High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations

Michael, Cassia; Choudhri, Omar; Dodd, Robert; Vasanawala, Shreyas; Alley, Marcus T.; Moseley, Michael E.; Holdsworth, Samantha J.; Grant, Gerald A.; Cheshier, Samuel; Yeom, Kristen W.

doi:10.3171/2018.3.peds17723

Cited by 19 publications

(14 citation statements)

References 41 publications

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“…In our study, incremental enhancement with increasing ferumoxytol dose from 1 to 4 mg/kg produced a progressive but uniform increase in vascular SNR, without changing the relative enhancement of arterial, portal venous, or systemic venous beds. The stable intravascular concentration of ferumoxytol has been exploited in humans for high‐resolution venography, 34 intracranial arteriovenous malformation imaging, 35 and to produce four‐dimensional images of the heart and great vessels with unprecedented spatio‐temporal resolution 26,27 . Ferumoxytol can also be used to support high signal‐to‐noise and contrast‐to‐noise values for four‐dimensional cardiovascular flow imaging 36 …”

Section: Discussionmentioning

confidence: 99%

Ferumoxytol‐enhanced magnetic resonance angiography provides comparable vascular conspicuity to CT angiography in dogs with intrahepatic portosystemic shunts

Wilson

Culp

Wisner

et al. 2021

Vet Radiology Ultrasound

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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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Section: Discussionmentioning

confidence: 99%

Ferumoxytol‐enhanced magnetic resonance angiography provides comparable vascular conspicuity to CT angiography in dogs with intrahepatic portosystemic shunts

Wilson

Culp

Wisner

et al. 2021

Vet Radiology Ultrasound

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“…Several investigators including our own group started to use ferumoxytol nanoparticles for MR imaging of vascular malformations [26,27], cardiovascular abnormalities [28] and tumors in children [19]. The sensitivity and specificity of ferumoxytol for imaging brain pathologies in patients has been extensively studied [29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Brain iron deposition after Ferumoxytol-enhanced MRI: A study of Porcine Brains

et al. 2020

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Recent evidence of gadolinium deposition in the brain has raised safety concerns. Iron oxide nanoparticles are re-emerging as promising alternative MR contrast agents, because the iron core can be metabolized. However, long-term follow up studies of the brain after intravenous iron oxide administration have not been reported thus far. In this study, we investigated, if intravenously administered ferumoxytol nanoparticles are deposited in porcine brains. Methods: In an animal care and use committee-approved prospective case-control study, ten Göttingen minipigs received either intravenous ferumoxytol injections at a dose of 5 mg Fe/kg (n=4) or remained untreated (n=6). Nine to twelve months later, pigs were sacrificed and the brains of all pigs underwent ex vivo MRI at 7T with T2 and T2*-weighted sequences. MRI scans were evaluated by measuring R2* values (R2*=1000/T2*) of the bilateral caudate nucleus, lentiform nucleus, thalamus, dentate nucleus, and choroid plexus. Pig brains were sectioned and stained with Prussian blue and evaluated for iron deposition using a semiquantitative scoring system. Data of ferumoxytol exposed and unexposed groups were compared with an unpaired t-test and a Mann-Whitney U test. Results: T2 and T2* signal of the different brain regions was not visually different between ferumoxytol exposed and unexposed controls. There were no significant differences in R2* values of the different brain regions in the ferumoxytol exposed group compared to controls (p>0.05). Prussian blue stains of the same brain regions, scored according to a semiquantitative score, were not significantly different either between the ferumoxytol exposed group and unexposed controls (p>0.05). Conclusions: Our study shows that intravenous ferumoxytol doses of 5-10 mg Fe/kg do not lead to iron deposition in the brain of pigs. We suggest iron oxide nanoparticles as a promising alternative for gadolinium-enhanced MRI.

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“…Brain AVMs have several angioarchitectural and geographic features that help to predict likelihood of future rupture, identify source of current hemorrhage, and probable morbidity of treatment 7–13. Angioarchitectural features, including feeding artery aneurysms, nidus aneurysms, large-caliber arteriovenous fistulous connections, and venous outflow stenoses, can be visualized to lesser or greater degrees by non-invasive imaging such as MR angiography (MRA) and CT angiography (CTA) 14 15. Digital subtraction angiography (DSA), given its higher spatial and temporal resolution, remains superior to non-invasive modalities in identifying relevant AVM angioarchitectural features as compared with non-invasive modalities 16 17.…”

Section: Diagnostic and Pre-treatment Imaging Of Brain Avmsmentioning

confidence: 99%

Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Leacy

Ansari

Schirmer

et al. 2022

J NeuroIntervent Surg

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BackgroundThe purpose of this review is to summarize the data available for the role of angiography and embolization in the comprehensive multidisciplinary management of brain arteriovenous malformations (AVMsMethodsWe performed a structured literature review for studies examining the indications, efficacy, and outcomes for patients undergoing endovascular therapy in the context of brain AVM management. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee and the SNIS Board of Directors.ResultsThe multidisciplinary evaluation and treatment of brain AVMs continues to evolve. Recommendations include: (1) Digital subtraction catheter cerebral angiography (DSA)—including 2D, 3D, and reformatted cross-sectional views when appropriate—is recommended in the pre-treatment assessment of cerebral AVMs. (I, B-NR). (2) It is recommended that endovascular embolization of cerebral arteriovenous malformations be performed in the context of a complete multidisciplinary treatment plan aiming for obliteration of the AVM and cure. (I, B-NR). (3) Embolization of brain AVMs before surgical resection can be useful to reduce intraoperative blood loss, morbidity, and surgical complexity. (IIa, B-NR). (4) The role of primary curative embolization of cerebral arteriovenous malformations is uncertain, particularly as compared with microsurgery and radiosurgery with or without adjunctive embolization. Further research is needed, particularly with regard to risk for AVM recurrence. (III equivocal, C-LD). (5) Targeted embolization of high-risk features of ruptured brain AVMs may be considered to reduce the risk for recurrent hemorrhage. (IIb, C-LD). (6) Palliative embolization may be useful to treat symptomatic AVMs in which curative therapy is otherwise not possible. (IIb, B-NR). (7) The role of AVM embolization as an adjunct to radiosurgery is not well-established. Further research is needed. (III equivocal, C-LD). (8) Imaging follow-up after apparent cure of brain AVMs is recommended to assess for recurrence. Although non-invasive imaging may be used for longitudinal follow-up, DSA remains the gold standard for residual or recurrent AVM detection in patients with concerning imaging and/or clinical findings. (I, C-LD). (9) Improved national and international reporting of patients of all ages with brain AVMs, their treatments, side effects from treatment, and their long-term outcomes would enhance the ability to perform clinical trials and improve the rigor of research into this rare condition. (I, C-EO).ConclusionsAlthough the quality of evidence is lower than for more common conditions subjected to multiple randomized controlled trials, endovascular therapy has an important role in the management of brain AVMs. Prospective studies are needed to strengthen the data supporting these recommendations.

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High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations

Cited by 19 publications

References 41 publications

Ferumoxytol‐enhanced magnetic resonance angiography provides comparable vascular conspicuity to CT angiography in dogs with intrahepatic portosystemic shunts

Ferumoxytol‐enhanced magnetic resonance angiography provides comparable vascular conspicuity to CT angiography in dogs with intrahepatic portosystemic shunts

Brain iron deposition after Ferumoxytol-enhanced MRI: A study of Porcine Brains

Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

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