarizes more than 3 years of clinical experience with ferumoxytol-enhanced MRA for a range of indications and anatomic regions. CONCLUSION Ferumoxytol-enhanced MRA has many advantages including that it is safe for patients with renal failure and provides a lengthy plateau of vascular signal as a blood pool agent that allows longer navigated MRA sequences.
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