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Published in: Journal of Cardiovascular Magnetic Resonance 1/2017

Open Access 01-12-2017 | Research

Ferumoxytol enhanced black-blood cardiovascular magnetic resonance imaging

Authors: Kim-Lien Nguyen, Eun-Ah Park, Takegawa Yoshida, Peng Hu, J. Paul Finn

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

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Abstract

Background

Bright-blood and black-blood cardiovascular magnetic resonance (CMR) techniques are frequently employed together during a clinical exam because of their complementary features. While valuable, existing black-blood CMR approaches are flow dependent and prone to failure. We aim to assess the effectiveness and reliability of ferumoxytol enhanced (FE) Half-Fourier Single-shot Turbo Spin-echo (HASTE) imaging without magnetization preparation pulses to yield uniform intra-luminal blood signal suppression by comparing FE-HASTE with pre-ferumoxytol HASTE imaging.

Methods

This study was IRB-approved and HIPAA compliant. Consecutive patients who were referred for FE-CMR between June 2013 and February 2017 were enrolled. Qualitative image scores reflecting the degree and reliability of blood signal suppression were based on a 3-point Likert scale, with 3 reflecting perfect suppression. For quantitative evaluation, homogeneity indices (defined as standard deviation of the left atrial signal intensity) and signal-to-noise ratios (SNR) for vascular lumens and cardiac chambers were measured.

Results

Of the 340 unique patients who underwent FE-CMR, HASTE was performed in 257. Ninety-three patients had both pre-ferumoxytol HASTE and FE-HASTE, and were included in this analysis. Qualitative image scores reflecting the degree and reliability of blood signal suppression were significantly higher for FE-HASTE images (2.9 [IQR 2.8–3.0] vs 1.8 [IQR 1.6–2.1], p < 0.001). Inter-reader agreement was moderate (k = 0.50, 95% CI 0.45–0.55). Blood signal suppression was more complete on FE-HASTE images than on pre-ferumoxytol HASTE, as indicated by lower mean homogeneity indices (24.5 [IQR 18.0–32.8] vs 108.0 [IQR 65.0–170.4], p < 0.001) and lower blood pool SNR for all regions (5.6 [IQR 3.2–10.0] vs 21.5 [IQR 12.5–39.4], p < 0.001).

