Molecular Imaging of Cerebrovascular Lesions
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ORIGINAL ARTICLE
Molecular Imaging of Cerebrovascular Lesions Nohra Chalouhi & Pascal Jabbour & Vincent Magnotta & David Hasan
Received: 12 August 2013 / Revised: 23 September 2013 / Accepted: 26 September 2013 # Springer Science+Business Media New York 2013
Abstract Inflammation is a key component in the pathogenesis of cerebrovascular lesions. Two agents have emerged as promising possibilities for imaging cerebrovascular lesions. These agents are ferumoxytol and myeloperoxidase (MPO)specific paramagnetic magnetic resonance (MR) contrast agent. Ferumoxytol is an iron oxide nanoparticle coated by a carbohydrate shell that is used in MRI studies as an inflammatory marker as it is cleared by macrophages. Ferumoxytolenhanced MRI allows noninvasive assessment of the inflammatory status of cerebral aneurysms and arteriovenous malformations and, possibly, may differentiate “unstable” lesions that require early intervention from “stable” lesions that can be safely observed. Several pilot studies have also suggested that MPO-specific paramagnetic MR contrast agent, di-5-hydroxytryptamide of gadopentetate dimeglumine, may allow imaging of inflammation in the wall of saccular aneurysms in animal models. However, studies in human subjects have yet to be performed. In this paper, we review current data regarding ferumoxytol-enhanced MRI and MPOspecific paramagnetic MR contrast agent and discuss current and future applications.
Keywords Aneurysm . AVM . Inflammation . Macrophages . Ferumoxytol . MRI . Myeloperoxidase N. Chalouhi : P. Jabbour Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA V. Magnotta : D. Hasan Department of Neurosurgery, University of Iowa, Iowa City, IA, USA D. Hasan (*) University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1061, USA e-mail: [email protected]
Introduction Intracranial aneurysms (IAs) and arteriovenous malformations (AVMs) account for most cerebrovascular lesions [1]. IAs are responsible for 85 % of subarachnoid hemorrhages (SAHs), while AVMs account for 5–9 % of all cases [2, 3]. Although important therapeutic advances have been made in recent decades, the mortality rate for patients with SAH remains high [3–5]. The risk of morbidity related to microsurgical and endovascular treatment is not insignificant and should be balanced against the natural history of unruptured IAs and AVMs [6, 7]. Uncertainties, however, remain regarding the natural history of these lesions further complicating the decision to intervene or not [1]. Factors commonly taken into account when contemplating treatment for IAs include patient age, patient preference, size/morphology of aneurysm, risk factors (smoking, arterial hypertension, etc.), location of aneurysm, personal or family history of SAH, and physician judgment. These factors, however, cannot be solely relied upon for guiding therapy in all patients. For patients with unruptured AVMs, it is even debated whether an intervention is beneficial [3, 8–10]. Th
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