Incidental ferumoxytol artifacts in clinical brain MR imaging
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Ferumoxytol (Feraheme) is a parenteral therapy approved for treatment of iron deficiency anemia. The product insert for ferumoxytol states that it may affect the diagnostic ability of MRI for up to 3 months. However, the expected effects may not be commonly recognized among clinical neuroradiologists. Our purpose is to describe the artifacts we have seen at our institution during routine clinical practice.
We reviewed the patients at our institution that had brain MRI performed within 90 days of receiving intravenous ferumoxytol. The imaging was reviewed for specific findings, including diffusion-weighted imaging vascular susceptibility artifact, gradient-echo echo-planar T2*-weighted vascular susceptibility artifact, SWI/SWAN vascular susceptibility artifact, hypointense vascular signal on T2-weighted images, pre-gadolinium contrast vascular enhancement on magnetization-prepared rapid acquisition gradient echo (MPRAGE) imaging, and effects on post-gadolinium contrast T1 imaging.
Multiple artifacts were observed in patients having a brain MRI within 3 days of receiving intravenous ferumoxytol. These included susceptibility artifact on DWI, GRE, and SWAN/SWI imaging, pre-gadolinium contrast increased vascular signal on MPRAGE imaging, and decreased expected enhancement on post-gadolinium contrast T1-weighted imaging.
Ferumoxytol can create imaging artifacts which complicate clinical interpretation when brain MRI is performed within 3 days of administration. Recognition of the constellation of artifacts produced by ferumoxytol is important in order to obviate additional unnecessary examinations and mitigate errors in interpretation.
KeywordsFerumoxytol Susceptibility Artifact MRI Brain
The authors thank Sonia Watson, PhD, for assistance with editing the manuscript.
Compliance with ethical standards
We declare that all human and animal studies have been approved by the institutional review board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Due to the retrospective nature of this study, informed consent was waived.
Conflict of interest
TK consults for SpineThera; however, there is no conflict of interest with this manuscript.
- 3.Weinstein JS, Varallyay CG, Dosa E, Gahramanov S, Hamilton B, Rooney WD, Muldoon LL, Neuwelt EA (2010) Superparamagnetic iron oxide nanoparticles: diagnostic magnetic resonance imaging and potential therapeutic applications in neurooncology and central nervous system inflammatory pathologies, a review. J Cereb Blood Flow Metab 30(1):15–35. doi: 10.1038/jcbfm.2009.192 CrossRefPubMedGoogle Scholar
- 8.Nasseri M, Gahramanov S, Netto JP, Fu R, Muldoon LL, Varallyay C, Hamilton BE, Neuwelt EA (2014) Evaluation of pseudoprogression in patients with glioblastoma multiforme using dynamic magnetic resonance imaging with ferumoxytol calls RANO criteria into question. Neuro-Oncology 16(8):1146–1154. doi: 10.1093/neuonc/not328 CrossRefPubMedPubMedCentralGoogle Scholar