Cerebral blood volume mapping with ferumoxytol in dynamic susceptibility contrast perfusion MRI: Comparison to standard of care

• Published in: Journal of magnetic resonance imaging 2018-08, Vol.48 (2), p.441-448
• Main Authors: Varallyay, Csanad G., Nesbit, Eric, Horvath, Andrea, Varallyay, Peter, Fu, Rongwei, Gahramanov, Seymur, Muldoon, Leslie L., Li, Xin, Rooney, William D., Neuwelt, Edward A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood volume; Brain; Brain Mapping; Brain tumors; Cerebral blood flow; cerebral blood volume; Cerebrovascular Circulation; Confidence intervals; Conspicuity; contrast agent; Contrast Media; dynamic susceptibility contrast; Female; Ferric Compounds - chemistry; Ferrosoferric Oxide - chemistry; ferumoxytol; Field strength; Gadolinium - chemistry; Globus pallidus; Heterocyclic Compounds - chemistry; Humans; Image quality; Iron oxides; Magnetic Resonance Imaging; Male; Mapping; Mathematical models; Medical imaging; Metal Nanoparticles; Middle Aged; Nanoparticles; Neuroimaging; neuroradiology; Noise; Noise levels; Organometallic Compounds - chemistry; Perfusion; Putamen; Quality assessment; Retrospective Studies; Standard of care; Statistical analysis; Statistical tests; Thalamus
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.25943

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.