Conclusion

FE-HASTE black-blood imaging offers an effective, reliable, and simple approach for flow independent blood signal suppression. The technique holds promise as a fast and routine complement to bright-blood cardiovascular imaging with ferumoxytol.
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Literature
1.
go back to reference Finn JP, Nael K, Deshpande V, Ratib O, Laub G. Cardiac MR imaging: state of the technology. Radiology. 2006;241:338–54.CrossRefPubMed Finn JP, Nael K, Deshpande V, Ratib O, Laub G. Cardiac MR imaging: state of the technology. Radiology. 2006;241:338–54.CrossRefPubMed
2.
go back to reference Bradley WG Jr. Carmen lecture. Flow phenomena in MR imaging. AJR Am J Roentgenol. 1988;150:983–94.CrossRefPubMed Bradley WG Jr. Carmen lecture. Flow phenomena in MR imaging. AJR Am J Roentgenol. 1988;150:983–94.CrossRefPubMed
3.
go back to reference Patel MR, Klufas RA, Alberico RA, Edelman RR. Half-fourier acquisition single-shot turbo spin-echo (HASTE) MR: comparison with fast spin-echo MR in diseases of the brain. AJNR Am J Neuroradiol. 1997;18:1635–40.PubMed Patel MR, Klufas RA, Alberico RA, Edelman RR. Half-fourier acquisition single-shot turbo spin-echo (HASTE) MR: comparison with fast spin-echo MR in diseases of the brain. AJNR Am J Neuroradiol. 1997;18:1635–40.PubMed
4.
5.
go back to reference Finn JP, Nguyen KL, Han F, Zhou Z, Salusky I, Ayad I, Hu P. Cardiovascular MRI with ferumoxytol. Clin Radiol. 2016;71:796–806.CrossRefPubMed Finn JP, Nguyen KL, Han F, Zhou Z, Salusky I, Ayad I, Hu P. Cardiovascular MRI with ferumoxytol. Clin Radiol. 2016;71:796–806.CrossRefPubMed
6.
go back to reference Bashir MR, Bhatti L, Marin D, Nelson RC. Emerging applications for ferumoxytol as a contrast agent in MRI. J Magn Reson Imaging. 2015;41:884–98.CrossRefPubMed Bashir MR, Bhatti L, Marin D, Nelson RC. Emerging applications for ferumoxytol as a contrast agent in MRI. J Magn Reson Imaging. 2015;41:884–98.CrossRefPubMed
7.
go back to reference Bashir MR, Mody R, Neville A, Javan R, Seaman D, Kim CY, Gupta RT, Jaffe TA. Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases. J Magn Reson Imaging. 2014;40:113–8.CrossRefPubMed Bashir MR, Mody R, Neville A, Javan R, Seaman D, Kim CY, Gupta RT, Jaffe TA. Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases. J Magn Reson Imaging. 2014;40:113–8.CrossRefPubMed
8.
go back to reference Winterer JT, Lehnhardt S, Schneider B, Neumann K, Allmann KH, Laubenberger J, Langer M. MRI of heart morphology. Comparison of nongradient echo sequences with single- and multislice acquisition. Investig Radiol. 1999;34:516–22.CrossRef Winterer JT, Lehnhardt S, Schneider B, Neumann K, Allmann KH, Laubenberger J, Langer M. MRI of heart morphology. Comparison of nongradient echo sequences with single- and multislice acquisition. Investig Radiol. 1999;34:516–22.CrossRef
9.
go back to reference Nguyen KL, Yoshida T, Han F, Ayad I, Reemtsen BL, Salusky IB, Satou GM, Hu P, Finn JP. MRI with ferumoxytol: a single center experience of safety across the age spectrum. J Magn Reson Imaging. 2017;45(3):804–12. [Epub 2016 Aug 2]CrossRefPubMed Nguyen KL, Yoshida T, Han F, Ayad I, Reemtsen BL, Salusky IB, Satou GM, Hu P, Finn JP. MRI with ferumoxytol: a single center experience of safety across the age spectrum. J Magn Reson Imaging. 2017;45(3):804–12. [Epub 2016 Aug 2]CrossRefPubMed
10.
go back to reference Hennig J, Nauerth A, Friedburg H. RARE imaging: a fast imaging method for clinical MR. Mag Reson Med. 1986;3:823–33.CrossRef Hennig J, Nauerth A, Friedburg H. RARE imaging: a fast imaging method for clinical MR. Mag Reson Med. 1986;3:823–33.CrossRef
11.
go back to reference Simonetti OP, Finn JP, White RD, Laub G, Henry DA. “black blood” T2-weighted inversion-recovery MR imaging of the heart. Radiology. 1996;199:49–57.CrossRefPubMed Simonetti OP, Finn JP, White RD, Laub G, Henry DA. “black blood” T2-weighted inversion-recovery MR imaging of the heart. Radiology. 1996;199:49–57.CrossRefPubMed
12.
go back to reference Edelman RR, Mattle HP, Wallner B, Bajakian R, Kleefield J, Kent C, Skillman JJ, Mendel JB, Atkinson DJ. Extracranial carotid arteries: evaluation with “black blood” MR angiography. Radiology. 1990;177:45–50.CrossRefPubMed Edelman RR, Mattle HP, Wallner B, Bajakian R, Kleefield J, Kent C, Skillman JJ, Mendel JB, Atkinson DJ. Extracranial carotid arteries: evaluation with “black blood” MR angiography. Radiology. 1990;177:45–50.CrossRefPubMed
13.
