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Ferumoxytol-enhanced vascular suppression in magnetic resonance neurography

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Abstract

Objective

To evaluate ferumoxytol-enhanced vascular suppression for visualizing branch nerves of the brachial plexus in magnetic resonance (MR) neurography.

Materials and methods

Signal simulations were performed to determine ferumoxytol’s effect on nerve-, fat-, and blood-to-muscle contrast and to optimize pulse sequence parameters. Prospective, in vivo assessment included 10 subjects with chronic anemia who underwent a total of 19 (9 bilateral) pre- and post-infusion brachial plexus exams using three-dimensional (3D), T2-weighted short-tau inversion recovery (T2-STIR) sequences at 3.0 T. Two musculoskeletal radiologists qualitatively rated sequences for the degree of vascular suppression and brachial plexus branch nerve conspicuity. Nerve-to-muscle, -fat, and -vessel contrast ratios were measured.

Results

Quantitative nerve/muscle and nerve/small vessel contrast ratios (CRs) increased with ferumoxytol (p < 0.05). Qualitative vascular suppression and suprascapular nerve visualization improved following ferumoxytol administration for both raters (p < .05). Pre- and post-ferumoxytol exams demonstrated moderate to near-perfect inter-rater agreement for nerve visualization and diagnostic confidence for the suprascapular and axillary nerves but poor to no agreement for the long thoracic nerve.

Conclusion

Ferumoxytol in T2-weighted brachial plexus MR neurography provides robust vascular suppression and aids visualization of the suprascapular nerve in volunteers without neuropathy.

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Abbreviations

CR:

Contrast ratio

IDA:

Iron deficiency anemia

TE:

Echo time

TI:

Inversion time

TR:

Repetition time

References

  1. Filler A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery. 2009;65(4 Suppl):A29-43.

    Article  Google Scholar 

  2. Does MD, Snyder RE. T2 relaxation of peripheral nerve measured in vivo. Magn Reson Imaging. 1995;13(4):575–80.

    Article  CAS  Google Scholar 

  3. Yoneyama M, Takahara T, Kwee TC, et al. Rapid high resolution MR neurography with a diffusion-weighted pre-pulse. Magn Reson Med Sci. 2013;12:111–9.

    Article  Google Scholar 

  4. Cervantes B, Kirschke JS, Klupp E, et al. Orthogonally combined motion- and diffusion-sensitized driven equilibrium (OC-MDSDE) preparation for vessel signal suppression in 3D turbo spin echo imaging of peripheral nerves in the extremities. Magn Reson Med. 2018;79:407–15.

    Article  Google Scholar 

  5. Chhabra A, Subhawong TK, Bizzell C, et al. 3T MR neurography using three dimensional diffusion-weighted PSIF: technical issues and advantages. Skeletal Radiol. 2011;40:1355–60.

    Article  Google Scholar 

  6. Xu X et al. Investigation of 3D reduced field of view carotid atherosclerotic plaque imaging. Magn Reson Imaging. 2017.

  7. Lindenholz A, et al. The use and pitfalls of intracranial vessel wall imaging: how we do it. Radiology. 2017;286(1):12–28.

    Article  Google Scholar 

  8. Abdel-Aty H, Simonetti O, Friedrich MG. T2-weighted cardiovascular magnetic resonance imaging. J Magn Reson Imaging. 2007;26(3):452–9.

    Article  Google Scholar 

  9. Brown R, et al. Effect of blood flow on double inversion recovery vessel wall MRI of the peripheral arteries: quantitation with T2 mapping and comparison with flow-insensitive T2-prepared inversion recovery imaging. Magnetic resonance in medicine : official journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine. 2010;63(3):736–44.

  10. Deshmukh S, Fayad LM, Ahlawat S. MR neurography (MRN) of the long thoracic nerve: retrospective review of clinical findings and imaging results at our institution over 4 years. Skeletal Radiol. 2017;46(11):1531–40.

    Article  Google Scholar 

  11. Aime S, Caravan P. Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J Magn Reson Imaging. 2009;30:1259–67.

    Article  Google Scholar 

  12. Chen WC, Tsai YH, Weng HH, et al. Value of enhancement technique in 3D–T2 STIR images of the brachial plexus. J Comput Assist Tomogr. 2014;38:335–9.

    Article  Google Scholar 

  13. Wang L, Niu Y, Kong X, et al. The application of paramagnetic contrast-based T2 effect to 3D heavily T2W high-resolution MR imaging of the brachial plexus and its branches. Eur J Radiol. 2016;85:578–84.

    Article  Google Scholar 

  14. Sneag DB, Daniels SP, Geannette C, et al. Post-contrast 3D inversion recovery magnetic resonance neurography for evaluation of branch nerves of the brachial plexus. Eur J Radiol. 2020;28(132):109304.

    Article  Google Scholar 

  15. Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D. High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology. 2014;270(3):834–41.

    Article  Google Scholar 

  16. Ahmad F, Treanor L, McGrath TA, Walker D, McInnes MDF, Schieda N. Safety of off-label use of ferumoxtyol as a contrast agent for MRI: a systematic review and meta-analysis of adverse events. J Magn Reson Imaging. 2021;53(3):840–58.

    Article  Google Scholar 

  17. Alkhunizi SM, Fakhoury M, Abou-Kheir W, Lawand N. Gadolinium retention in the central and peripheral nervous system: implications for pain, cognition, and neurogenesis. Radiology. 2020;297(2):407–16.

