Vascular applications of ferumoxytol-enhanced magnetic resonance imaging of the abdomen and pelvis
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REVIEW
Vascular applications of ferumoxytol‑enhanced magnetic resonance imaging of the abdomen and pelvis Andrew W. Bowman1 · Cory R. Gooch1 · Lauren F. Alexander1 · Madhura A. Desai1 · Candice W. Bolan1 Received: 2 June 2020 / Revised: 1 October 2020 / Accepted: 10 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Ferumoxytol is an injectable ultrasmall superparamagnetic iron oxide that has been gaining interest regarding its off-label use as an intravenous contrast agent in magnetic resonance imaging (MRI). Due to its large particle size, its use with MRI produces exquisite images of blood vessels with little background contamination or parenchymal enhancement of the abdominopelvic organs, except for the liver and spleen. Because ferumoxytol is neither an iodinated nor a gadolinium-based contrast agent, there are no restrictions for its use in patients with poor renal function. This article will highlight normal features in ferumoxytol-enhanced MRI in the abdomen and pelvis as well as its applications in evaluating vascular pathology, presurgical planning, and other problem solving. Keywords Ferumoxytol · Magnetic resonance imaging · Transplant imaging · Deep inferior epigastric perforator free flap
Introduction Ferumoxytol (Feraheme, AMAG Pharmaceuticals, Cambridge, MA) is a commercially available injectable ultrasmall superparamagnetic iron oxide (USPIO) originally approved by the U.S. Food and Drug Administration (FDA) in 2009 for use as an iron replacement product for the treatment of iron deficiency anemia in adults with chronic kidney disease [1, 2]. It is a semisynthetic, carbohydrate-coated nanoparticle which, when injected intravenously, has a long intravascular half-life of 14–21 h before being taken up by the mononuclear phagocyte system of the liver, spleen, lymph nodes, and bone marrow [3]. Ferumoxytol’s overall colloidal particle size is 17–31 nm in diameter which plays a significant role in its intravascular retention time. This long intravascular half-life has led to recent investigations regarding its off-label use as an intravenous contrast agent in magnetic resonance imaging (MRI). Similar to other iron oxides, ferumoxytol shortens T1, T2, and T2* relaxation times, though the degree to which this occurs is dependent on magnetic field strength [4, 5]. Regardless, at clinically applicable field strengths, * Andrew W. Bowman [email protected] 1
Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
ferumoxytol administration demonstrates hyperintense intravascular enhancement on T1-weighted images. Its prolonged intravascular half-life allows for blood pool imaging, with the ability to repeat delayed imaging hours to days later if necessary without administration of additional contrast. Additionally, as ferumoxytol is neither a gadolinium-based or iodinated contrast agent, there are no restrictions for its use in patients with diminished renal function. A summary of ferumoxytol’s advantages and disadvantages a
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