go back to reference Nguyen TD, de Rochefort L, Spincemaille P, Cham MD, Weinsaft JW, Prince MR, Wang Y. Effective motion-sensitizing magnetization preparation for black blood magnetic resonance imaging of the heart. J Magn Reson Imaging. 2008;28:1092–100.CrossRefPubMedPubMedCentral Nguyen TD, de Rochefort L, Spincemaille P, Cham MD, Weinsaft JW, Prince MR, Wang Y. Effective motion-sensitizing magnetization preparation for black blood magnetic resonance imaging of the heart. J Magn Reson Imaging. 2008;28:1092–100.CrossRefPubMedPubMedCentral
14.
go back to reference Wang J, Yarnykh VL, Hatsukami T, Chu B, Balu N, Yuan C. Improved suppression of plaque-mimicking artifacts in black-blood carotid atherosclerosis imaging using a multislice motion-sensitized driven-equilibrium (MSDE) turbo spin-echo (TSE) sequence. Mag Reson Med. 2007;58:973–81.CrossRef Wang J, Yarnykh VL, Hatsukami T, Chu B, Balu N, Yuan C. Improved suppression of plaque-mimicking artifacts in black-blood carotid atherosclerosis imaging using a multislice motion-sensitized driven-equilibrium (MSDE) turbo spin-echo (TSE) sequence. Mag Reson Med. 2007;58:973–81.CrossRef
15.
go back to reference Srinivasan S, Hu P, Kissinger KV, Goddu B, Goepfert L, Schmidt EJ, Kozerke S, Nezafat R. Free-breathing 3D whole-heart black-blood imaging with motion sensitized driven equilibrium. J Magn Reson Imaging. 2012;36:379–86.CrossRefPubMedPubMedCentral Srinivasan S, Hu P, Kissinger KV, Goddu B, Goepfert L, Schmidt EJ, Kozerke S, Nezafat R. Free-breathing 3D whole-heart black-blood imaging with motion sensitized driven equilibrium. J Magn Reson Imaging. 2012;36:379–86.CrossRefPubMedPubMedCentral
16.
go back to reference Edelman RR, Botelho M, Pursnani A, Giri S, Koktzoglou I. Improved dark blood imaging of the heart using radial balanced steady-state free precession. J Cardiovasc Magn Reson. 2016;18:69.CrossRefPubMedPubMedCentral Edelman RR, Botelho M, Pursnani A, Giri S, Koktzoglou I. Improved dark blood imaging of the heart using radial balanced steady-state free precession. J Cardiovasc Magn Reson. 2016;18:69.CrossRefPubMedPubMedCentral
17.
go back to reference Neuwelt EA, Hamilton BE, Varallyay CG, Rooney WR, Edelman RD, Jacobs PM, Watnick SG. Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)? Kidney Int. 2009;75:465–74.CrossRefPubMed Neuwelt EA, Hamilton BE, Varallyay CG, Rooney WR, Edelman RD, Jacobs PM, Watnick SG. Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)? Kidney Int. 2009;75:465–74.CrossRefPubMed
18.
go back to reference Finn JP, Nguyen KL and Hu P. Ferumoxytol vs. Gadolinium agents for contrast-enhanced MRI: Thoughts on evolving indications, risks, and benefits. J Magn Reson Imaging. 2017. doi:10.1002/jmri.25580. Finn JP, Nguyen KL and Hu P. Ferumoxytol vs. Gadolinium agents for contrast-enhanced MRI: Thoughts on evolving indications, risks, and benefits. J Magn Reson Imaging. 2017. doi:10.​1002/​jmri.​25580.
19.
go back to reference Li W, Salanitri J, Tutton S, Dunkle EE, Schneider JR, Caprini JA, Pierchala LN, Jacobs PM, Edelman RR. Lower extremity deep venous thrombosis: evaluation with ferumoxytol-enhanced MR imaging and dual-contrast mechanism--preliminary experience. Radiology. 2007;242:873–81.CrossRefPubMed Li W, Salanitri J, Tutton S, Dunkle EE, Schneider JR, Caprini JA, Pierchala LN, Jacobs PM, Edelman RR. Lower extremity deep venous thrombosis: evaluation with ferumoxytol-enhanced MR imaging and dual-contrast mechanism--preliminary experience. Radiology. 2007;242:873–81.CrossRefPubMed
20.
go back to reference Vu AT, Li W, Tutton S, Pierchala L, Prasad P, Edelman RR. Robust and efficient whole heart black blood cine imaging. Proc Intl Soc Mag Reson Med. 2005;13:1638. Vu AT, Li W, Tutton S, Pierchala L, Prasad P, Edelman RR. Robust and efficient whole heart black blood cine imaging. Proc Intl Soc Mag Reson Med. 2005;13:1638.
22.
go back to reference Hetzel D, Strauss W, Bernard K, Li Z, Urboniene A, Allen LF. A phase III, randomized, open-label trial of ferumoxytol compared with iron sucrose for the treatment of iron deficiency anemia in patients with a history of unsatisfactory oral iron therapy. Am J Hematol. 2014;89:646–50.CrossRefPubMedPubMedCentral Hetzel D, Strauss W, Bernard K, Li Z, Urboniene A, Allen LF. A phase III, randomized, open-label trial of ferumoxytol compared with iron sucrose for the treatment of iron deficiency anemia in patients with a history of unsatisfactory oral iron therapy. Am J Hematol. 2014;89:646–50.CrossRefPubMedPubMedCentral
23.
go back to reference Vadhan-Raj S, Strauss W, Ford D, Bernard K, Boccia R, Li J, Allen LF. Efficacy and safety of IV ferumoxytol for adults with iron deficiency anemia previously unresponsive to or unable to tolerate oral iron. Am J Hematol. 2014;89:7–12.CrossRefPubMed Vadhan-Raj S, Strauss W, Ford D, Bernard K, Boccia R, Li J, Allen LF. Efficacy and safety of IV ferumoxytol for adults with iron deficiency anemia previously unresponsive to or unable to tolerate oral iron. Am J Hematol. 2014;89:7–12.CrossRefPubMed
