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Cardiovascular MRI with ferumoxytol
J P Finn1, K-L Nguyen2, F Han1
1Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Abstract:
The practice of contrast-enhanced magnetic resonance angiography (CEMRA) has changed significantly in the span of a decade. Concerns regarding gadolinium (Gd)-associated nephrogenic systemic fibrosis in those with severely impaired renal function spurred developments in low-dose CEMRA and non-contrast MRA as well as efforts to seek alternative MR contrast agents. Originally developed for MR imaging use, ferumoxytol (an ultra-small superparamagnetic iron oxide nanoparticle), is currently approved by the US Food and Drug Administration for the treatment of iron deficiency anaemia in adults with renal disease. Since its clinical availability in 2009, there has been rising interest in the scientific and clinical use of ferumoxytol as an MR contrast agent. The unique physicochemical and pharmacokinetic properties of ferumoxytol, including its long intravascular half-life and high r1 relaxivity, support a spectrum of MRI applications beyond the scope of Gd-based contrast agents. Moreover, whereas Gd is not found in biological systems, iron is essential for normal metabolism, and nutritional iron deficiency poses major public health challenges worldwide. Once the carbohydrate shell of ferumoxytol is degraded, the elemental iron at its core is incorporated into the reticuloendothelial system. These considerations position ferumoxytol as a potential game changer in the field of CEMRA and MRI. In this paper, we aim to summarise our experience with the cardiovascular applications of ferumoxytol and provide a brief synopsis of ongoing investigations on ferumoxytol-enhanced MR applications.
Insights
Ferumoxytol, an iron-based nanoparticle, shows promise as a novel contrast agent for magnetic resonance angiography (MRA). Its unique properties offer a safer alternative to gadolinium-based agents, particularly for patients with kidney disease.
Area of Science:
- Radiology
- Nanotechnology
- Cardiovascular Imaging
Background:
- Contrast-enhanced magnetic resonance angiography (CEMRA) practices have evolved due to safety concerns with gadolinium (Gd)-based contrast agents, particularly nephrogenic systemic fibrosis in renal impairment.
- This has driven the development of low-dose CEMRA, non-contrast MRA, and alternative contrast agents.
- Ferumoxytol, an ultra-small superparamagnetic iron oxide nanoparticle, is FDA-approved for anemia in renal disease and has gained interest as an MRI contrast agent.
Purpose of the Study:
- To summarize cardiovascular applications and ongoing investigations of ferumoxytol as a magnetic resonance imaging (MRI) contrast agent.
- To highlight ferumoxytol's potential as a game-changer in CEMRA and MRI.
Main Methods:
- Review of clinical experience with cardiovascular applications of ferumoxytol.
- Synopsis of ongoing research into ferumoxytol-enhanced MR applications.
Main Results:
- Ferumoxytol possesses unique physicochemical and pharmacokinetic properties, including a long intravascular half-life and high r1 relaxivity.
- These properties support a broad range of MRI applications, potentially exceeding those of Gd-based agents.
- Iron, unlike Gd, is essential for human metabolism, and ferumoxytol's iron core is incorporated into the reticuloendothelial system after degradation.
Conclusions:
- Ferumoxytol's safety profile and biological relevance position it as a significant advancement in CEMRA and MRI.
- Its potential extends beyond current Gd-based contrast agent applications.
- Further research into ferumoxytol-enhanced MR applications is warranted.
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