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How to stop using gadolinium chelates for magnetic resonance imaging: clinical-translational experiences with ferumoxytol

  • Pediatric Body MRI
  • Published:
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Abstract

Gadolinium chelates have been used as standard contrast agents for clinical MRI for several decades. However, several investigators recently reported that rare Earth metals such as gadolinium are deposited in the brain for months or years. This is particularly concerning for children, whose developing brain is more vulnerable to exogenous toxins compared to adults. Therefore, a search is under way for alternative MR imaging biomarkers. The United States Food and Drug Administration (FDA)-approved iron supplement ferumoxytol can solve this unmet clinical need: ferumoxytol consists of iron oxide nanoparticles that can be detected with MRI and provide significant T1- and T2-signal enhancement of vessels and soft tissues. Several investigators including our research group have started to use ferumoxytol off-label as a new contrast agent for MRI. This article reviews the existing literature on the biodistribution of ferumoxytol in children and compares the diagnostic accuracy of ferumoxytol- and gadolinium-chelate-enhanced MRI. Iron oxide nanoparticles represent a promising new class of contrast agents for pediatric MRI that can be metabolized and are not deposited in the brain.

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Acknowledgments

This study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD, R01 HD081123A) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR054458).

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Authors and Affiliations

  1. Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Stanford, CA, 94305-5614, USA

    Heike E. Daldrup-Link, Ashok J. Theruvath, Ali Rashidi, Michael Iv & Michael Moseley

  2. Division of Hematology/Oncology, Department of Pediatrics, Stanford University, Stanford, CA, USA

    Heike E. Daldrup-Link, Robbie G. Majzner & Sheri L. Spunt

  3. Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA

    Stuart Goodman

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  1. Heike E. Daldrup-Link
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  4. Michael Iv
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Correspondence to Heike E. Daldrup-Link.

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Daldrup-Link, H.E., Theruvath, A.J., Rashidi, A. et al. How to stop using gadolinium chelates for magnetic resonance imaging: clinical-translational experiences with ferumoxytol. Pediatr Radiol 52, 354–366 (2022). https://doi.org/10.1007/s00247-021-05098-5

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