Ferumoxytol-Enhanced MRI to Image Inflammation Within Human Brain Arteriovenous Malformations: a Pilot Investigation
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ORIGINAL ARTICLE
Ferumoxytol-Enhanced MRI to Image Inflammation Within Human Brain Arteriovenous Malformations: a Pilot Investigation David M. Hasan & Matthew Amans & Tarik Tihan & Christopher Hess & Yi Guo & Soonmee Cha & Hua Su & Alastair J. Martin & Michael T. Lawton & Edward A. Neuwelt & David A. Saloner & William L. Young
Received: 24 February 2012 / Revised: 29 March 2012 / Accepted: 2 April 2012 / Published online: 15 May 2012 # Springer Science+Business Media, LLC 2012
Abstract Inflammation cell infiltration and cytokine expression are seen in the vascular walls and intervening stroma of resected brain arteriovenous malformation (bAVM) specimens, even in unruptured and previously untreated lesions. Macrophages may play a critical role in bAVM progression to rupture and could serve as a marker for rupture risk. We assessed feasibility of imaging macrophages within the bAVM nidus using ferumoxytol-enhanced magnetic resonance imaging (MRI) in four patients with already diagnosed bAVMs using iron-sensitive imaging (ISI; T2* GE MRI sequence). Patients were imaged at baseline and at either 1 day (n02) or 5 days (n0 2) after infusion of 5 mg/kg of ferumoxytol. Residual intravas-
cular ferumoxytol obscured evaluation for uptake in bAVM vascular walls and stroma at the 1-day time point. The two cases imaged at 5 days showed less intravascular tracer but had signal loss in the nidal region consistent with ferumoxytol localization. One case underwent surgical resection; there was prominent vascular wall CD68 staining. Ferumoxytolenhanced MRI for assessing bAVM inflammatory cell burden appears feasible and has the potential to be developed as a biomarker to study lesional inflammatory events. Keywords Arteriovenous malformations . Inflammation . Magnetic resonance imaging . Ferumoxytol . USPIO
Hasan and Amans contributed equally to this work D. M. Hasan Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
E. A. Neuwelt Departments of Neurological Surgery and Neurology, Oregon Health & Science University, Portland, OR, USA
M. Amans : C. Hess : S. Cha : A. J. Martin : D. A. Saloner Department of Radiology, University of California, San Francisco, San Francisco, CA, USA Y. Guo : H. Su : W. L. Young Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA T. Tihan Department of Pathology, University of California, San Francisco, San Francisco, CA, USA M. T. Lawton : W. L. Young Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
W. L. Young Department of Neurology, University of California San Francisco, San Francisco, CA, USA
W. L. Young (*) Department of Anesthesia and Perioperative Care, University of California, San Francisco, 1001 Potrero Ave, Room 3C-38, San Francisco, CA 94110, USA e-mail: [email protected]
Transl. Stroke Res. (2012) 3 (Suppl 1):S166–S173
Abbreviations bAVM Brain arteriovenous malformation GE Gradient ec
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