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Ferumoxytol-enhanced ultrashort TE MRA and quantitative morphometry of the human kidney vasculature

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Abstract

Purpose

To evaluate the feasibility of Quantitative Ultrashort-Time-to-Echo Contrast-Enhanced (QUTE-CE) MRA using ferumoxytol as a contrast agent for abdominal angiography in the kidney.

Methods

Four subjects underwent ferumoxytol-enhanced MRA with the 3D UTE Spiral VIBE WIP sequence at 3 T. Image quality metrics were quantified, specifically the blood Signal-to-Noise Ratio (SNR), blood-tissue Contrast-to-Noise Ratio (CNR) and Intraluminal Signal Heterogeneity (ISH) from both the aorta and inferior vena cava (IVC). Morphometric analysis of the vessels was performed using manual approach and semi-automatic approach using Vascular Modeling ToolKit (VMTK). Image quality and branching order were compared between QUTE-CE MRA and the Gadolinium (Gd) CEMRA reference image.

Results

QUTE-CE MRA provides a bright blood snapshot that delineates arteries and veins equally in the same scan. The maximum SNR and CNR values were 3,282 ± 1,218 and 1,295 ± 580, respectively – significantly higher than available literature values using other CEMRA techniques. QUTE-CE MRA had lower ISH and depicted higher vessel branching order (7th vs 3rd) within the kidney compared to a standard dynamic clinical Gd CEMRA scan. Morphometric analysis yielded quantitative results for the total kidney volume, total cyst volume and for diameters of the branching arterial network down to the 7th branch. Vessel curvature was significantly increased (p < 0.001) in the presence of a renal cyst compared to equivalent vessels in normal kidney regions.

Conclusion

QUTE-CE MRA is feasible for kidney angiography, providing greater detail of kidney vasculature, enabling quantitative morphometric analysis of the abdominal and intra-renal vessels and yielding metrics relevant to vascular diseases while using a contrast agent ferumoxytol that is safe for CKD patients.

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Availability of data and material

All data analyzed during this study were included in this manuscript and its supplementary information.

Code availability

Advanced Normalization Toolkit (ANTS, http://stnava.github.io/ANTs/), 3D Slicer (http://www.slicer.org), Vascular Modeling ToolKit (VMTK, www.vmtk.org).

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Acknowledgments

We acknowledge Dr. John E. Kirsch for helpful advice on experimental setup.

Funding

This study was funded by National Institutes of Health (Grant numbers 1R41DA043974-01 and 1R21DK118449-01).

Author information

Author notes

  1. Liam Timms and Tianyi Zhou have shared the first authorship.

Authors and Affiliations

  1. Northeastern University, Boston, MA, USA

    Liam Timms, Tianyi Zhou, Yue Lyu, Ju Qiao & Srinivas Sridhar

  2. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Vishala Mishra, Rita Maria Lahoud & Mukesh Harisinghani

  3. Department of Nephrology, Massachusetts General Hospital, Boston, MA, USA

    Gayatri Veeramani Jayaraman & Andrew S. Allegretti

  4. Department of Nephrology, Brigham and Women’s Hospital, Boston, MA, USA

    Gayatri Veeramani Jayaraman

  5. Tufts Medical Center, Boston, MA, USA

    David Drew

  6. Siemens Medical Solutions, Boston, MA, USA

    Ravi T. Seethamraju

  7. Theranano LLC, Newton, MA, USA

    Srinivas Sridhar

  8. 435 Egan Research Center, 120 Forsyth Street, Boston, MA, 02115, USA

    Srinivas Sridhar

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Contributions

LT, MH and SS contributed to the study concept and design. LT, JQ, RML, VM, AA, GVJ and MH contributed to data acquisition. Data analysis were performed by LT, TZ and YL. The manuscript was drafted by LT, TZ and SS. Critical editing and revision of the manuscript was done by LT, TZ, SS, RTS, and DD. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Srinivas Sridhar.

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Conflict of interest

RTS reports personal fees from Siemens Medical Solutions, Inc., outside the submitted work. SS reports grants from Theranano LLC and grants from Northeastern University, during the conduct of the study; In addition, SS has a patent WO2017019182A1 pending.

Ethical approval

This study was conducted with approval by the Massachusetts General Hospital Institutional Review board IRB:2017P001262. All procedures performed in the study involving human participants were Heal Insurance Portability and Accountability Act (HIPAA) compliant.

Consent to participate

Subjects provided informed written consent for the imaging procedure which is an off-label use of ferumoxytol.

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Timms, L., Zhou, T., Lyu, Y. et al. Ferumoxytol-enhanced ultrashort TE MRA and quantitative morphometry of the human kidney vasculature. Abdom Radiol 46, 3288–3300 (2021). https://doi.org/10.1007/s00261-021-02984-2

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  • DOI: https://doi.org/10.1007/s00261-021-02984-2

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