    Article  Google Scholar 

  18. Grobner T. Gadolinium–a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006;21(4):1104–8.

    Article  CAS  Google Scholar 

  19. McDonald JS, McDonald RJ. MR imaging safety considerations of gadolinium-based contrast agents: gadolinium retention and nephrogenic systemic fibrosis. Magn Reson Imaging Clin N Am. 2020;28(4):497–507.

    Article  Google Scholar 

  20. Toth GB, Varallyay CG, Horvath A, et al. Current and potential imaging applications of ferumoxytol for magnetic resonance imaging. Kidney Int. 2017;92(1):47–66.

    Article  CAS  Google Scholar 

  21. Daldrup-Link HE. Ten things you might not know about iron oxide nanoparticles. Radiology. 2017;284(3):616–29.

    Article  Google Scholar 

  22. Knobloch G, Colgan T, Wiens C, et al. Relaxivity of ferumoxytol at 1.5 T and 3.0 T. Invest Radiol. 2018;53(5):257–63.

    Article  CAS  Google Scholar 

  23. Nguyen KL, Park EA, Yoshida T, Hu P, Finn JP. Ferumoxytol enhanced black-blood cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson. 2017;19(1):106.

    Article  Google Scholar 

  24. Wu W, Klockow JL, Mohanty S, Ku KS, Aghighi M, Melemenidis S, et al. Theranostic nanoparticles enhance the response of glioblastomas to radiation. Nanotheranostics. 2019;3(4):299–310.

    Article  Google Scholar 

  25. Prince MR, Zhang HL, Chabra SG, Jacobs P, Wang Y. A pilot investigation of new superparamagnetic iron oxide (ferumoxytol) as a contrast agent for cardiovascular MRI. J Xray Sci Technol. 2003;11(4):231–40.

    CAS  PubMed  Google Scholar 

  26. Stirrat CG, et al. Ferumoxytol-enhanced magnetic resonance imaging methodology and normal values at 1.5 and 3T. J Cardiovasc Magn Reson. 2016;18(1):1–9.

    Article  Google Scholar 

  27. Maki JH, et al. Dark blood magnetic resonance lymphangiography using dual-agent relaxivity contrast (DARC-MRL): a novel method combining gadolinium and iron contrast agents. Curr Probl Diagn Radiol. 2016;45(3):174–9.

    Article  Google Scholar 

  28. Mitsumori LM, et al. Peripheral magnetic resonance lymphangiography: techniques and applications. Tech Vasc Interv Radiol. 2016;19(4):262–72.

    Article  Google Scholar 

  29. Datta S, Satten G. A signed-rank test for clustered data. Biometrics. 2008;64:501–7.

    Article  Google Scholar 

  30. Durkalski V, Palesch Y, Lipsitz S, Rust P. Analysis of clustered matched pair data. Stat Med. 2003;22:2417–28.

    Article  Google Scholar 

  31. Gregg M. Marginal methods and software for clustered data with cluster- and group-size informativeness. PhD dissertation, University of Louisville, 2020.

  32. Gwet KL. Computing inter-rater reliability and its variance in the presence of high agreement. Br J Math Stat Psychol. 2008;61:29–48.

    Article  Google Scholar 

  33. Gregg M, Datta S, Lorenz D. htestClust: reweighted marginal hypothesis tests for clustered data. R package version 0.2.0. https://CRAN.R-project.org/package=htestClust. 2020.

  34. Nadler SBB, Hidalgo JHH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224–32.

    PubMed  Google Scholar 

  35. Data on file. AMAG Pharmaceuticals, Inc. https://www.feraheme.com/. Accessed 4 May 2021.

  36. US Food and Drug Administration. FDA drug safety communication: FDA strengthens warnings and changes prescribing instructions to decrease the risk of serious allergic reactions with anemia drug Feraheme (ferumoxytol). Accessed on March 19, 2021. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm440138.htm.

  37. Wise-Faberowski L, Velasquez N, Chan F, Vasanawala S, McElhinney DB, Ramamoorthy C. Safety of ferumoxytol in children undergoing cardiac MRI under general anaesthesia. Cardiol Young. 2018;28(7):916–21.

    Article  Google Scholar 

  38. Nguyen KL, Yoshida T, Kathuria-Prakash N, et al. Multicenter safety and practice for off-label diagnostic use of ferumoxytol in MRI. Radiology. 2019;293(3):554–64.

    Article  Google Scholar 

  39. Neuwelt EA, Hamilton BE, Varallyay CG, et al. Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)? Kidney Int. 2009;75(5):465–74.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank Drs. John Carrino and Steven P. Daniels for their motivation for the project and support.

Hospital for Special Surgery has an institutional research agreement with General Electric Healthcare.

Funding

This study was funded by a Seed Grant from the International Skeletal Society (ISS).

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Authors and Affiliations

  1. Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA

    Sophie C. Queler, Ek Tsoon Tan, Christian Geannette & Darryl B. Sneag

  2. Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, 535 E. 70th St., New York, NY, 10021, USA

    Martin Prince

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  1. Sophie C. Queler
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Correspondence to Darryl B. Sneag.

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Queler, S.C., Tan, E.T., Geannette, C. et al. Ferumoxytol-enhanced vascular suppression in magnetic resonance neurography. Skeletal Radiol 50, 2255–2266 (2021). https://doi.org/10.1007/s00256-021-03804-w

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  • DOI: https://doi.org/10.1007/s00256-021-03804-w

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