4D flow image quality with blood pool contrast: a comparison of gadofosveset trisodium and ferumoxytol

Abstract

To evaluate the effect of MRI blood pool contrast agent on 4D flow image quality and ventricular volume measurements. Adult patients referred for clinical cardiac MRI (n = 22) were imaged with 4D flow. Patients with renal failure (n = 10) received ferumoxytol, and the remainder (n = 12) received gadofosveset trisodium. Image quality was assessed with (1) signal-to-noise ratio (SNR); (2) contrast-to-noise ratio (CNR); and (3) 5-point Likert scale based on endocardial border definition (1 = none; 2 = partial but unable to visualize; 3 = able to roughly estimate; 4 = visible for most of the cardiac cycle; 5 = excellent definition). A subset (n = 15) had short axis steady-state free precession (SSFP) cine imaging allowing for comparison of standard volumetric measurement technique with 4D flow derived volumetric measurements. 4D flow studies using ferumoxytol demonstrated a higher median Likert score of 5 (IQR, 5-5) versus 3 (IQR, 2-3). Median cavity SNR and CNR were higher for ferumoxytol compared to gadofosveset trisodium [65 (IQR, 50-74) versus 22 (IQR, 14-28), p < 0.001; and 40 (IQR, 32-49) versus 4 (IQR, 3-10), p < 0.001]. Good correlation (p < 0.001) was seen between SSFP and 4D flow measured ventricular volumes (ESV and EDV) with ferumoxytol (r = 0.998, mean difference = 1.2 mL, LOA = - 7.7-10.1 mL) and gadofosveset trisodium (r = 0.942, mean difference = - 2.7 mL, LOA = - 35.7-27.1 mL). Ferumoxytol used off-label as an MRI blood pool contrast agent offers an attractive alternative to gadofosveset trisodium in patients with renal failure, with excellent 4D flow image quality and good correlation of volumetric measurements compared to the CMR reference (SSFP).

Volumetric Fetal Flow Imaging with Magnetic Resonance Imaging

“…To achieve good contrast in conventional clinical 4D flow MRI, contrast agents (such as ferumoxytol and gadolinium) are injected [26]. However, contrast agents have disadvantages.…”

Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging

“…Kamphuis et al found good scanrescan reproducibility of diastolic left ventricular kinetic energy, viscous energy loss, and vorticity assessment [74]. Ferumoxytol was found to be a good alternative to gadofosveset trisodium for 4D flow image quality [75]. Pulse wave velocity calculated from 4D flow of the aorta at 3T and was found to significantly correlated to measures of arterial stiffness determined with transesophageal echocardiography in stroke patients [76].…”

Hemodynamic Assessment of Structural Heart Disease Using 4D Flow MRI: How We Do It

“…This strategy maximizes SNR for vascular luminal visualization and therefore VNR for flow quantification. Iron-based contrast, ferumoxytol, is also effective for maximizing intravascular SNR [8][9][10], though we use this infrequently in adult patients due to logistical hurdles, cost, and inability to provide myocardial delayed enhancement.…”