Using iron oxide nanoparticles to diagnose CNS inflammatory diseases and PCNSL

Abstract

Objective: The study goal was to assess the benefits and potential limitations in the use of ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles in the MRI diagnosis of CNS inflammatory diseases and primary CNS lymphoma.Methods: Twenty patients with presumptive or known CNS lesions underwent MRI study. Eighteen patients received both gadolinium-based contrast agents (GBCAs) and 1 of 2 USPIO contrast agents (ferumoxytol and ferumoxtran-10) 24 hours apart, which allowed direct comparative analysis. The remaining 2 patients had only USPIO-enhanced MRI because of a renal contraindication to GBCA. Conventional T1-and T2-weighted MRI were acquired before and after contrast administration in all patients, and perfusion MRI for relative cerebral blood volume (rCBV) assessment was obtained in all 9 patients receiving ferumoxytol.Results: USPIO-enhanced MRI showed an equal number of enhancing brain lesions in 9 of 18 patients (50%), more enhancing lesions in 2 of 18 patients (11%), and fewer enhancing lesions in 3 of 18 patients (17%) compared with GBCA-enhanced MRI. Four of 18 patients (22%) showed no MRI enhancement. Dynamic susceptibility-weighted contrast-enhanced perfusion MRI using ferumoxytol showed low rCBV (ratio ,1.0) in 3 cases of demyelination or inflammation, modestly elevated rCBV in 5 cases of CNS lymphoma or lymphoproliferative disorder (range: 1.3-4.1), and no measurable disease in one case.Conclusions: This study showed that USPIO-enhanced brain MRI can be useful in the diagnosis of CNS inflammatory disorders and lymphoma, and is also useful for patients with renal compromise at risk of nephrogenic systemic fibrosis who are unable to receive GBCA. Neurology â 2013;81:256-263 GLOSSARY CNSL 5 CNS lymphoma; DSC 5 dynamic susceptibility-weighted contrast-enhanced; GBCA 5 gadolinium-based contrast agent; NSF 5 nephrogenic systemic fibrosis; PCNSL 5 primary CNS lymphoma; PTLD 5 posttransplant lymphoproliferative disorder; PWI 5 perfusion-weighted imaging; rCBV 5 relative cerebral blood volume; USPIO 5 ultrasmall superparamagnetic iron oxide.

A comprehensive literatures update of clinical researches of superparamagnetic resonance iron oxide nanoparticles for magnetic resonance imaging

“…The uptake of USPIOs by phagocytic monocytes and macrophages provides an in vivo tool by which MRI can be used to monitor the involvement of macrophages in inflammatory processes, such as multiple sclerosis (MS), stroke, brain tumors, and vulnerable plaque in carotid artery (1,(92)(93)(94)(95)(96)(97)(98)(99).…”

“…This infiltration was associated with local higher loss of tissue structure and persistent local loss of tissue structure. Farrell et al (97) reported that ferumoxytol or ferumoxtran-10-enhanced brain MRI can be useful in the diagnosis of central nerve system inflammatory disorders (demyelination or inflammation) and lymphoma (lymphoma or lymphoproliferative disorder), and is also useful for patients with renal compromise at risk of nephrogenic systemic fibrosis who are unable to receive GBCA.…”

Bidirectional Contrast agent leakage correction of dynamic susceptibility contrast (DSC)‐MRI improves cerebral blood volume estimation and survival prediction in recurrent glioblastoma treated with bevacizumab

“…23 Furthermore, there is potentially a requirement of 2 consecutive days of imaging to obtain relatively intracellular-weighted or interstitial-weighted images, the scans that would be more analogous to the gadolinium-based anatomical scans. 24 The use of a bidirectional leakage correction model changed the estimated rCBV values significantly compared to both the standard unidirectional leakage correction model and rCBV measured without leakage correction, despite relatively short DSC-MRI acquisition times. The change from pretreatment baseline in rCBV estimated using the Bidir-model 2 months after bevacizumab therapy in recurrent GBM stratified patients according OS, whereas uncorrected and standard Unidir-model estimates of change in rCBV did not.…”

Treatment of Primary CNS Lymphoma

“…There are no specific features, which allow a reliable differentiation between PCNSL and other primary or secondary brain tumors as well as inflammatory lesions. The use of ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles may improve the MRI diagnosis of PCNSL [4]. This technique, however, has not yet entered the clinical routine examination.…”