24.
go back to reference Macdougall IC, Strauss WE, McLaughlin J, Li Z, Dellanna F, Hertel J. A randomized comparison of ferumoxytol and iron sucrose for treating iron deficiency anemia in patients with CKD. Clin J Am Soc Nephrol. 2014;9:705–12.CrossRefPubMedPubMedCentral Macdougall IC, Strauss WE, McLaughlin J, Li Z, Dellanna F, Hertel J. A randomized comparison of ferumoxytol and iron sucrose for treating iron deficiency anemia in patients with CKD. Clin J Am Soc Nephrol. 2014;9:705–12.CrossRefPubMedPubMedCentral
25.
go back to reference Schiller B, Bhat P, Sharma A. Safety and effectiveness of ferumoxytol in hemodialysis patients at 3 dialysis chains in the United States over a 12-month period. Clin Ther. 2014;36:70–83.CrossRefPubMed Schiller B, Bhat P, Sharma A. Safety and effectiveness of ferumoxytol in hemodialysis patients at 3 dialysis chains in the United States over a 12-month period. Clin Ther. 2014;36:70–83.CrossRefPubMed
26.
go back to reference Auerbach M, Strauss W, Auerbach S, Rineer S, Bahrain H. Safety and efficacy of total dose infusion of 1,020 mg of ferumoxytol administered over 15 min. Am J Hematol. 2013;88:944–7.CrossRefPubMed Auerbach M, Strauss W, Auerbach S, Rineer S, Bahrain H. Safety and efficacy of total dose infusion of 1,020 mg of ferumoxytol administered over 15 min. Am J Hematol. 2013;88:944–7.CrossRefPubMed
27.
go back to reference Balakrishnan VS, Rao M, Kausz AT, Brenner L, Brenner L, Pereira BJG, Frigo TB, Lewis JM. Physicochemical properties of ferumoxytol, a new intravenous iron preparation. Eur J Clin Investig. 2009;39:489–96.CrossRef Balakrishnan VS, Rao M, Kausz AT, Brenner L, Brenner L, Pereira BJG, Frigo TB, Lewis JM. Physicochemical properties of ferumoxytol, a new intravenous iron preparation. Eur J Clin Investig. 2009;39:489–96.CrossRef
28.
go back to reference Provenzano R, Schiller B, Rao M, Coyne D, Brenner L, Pereira BJ. Ferumoxytol as an intravenous iron replacement therapy in hemodialysis patients. Clin J Am Soc Nephrol. 2009;4:386–93.CrossRefPubMedPubMedCentral Provenzano R, Schiller B, Rao M, Coyne D, Brenner L, Pereira BJ. Ferumoxytol as an intravenous iron replacement therapy in hemodialysis patients. Clin J Am Soc Nephrol. 2009;4:386–93.CrossRefPubMedPubMedCentral
29.
go back to reference Ning P, Zucker EJ, Wong P, Vasanawala SS. Hemodynamic safety and efficacy of ferumoxytol as an intravenous contrast agents in pediatric patients and young adults. Magn Reson Imaging. 2016;34:152–8.CrossRefPubMed Ning P, Zucker EJ, Wong P, Vasanawala SS. Hemodynamic safety and efficacy of ferumoxytol as an intravenous contrast agents in pediatric patients and young adults. Magn Reson Imaging. 2016;34:152–8.CrossRefPubMed
30.
go back to reference Muehe AM, Feng D, von Eyben R, Luna-Fineman S, Link MP, Muthig T, Huddleston AE, Neuwelt EA, Daldrup-Link HE. Safety report of Ferumoxytol for magnetic resonance imaging in children and young adults. Investig Radiol. 2016;51:221–7.CrossRef Muehe AM, Feng D, von Eyben R, Luna-Fineman S, Link MP, Muthig T, Huddleston AE, Neuwelt EA, Daldrup-Link HE. Safety report of Ferumoxytol for magnetic resonance imaging in children and young adults. Investig Radiol. 2016;51:221–7.CrossRef
31.
go back to reference Varallyay CG, Toth GB, Fu R, Netto JP, Firkins J, Ambady P and Neuwelt EA. What Does the Boxed Warning Tell Us? Safe Practice of Using Ferumoxytol as an MRI Contrast Agent. AJNR Am J Neuroradiol. 2017. doi:10.3174/ajnr.A5188. Varallyay CG, Toth GB, Fu R, Netto JP, Firkins J, Ambady P and Neuwelt EA. What Does the Boxed Warning Tell Us? Safe Practice of Using Ferumoxytol as an MRI Contrast Agent. AJNR Am J Neuroradiol. 2017. doi:10.​3174/​ajnr.​A5188.
33.
go back to reference Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907–16.CrossRefPubMed Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907–16.CrossRefPubMed
35.
go back to reference Bradbury MW. Transport of iron in the blood-brain-cerebrospinal fluid system. J Neurochem. 1997;69:443–54.CrossRefPubMed Bradbury MW. Transport of iron in the blood-brain-cerebrospinal fluid system. J Neurochem. 1997;69:443–54.CrossRefPubMed
Metadata
Title
Ferumoxytol enhanced black-blood cardiovascular magnetic resonance imaging
Authors
Kim-Lien Nguyen
Eun-Ah Park
Takegawa Yoshida
Peng Hu
J. Paul Finn
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-017-0422-y

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