TY - JOUR
T1 - Cerebral blood volume mapping with ferumoxytol in dynamic susceptibility contrast perfusion MRI
T2 - Comparison to standard of care
AU - Varallyay, Csanad G.
AU - Nesbit, Eric
AU - Horvath, Andrea
AU - Varallyay, Peter
AU - Fu, Rongwei
AU - Gahramanov, Seymur
AU - Muldoon, Leslie L.
AU - Li, Xin
AU - Rooney, William D.
AU - Neuwelt, Edward A.
N1 - Funding Information:
National Institutes of Health; contract grant number: NS053468; CA199111; CA137488-15S1; 1R25EB016671; Contract grant sponsor: Federal funds from the National Cancer Institute, National Institutes of Health; contract grant number: HHSN261200800001E; Walter S. and Lucienne Driskill Foundation; Contract grant sponsor: Veterans Administration Merit Review grant (all to E.A.N.); National Institute of Biomedical Imaging and Bioengineering; contract grant number: 1R25EB016671 (to C.V.)
Publisher Copyright:
© 2018 International Society for Magnetic Resonance in Medicine
PY - 2018/8
Y1 - 2018/8
N2 - Background: Cerebral blood volume (CBV) mapping with a dynamic susceptibility contrast (DSC) perfusion technique has become a clinical tool in diagnosing and follow-up of brain tumors. Ferumoxytol, a long-circulating iron oxide nanoparticle, has been tested for CBV mapping, but the optimal dose has not been established. Purpose: To compare ferumoxytol DSC of two different doses to standard of care gadoteridol by analyzing time–intensity curves and CBV maps in normal-appearing brain regions. Study Type: Retrospective. Subjects: Fifty-four patients with various brain disorders. Field Strength/Sequence: 3T MRI. DSC-MRI was performed with 0.1 mmol/kg gadoteridol and 1 day later with ferumoxytol in doses of 1 or 2 mg/kg. Assessment: Signal changes during first pass, relative CBV (rCBV) in normal-appearing thalamus, putamen, and globus pallidus, and contrast-to-noise ratio (CNR) of the CBV maps were compared between gadoteridol and various doses of ferumoxytol using an automated method. To subjectively assess the quality of the CBV maps, two blinded readers also assessed visual conspicuity of the putamen. Statistical Tests: Linear mixed effect model was used for statistical comparison. Results: Compared to gadoteridol, 1 mg/kg ferumoxytol showed no difference in CNR (P = 0.6505), peak ΔR2*, and rCBV in the putamen (P = 0.2669, 0.0871) or in the thalamus (P = 0.517, 0.9787); 2 mg/kg ferumoxytol increased peak ΔR2* as well as the CNR (P < 0.0001), but also mildly increased rCBV in putamen and globus pallidus (P = 0.0005, 0.0012). Signal intensities during first pass remained highly above the noise level, with overlapping of 95% confidence intervals with noise only in 3 out of 162 tested regions. Compared to gadoteridol, the visual image quality showed mild improvement with 1 mg/kg (P = 0.02) and marked improvement with 2 mg/kg ferumoxytol (P < 0.0001). Data Conclusion: 1 mg/kg ferumoxytol provides similar imaging results to standard gadoteridol for DSC-MRI, and 2 mg/kg has a benefit of increased CNR, but may also result in mildly increased rCBV values. Level of Evidence: 3. Technical Efficacy: Stage 1. J. MAGN. RESON. IMAGING 2018;48:441–448.
AB - Background: Cerebral blood volume (CBV) mapping with a dynamic susceptibility contrast (DSC) perfusion technique has become a clinical tool in diagnosing and follow-up of brain tumors. Ferumoxytol, a long-circulating iron oxide nanoparticle, has been tested for CBV mapping, but the optimal dose has not been established. Purpose: To compare ferumoxytol DSC of two different doses to standard of care gadoteridol by analyzing time–intensity curves and CBV maps in normal-appearing brain regions. Study Type: Retrospective. Subjects: Fifty-four patients with various brain disorders. Field Strength/Sequence: 3T MRI. DSC-MRI was performed with 0.1 mmol/kg gadoteridol and 1 day later with ferumoxytol in doses of 1 or 2 mg/kg. Assessment: Signal changes during first pass, relative CBV (rCBV) in normal-appearing thalamus, putamen, and globus pallidus, and contrast-to-noise ratio (CNR) of the CBV maps were compared between gadoteridol and various doses of ferumoxytol using an automated method. To subjectively assess the quality of the CBV maps, two blinded readers also assessed visual conspicuity of the putamen. Statistical Tests: Linear mixed effect model was used for statistical comparison. Results: Compared to gadoteridol, 1 mg/kg ferumoxytol showed no difference in CNR (P = 0.6505), peak ΔR2*, and rCBV in the putamen (P = 0.2669, 0.0871) or in the thalamus (P = 0.517, 0.9787); 2 mg/kg ferumoxytol increased peak ΔR2* as well as the CNR (P < 0.0001), but also mildly increased rCBV in putamen and globus pallidus (P = 0.0005, 0.0012). Signal intensities during first pass remained highly above the noise level, with overlapping of 95% confidence intervals with noise only in 3 out of 162 tested regions. Compared to gadoteridol, the visual image quality showed mild improvement with 1 mg/kg (P = 0.02) and marked improvement with 2 mg/kg ferumoxytol (P < 0.0001). Data Conclusion: 1 mg/kg ferumoxytol provides similar imaging results to standard gadoteridol for DSC-MRI, and 2 mg/kg has a benefit of increased CNR, but may also result in mildly increased rCBV values. Level of Evidence: 3. Technical Efficacy: Stage 1. J. MAGN. RESON. IMAGING 2018;48:441–448.
KW - cerebral blood volume
KW - contrast agent
KW - dynamic susceptibility contrast
KW - ferumoxytol
KW - neuroradiology
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U2 - 10.1002/jmri.25943
DO - 10.1002/jmri.25943
M3 - Article
C2 - 29314418
AN - SCOPUS:85040033664
SN - 1053-1807
VL - 48
SP - 441
EP - 448
JO - Journal of Magnetic Resonance Imaging
JF - Journal of Magnetic Resonance Imaging
IS - 2
ER -