Magnetic resonance imaging of intracranial tumors: intra-patient comparison of gadoteridol and ferumoxytol

Abstract

This study aims to compare gadoteridol with ferumoxytol for contrast-enhanced and perfusion-weighted (PW) MRI of intracranial tumors. The final analysis included 26 patients, who underwent 3 consecutive days of 3T MRI. Day 1 consisted of anatomical pre- and postcontrast images, and PW MRI was acquired using gadoteridol (0.1 mmol/kg). On Day 2, the same MRI sequences were obtained with ferumoxytol (510 mg) and on Day 3, the anatomical images were repeated to detect delayed ferumoxytol-induced signal changes. The T₁-weighted images were evaluated qualitatively and quantitatively for enhancement volume and signal intensity (SI) changes; PW data were used to estimate the relative cerebral blood volume (rCBV). All 26 lesions showed 24-hour T₁-weighted ferumoxytol enhancement; 16 also had T₂-weighted hypointensities. In 6 patients, ferumoxytol-induced signal changes were noted in areas with no gadoteridol enhancement. Significantly greater (P< .0001) SI changes were seen with gadoteridol, and qualitative analyses (lesion border delineation, internal morphology, contrast enhancement) also showed significant preferences (P= .0121; P = .0015; P < .0001, respectively) for this agent. There was no significant difference in lesion enhancement volumes between contrast materials. The ferumoxytol-rCBV values were significantly higher (P = .0016) compared with the gadoteridol-rCBV values. In conclusion, ferumoxytol provides important information about tumor biology that complements gadoteridol imaging. The rCBV measurements indicate areas of tumor undergoing rapid growth, whereas the 24-hour scans mark the presence of inflammatory cells. Both of these functions provide useful information about tumor response to treatment. We suggest that dynamic and anatomical imaging with ferumoxytol warrant further assessment in brain tumor therapy.

In vivo nanoparticle imaging of innate immune cells can serve as a marker of disease severity in a model of multiple sclerosis

“…This correlation was confirmed on the cellular level where CLIO uptake by macrophages correlated significantly with the clinical score. Iron oxide nanoparticle imaging has been performed in a wide variety of diseases (16,17,(33)(34)(35), but apart from liver imaging (36), iron oxide imaging has not yet been translated into clinical practice, partially because of economic, safety, and technical reasons (37)(38)(39)(40). However, imaging of inflammation is of major clinical interest.…”

“…Flow cytometric analyses were performed to phenotype inflammatory infiltrates. Finally, we used the Food and Drug Administration (FDA)-approved iron oxide nanoparticle ferumoxytol (16)(17)(18)(19)(20) to corroborate the clinical potential of our approach. Clearing of Mouse Brains and Acquisition of UM Data.…”

Using iron oxide nanoparticles to diagnose CNS inflammatory diseases and PCNSL

“…Exclusion criteria have been reported previously. 18,19 Patients who were HIV positive receiving combination antiretroviral therapy were ineligible because of the potential for pharmacokinetic interactions with USPIO agents.…”

A Review of Clinical Translation of Inorganic Nanoparticles

“…Here, we will highlight a few of these recent examples. The first study directly compared ferumoxytol and gadoteridol, a commonly used MRI contrast agent, in a patient with glioblastoma multiforme (69). One of the main issues with gadoteridol is that this class of contrast enhancing agents are connected to nephrogenic systemic fibrosis, which has limited use of gadoteridol agents in patients with low glomerular filtration rates (70).…”

“…This patient showed ferumoxytol enhancement in areas that did not appear in the gadoteridol contrast images. This enhancement was attributed to the presence of inflammatory cells, since ferumoxytol will be internalized by macrophages, by virtue of being a nanoparticle (69). Most recently, ferumoxytol has been clinically investigated to capture the initiation and progression of type-1 diabetes, which has proven to be especially challenging to visualize in a noninvasive way.…”