Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)?
Gadolinium (Gd) based contrast agents (GBCAs) in magnetic resonance imaging (MRI) are used in daily clinical practice and appear safe in most patients; however, nephrogenic systemic fibrosis (NSF) is a recently recognized severe complication associated with GBCAs. It affects primarily patients with renal disease, such as stage 4 or 5 chronic kidney disease (CKD; glomerular filtration rate <30 ml/min per 1.73 m(2)), acute kidney injury, or kidney and liver transplant recipients with kidney dysfunction. Contrast-enhanced MRI and computed tomography (CT) scans provide important clinical information and influence patient management. An alternative contrast agent is needed to obtain adequate imaging results while avoiding the risk of NSF in this vulnerable patient group. One potential alternative is ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles, which provide enhancement characteristics similar to GBCAs. We review our experience in approximately 150 patients on the potential benefits of the USPIOs ferumoxtran-10 and ferumoxytol. We focus on central nervous system (CNS) MRI but also review imaging of other vascular beds. Safety studies, including USPIO administration (ferumoxytol) as iron supplement therapy in CKD patients on and not on dialysis, suggest that decreased kidney function does not alter the safety profile. We conclude that for both CNS MR imaging and MR angiography, USPIO agents like ferumoxytol are a viable option for patients at risk for NSF.
Department of Neurology and Neurosurgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
Edward A
EA
Neuwelt
Bronwyn E
BE
Hamilton
Csanad G
CG
Varallyay
William R
WR
Rooney
Robert D
RD
Edelman
Paula M
PM
Jacobs
Suzanne G
SG
Watnick
D002490:Central Nervous System / Q000473:pathology; D002908:Chronic Disease; D003287:Contrast Media / Q000009:adverse effects*; D003911:Dextrans; D052203:Ferrosoferric Oxide / Q000633:toxicity; D005682:Gadolinium / Q000633:toxicity; D005919:Glomerular Filtration Rate; D006801:Humans; D007501:Iron / Q000633:toxicity; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D053758:Nanoparticles / Q000633:toxicity; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced / Q000517:prevention & control*; D010087:Oxides / Q000633:toxicity; D012307:Risk Factors
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; C097921:ferumoxtran-10; D005682:Gadolinium; D007501:Iron; D052203:Ferrosoferric Oxide