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

Csanad G. Varallyay, Eric Nesbit, Andrea Horvath, Peter Varallyay, Rongwei Fu, Seymur Gahramanov, Leslie L. Muldoon, Xin Li, William D. Rooney, Edward A. Neuwelt

Research output: Contribution to journalArticle

Abstract

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.

LanguageEnglish (US)
JournalJournal of Magnetic Resonance Imaging
DOIs
StateAccepted/In press - Jan 1 2018

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Ferrosoferric Oxide
Standard of Care
Contrast Media
Perfusion
Noise
Putamen
Globus Pallidus
Thalamus
Cerebral Blood Volume
Brain Diseases
Brain Neoplasms
Nanoparticles
gadoteridol
Retrospective Studies
Confidence Intervals

Keywords

  • Cerebral blood volume
  • Contrast agent
  • Dynamic susceptibility contrast
  • Ferumoxytol
  • Neuroradiology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{16926bdd8e29489fbafb562912ed15bd,
title = "Cerebral blood volume mapping with ferumoxytol in dynamic susceptibility contrast perfusion MRI: Comparison to standard of care",
abstract = "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.",
keywords = "Cerebral blood volume, Contrast agent, Dynamic susceptibility contrast, Ferumoxytol, Neuroradiology",
author = "Varallyay, {Csanad G.} and Eric Nesbit and Andrea Horvath and Peter Varallyay and Rongwei Fu and Seymur Gahramanov and Muldoon, {Leslie L.} and Xin Li and Rooney, {William D.} and Neuwelt, {Edward A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/jmri.25943",
language = "English (US)",
journal = "Journal of Magnetic Resonance Imaging",
issn = "1053-1807",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Cerebral blood volume mapping with ferumoxytol in dynamic susceptibility contrast perfusion MRI

T2 - Journal of Magnetic Resonance Imaging

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.

PY - 2018/1/1

Y1 - 2018/1/1

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.

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.

KW - Cerebral blood volume

KW - Contrast agent

KW - Dynamic susceptibility contrast

KW - Ferumoxytol

KW - Neuroradiology

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DO - 10.1002/jmri.25943

M3 - Article

JO - Journal of Magnetic Resonance Imaging

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SN - 1053-1807

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