Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Radiology

07-05-2024 | Varicosis | Contrast Media

Ferumoxytol-enhanced MR venography for mapping lower-extremity venous networks and evaluating varicose veins in patients with diabetes

Authors: Yuehong Liu, Bin Cao, Xinyu Wang, Jiali Zhong, Zhenyu Li, Ruchen Peng, Dong Zhao, Ning Gu, Qi Yang

Published in: European Radiology

Login to get access

Abstract

Objectives

Comprehensive evaluation of lower-extremity varicose veins (VVs) in patients with diabetes is crucial for treatment strategizing. The study aims to assess the feasibility of using ferumoxytol-enhanced MR venography (FE-MRV) for lower-extremity venous mapping and the detection of VVs in patients with diabetes.

Materials and methods

As part of a phase II clinical trial of a generic brand of ferumoxytol, documented patients with diabetes were enrolled and underwent FE-MRV on a 3-Τ MRI system. Two observers assessed FE-MRV images for image quality, signal intensity ratio (SIR), perforator (PV) diameter, and luminal signal uniformity in deep-to-superficial venous networks with the assessment of intra- and inter-rater reliability. FE-MRV was used to detect lower-extremity VVs.

Results

Eleven patients underwent FE-MRV without adverse events. The average image quality, as scored by the two observers who assessed 275 venous segments, was 3.4 ± 0.6. Two observers strongly agreed on image quality (κ = 0.90) and SIR measurements (interclass correlation coefficient [ICC]: 0.72) and had good agreement on PV diameter (ICC: 0.64). FE-MRV revealed uniform luminal signals in deep and saphenous venous networks (0.13 ± 0.05 vs 0.08 ± 0.03). Below-knee segments exhibited a significantly higher heterogeneity index than above-knee (p = 0.039) segments. Superficial VVs were observed in 55% (12/22) of legs in 64% (7/11) of patients. Calf muscle VVs were present in 64% (14/22) of legs in 9 patients.

Conclusion

FE-MRV safely and robustly mapped entire lower-extremity venous networks, enabling the detection and pre-treatment evaluation of both superficial, and deep VVs in patients with diabetes.

Clinical relevance statement

Ferumoxytol-enhanced magnetic resonance venography offers a “one-stop” imaging strategy for the detection and pre-operative evaluation of both superficial and deep VVs in diabetic patients.

