Four-dimensional Multiphase Steady-State MRI with Ferumoxytol Enhancement: Early Multicenter Feasibility in Pediatric Congenital Heart Disease

Nguyen, Kim‐Lien; Ghosh, Reena M.; Griffin, Lindsay; Yoshida, Takegawa; Bedayat, Arash; Rigsby, Cynthia K.; Fogel, Mark A.; Whitehead, Kevin K.; Hu, Peng; Finn, J. Paul

doi:10.1148/radiol.2021203696

Cited by 20 publications

(12 citation statements)

References 21 publications

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“…In our cohort, a similar score was achieved with the single native MTC-BOOST sequence. A recent multicenter study in pediatric patients with CHD proposed the use of feromuxytol-enhanced four-dimensional multiphase steady-state imaging with fast acquisition time to dynamically capture all anatomic features ( 23 ). However, off-label use of feromuxytol in MRI is currently approved only in the United States.…”

Section: Discussionmentioning

confidence: 99%

Free-breathing, Contrast Agent–free Whole-Heart MTC-BOOST Imaging: Single-Center Validation Study in Adult Congenital Heart Disease

Fotaki¹,

Pushparajah²,

Hajhosseiny³

et al. 2023

Radiology: Cardiothoracic Imaging

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Purpose To assess the clinical performance of the three-dimensional, free-breathing, Magnetization Transfer Contrast Bright-and-black blOOd phase-SensiTive (MTC-BOOST) sequence in adult congenital heart disease (ACHD). Materials and Methods In this prospective study, participants with ACHD undergoing cardiac MRI between July 2020 and March 2021 were scanned with the clinical T2-prepared balanced steady-state free precession sequence and proposed MTC-BOOST sequence. Four cardiologists scored their diagnostic confidence on a four-point Likert scale for sequential segmental analysis on images acquired with each sequence. Scan times and diagnostic confidence were compared using the Mann-Whitney test. Coaxial vascular dimensions at three anatomic landmarks were measured, and agreement between the research sequence and the corresponding clinical sequence was assessed with Bland-Altman analysis. Results The study included 120 participants (mean age, 33 years ± 13 [SD]; 65 men). The mean acquisition time of the MTC-BOOST sequence was significantly lower compared with that of the conventional clinical sequence (9 minutes ± 2 vs 14 minutes ± 5; P < .001). Diagnostic confidence was higher for the MTC-BOOST sequence compared with the clinical sequence (mean, 3.9 ± 0.3 vs 3.4 ± 0.7; P < .001). Narrow limits of agreement and mean bias less than 0.08 cm were found between the research and clinical vascular measurements. Conclusion The MTC-BOOST sequence provided efficient, high-quality, and contrast agent–free three-dimensional whole-heart imaging in ACHD, with shorter, more predictable acquisition time and improved diagnostic confidence compared with the reference standard clinical sequence. Keywords: MR Angiography, Cardiac Supplemental material is available for this article. Published under a CC BY 4.0 license

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Section: Discussionmentioning

confidence: 99%

Free-breathing, Contrast Agent–free Whole-Heart MTC-BOOST Imaging: Single-Center Validation Study in Adult Congenital Heart Disease

Fotaki¹,

Pushparajah²,

Hajhosseiny³

et al. 2023

Radiology: Cardiothoracic Imaging

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“…Due to its long intravascular half-life of more than 15 h, ferumoxytol is considered a true blood pool agent [ 35 ]. The long steady state intravascular half-life provides opportunities for repeat scans without loss of image quality, as well as for more time-consuming sequences such as 4D MRA (MUSIC) and 4D flow [ 24 ]. The r1 relaxivity is also several-fold higher for ferumoxytol as compared to available GBCAs [ 26 ].…”

Section: Evolution Of Cmr/mra Contrast Agentsmentioning

confidence: 99%

“…The challenges involved in imaging CHD include (1) complex intracardiac and extracardiac vascular anatomy, (2) requirement for high temporal and spatial resolution, (3) need for repeated examinations over a lifetime, (4) anesthesia in younger patients and some older patients, (5) and regional variability in CMR availability and/or CHD expertise. These, and other challenges, can potentially be addressed through the use of ferumoxytol [ 6 , 8 , 18 , 24 , 41 , 45 ].…”

Section: Ferumoxytol-enhanced Mra (Fe-mra) and 4d Phase Contrast Mri ...mentioning

confidence: 99%

Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease

Renella

Prosper³

et al. 2022

Children

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Cardiac magnetic resonance imaging and angiography have a crucial role in the diagnostic evaluation and follow up of pediatric and adult patients with congenital heart disease. Although much of the information required of advanced imaging studies can be provided by standard gadolinium-enhanced magnetic resonance imaging, the limitations of precise bolus timing, long scan duration, complex imaging protocols, and the need to image small structures limit more widespread use of this modality. Recent experience with off-label diagnostic use of ferumoxytol has helped to mitigate some of these barriers. Approved by the U.S. FDA for intravenous treatment of anemia, ferumoxytol is an ultrasmall superparamagnetic iron oxide nanoparticle that has a long blood pool residence time and high relaxivity. Once metabolized by macrophages, the iron core is incorporated into the reticuloendothelial system. In this work, we aim to summarize the evolution of ferumoxytol-enhanced cardiovascular magnetic resonance imaging and angiography and highlight its many applications for congenital heart disease.

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“…The comprehensive sequences use respiratory navigation obviating the need for breath holds. A recent multicentre study was performed by Nguyen et al [21 ▪▪ ] using 4D flow with ferumoxytol enhancement. Ferumoxytol, itself a CMR innovation, is an intravenous iron-based contrast agent with a considerably longer half-life than gadolinium-based contrast agents.…”

Section: Future Directionsmentioning

confidence: 99%

Use of advanced cardiac imaging in congenital heart disease: growth, indications and innovations

Steele

Moore

Lang

2021

Current Opinion in Pediatrics

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Purpose of review Significant improvements in the diagnosis and management of patients with congenital heart disease (CHD) have led to improved survival. These patients require life-long noninvasive evaluation. The use of advanced imaging such as cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT) has increased to support this need. The purpose of this review is to discuss the basics of advanced cardiac imaging, indications and review the recent innovations. Recent findings Recent literature has demonstrated the increasing reliance of advanced imaging for CHD patients. In addition, research is focusing on CMR techniques to shorten scan time and address previous limitations that made imaging younger and sicker patients more challenging. CCT research has involved demonstrating high-quality images with low radiation exposure. Advances in digital technology have impacted the interactivity of 3D imaging through the use of virtual and augmented reality platforms. With the increased reliance of advanced imaging, appropriate use criteria have been developed to address possible under or over utilization. Summary The utilization of advanced cardiac imaging continues to increase. As CMR and CCT continue to grow, increased knowledge of these modalities and their usage will be necessary for clinicians caring for CHD patients.

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Four-dimensional Multiphase Steady-State MRI with Ferumoxytol Enhancement: Early Multicenter Feasibility in Pediatric Congenital Heart Disease

Cited by 20 publications

References 21 publications

Free-breathing, Contrast Agent–free Whole-Heart MTC-BOOST Imaging: Single-Center Validation Study in Adult Congenital Heart Disease

Free-breathing, Contrast Agent–free Whole-Heart MTC-BOOST Imaging: Single-Center Validation Study in Adult Congenital Heart Disease

Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease

Use of advanced cardiac imaging in congenital heart disease: growth, indications and innovations

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