title: Hepatic MR imaging with ferumoxides: multicenter study of safety and effectiveness of direct injection protocol.
abstract: OBJECTIVE
  To compare the safety and effectiveness of an undiluted direct injection of ferumoxides with those of a diluted slow infusion of ferumoxides during 30 minutes in patients with known liver lesions or in those suspected of having them.
  
  
  METHODS
  Two hundred thirty-three patients at 16 institutions were randomized to receive either an undiluted direct injection of 0.56 mg of iron per kilogram of body weight of ferumoxides administered during 2 minutes (2 mL/min) or a diluted slow infusion administered during 30 minutes. Safety was assessed with monitoring for adverse events and laboratory tests. For sensitivity, specificity, and accuracy analysis, two independent blinded observers identified and classified lesions as benign or malignant with precontrast images and with pre- and postcontrast images combined.
  
  
  RESULTS
  There was no statistically significant difference in adverse events in the group with direct injection compared with those in the group with infusion (21 [18%] of 114 patients vs 19 [17%] of 112 patients, respectively). No serious adverse events were observed. The most common adverse events in the group with direct injection versus the group with infusion were headache (five [4%] of 114 vs three [3%] of 112, respectively) and back pain (five [4%] of 114 vs three [3%] of 112, respectively). Overall, in 68 (62%) of 109 patients with direct injection and 71 (66%) of 108 patients with infusion, additional magnetic resonance (MR) imaging information was obtained after ferumoxides administration (P =.67). Sensitivity, specificity, and accuracy for the diagnosis of malignancy were significantly improved by adding images obtained after ferumoxides administration to the images obtained before contrast agent administration (P <.05 for all comparisons).
  
  
  CONCLUSIONS
  Direct injection of ferumoxides has safety and effectiveness profiles similar to those of slow infusion of the agent. Further findings indicate that the addition of ferumoxides increases the sensitivity and specificity of hepatic MR evaluation when compared with unenhanced MR imaging.
authors.affiliation: Johns Hopkins University School of Med, 600 N Wolfe St, Baltimore, MD 21287, USA. dbluemke@jhmi.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Therese M
authors.initials: TM
authors.lastname: Weber
authors.forename: Daniel
authors.initials: D
authors.lastname: Rubin
authors.forename: Eduard E
authors.initials: EE
authors.lastname: de Lange
authors.forename: Richard
authors.initials: R
authors.lastname: Semelka
authors.forename: Richard D
authors.initials: RD
authors.lastname: Redvanly
authors.forename: Judith
authors.initials: J
authors.lastname: Chezmar
authors.forename: Eric
authors.initials: E
authors.lastname: Outwater
authors.forename: Ruth
authors.initials: R
authors.lastname: Carlos
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saini
authors.forename: George A
authors.initials: GA
authors.lastname: Holland
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Mammone
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Brown
authors.forename: Bart
authors.initials: B
authors.lastname: Milestone
authors.forename: Marcia C
authors.initials: MC
authors.lastname: Javitt
authors.forename: Paula
authors.initials: P
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D006801:Humans; D007262:Infusions, Intravenous; D007267:Injections; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage* / Q000009:adverse effects; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D007501:Iron; C065507:ferumoxides; D052203:Ferrosoferric Oxide