Key Points

  • Diabetic patients with VVs are at a higher risk of ulcer-related complications.
  • FE-MRV allowed rapid and comprehensive visualization of the lower-limb venous networks and abdominopelvic veins in diabetic patients.
  • This technique allowed for the detection of superficial and deep VVs in diabetic patients before the development of severe peripheral artery disease.
Appendix
Available only for authorised users
Literature
1.
Chang SL, Huang YL, Lee MC et al (2018) Association of varicose veins with incident venous thromboembolism and peripheral artery disease. JAMA 319:807–817CrossRefPubMedPubMedCentral
2.
Nyamekye IK (2022) European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. J Med Vasc 47:53–55PubMed
3.
Gloviczki P, Lawrence PF, Wasan SM et al (2024) The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the Management of varicose veins of the lower extremities. Part II. Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord 12:101670
4.
O’Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD (2016) Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord 4:97–105CrossRefPubMed
5.
Expert Panels on Interventional Radiology and Vascular Imaging (2023) ACR appropriateness criteria® lower extremity chronic venous disease. J Am Coll Radiol 20:S481–S500CrossRef
6.
Barnes JA, Eid MA, Creager MA, Goodney PP (2020) Epidemiology and risk of amputation in patients with diabetes mellitus and peripheral artery disease. Arterioscler Thromb Vasc Biol 40:1808–1817CrossRefPubMedPubMedCentral
7.
8.
9.
Min SK, Kim SY, Park YJ et al (2010) Role of three-dimensional computed tomography venography as a powerful navigator for varicose vein surgery. J Vasc Surg 51:893–899CrossRefPubMed
10.
Muller MA, Mayer D, Seifert B, Marincek B, Willmann JK (2008) Recurrent lower-limb varicose veins: effect of direct contrast-enhanced three-dimensional MR venographic findings on diagnostic thinking and therapeutic decisions. Radiology 247:887–895CrossRefPubMed
11.
12.
Finn JP, Nguyen KL, Hu P (2017) Ferumoxytol vs. gadolinium agents for contrast-enhanced MRI: thoughts on evolving indications, risks, and benefits. J Magn Reson Imaging 46:919–923CrossRefPubMedPubMedCentral
13.
14.
Chen B, Li Y, Zhang X, Liu F, Liu Y, Xiong F, Gu N (2016) An efficient synthesis of ferumoxytol induced by alternating-current magnetic field. Materials Letters 170:93–96CrossRef
15.
De Maeseneer MG, Kakkos SK, Aherne T et al (2022) Editor’s Choice—European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg 63:184–267CrossRefPubMed
16.
17.
18.
Eid MA, Mehta K, Barnes JA et al (2023) The global burden of peripheral artery disease. J Vasc Surg 77:1119–1126 e1111CrossRefPubMed
19.
Zhong J, Chen J, Zhao ZG et al (2014) Diabetes mellitus is associated with early chronic venous disorder of the lower extremities in Chinese patients with cardiometabolic risk factors. Diabetes Metab Res Rev 30:505–512CrossRefPubMed
20.
Paneni F, Beckman JA, Creager MA, Cosentino F (2013) Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Eur Heart J 34:2436–2443CrossRefPubMedPubMedCentral
21.
Noor S, Zubair M, Ahmad J (2015) Diabetic foot ulcer-A review on pathophysiology, classification and microbial etiology. Diabetes Metab Syndr 9:192–199CrossRefPubMed
22.
23.
24.
Corwin MT, Fananapazir G, Chaudhari AJ (2016) MR angiography of renal transplant vasculature with ferumoxytol:: comparison of high-resolution steady-state and first-pass acquisitions. Acad Radiol 23:368–373CrossRefPubMed
25.
Li W, Salanitri J, Tutton S et al (2007) Lower extremity deep venous thrombosis: evaluation with ferumoxytol-enhanced MR imaging and dual-contrast mechanism-preliminary experience. Radiology 242:873–881CrossRefPubMed
26.
Bashir MR, Mody R, Neville A et al (2014) 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 40:113–118CrossRefPubMed
27.
Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Diaz C, Martinez-Zapata MJ (2021) CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 9:CD009648PubMed
28.
Aschauer M, Deutschmann HA, Stollberger R et al (2003) Value of a blood pool contrast agent in MR venography of the lower extremities and pelvis: preliminary results in 12 patients. Magn Reson Med 50:993–1002CrossRefPubMed
29.
Stoumpos S, Hall Barrientos P, Black DH et al (2020) Ferumoxytol MR angiography: a novel technique for assessing iliac vasculature in potential kidney transplant recipients. JACC Cardiovasc Imaging 13:1847–1848CrossRefPubMed
30.
Hope MD, Hope TA, Zhu C et al (2015) Vascular imaging with ferumoxytol as a contrast agent. AJR Am J Roentgenol 205:W366–W373CrossRef
31.
Lehrman ED, Plotnik AN, Hope T, Saloner D (2019) Ferumoxytol-enhanced MRI in the peripheral vasculature. Clin Radiol 74:37–50CrossRefPubMed
32.
Ghodrati V, Rivenson Y, Prosper A et al (2022) Automatic segmentation of peripheral arteries and veins in ferumoxytol-enhanced MR angiography. Magn Reson Med 87:984–998CrossRefPubMed
Metadata
Title
Ferumoxytol-enhanced MR venography for mapping lower-extremity venous networks and evaluating varicose veins in patients with diabetes
Authors
Yuehong Liu
Bin Cao
Xinyu Wang
Jiali Zhong
Zhenyu Li
Ruchen Peng
Dong Zhao
Ning Gu
Qi Yang
Publication date
07-05-2024
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-10772-x