title: Potential for differentiation of pseudoprogression from true tumor progression with dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging using ferumoxytol vs. gadoteridol: a pilot study.
abstract: OBJECTIVE
  We evaluated dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging (DSC-MRI) using gadoteridol in comparison to the iron oxide nanoparticle blood pool agent, ferumoxytol, in patients with glioblastoma multiforme (GBM) who received standard radiochemotherapy (RCT).
  
  
  METHODS
  Fourteen patients with GBM received standard RCT and underwent 19 MRI sessions that included DSC-MRI acquisitions with gadoteridol on Day 1 and ferumoxytol on Day 2. Relative cerebral blood volume (rCBV) values were calculated from DSC data obtained from each contrast agent. T1-weighted acquisition post-gadoteridol administration was used to identify enhancing regions.
  
  
  RESULTS
  In seven MRI sessions of clinically presumptive active tumor, gadoteridol-DSC showed low rCBV in three and high rCBV in four, whereas ferumoxytol-DSC showed high rCBV in all seven sessions (p = 0.002). After RCT, seven MRI sessions showed increased gadoteridol contrast enhancement on T1-weighted scans coupled with low rCBV without significant differences between contrast agents (p = 0.9). Based on post-gadoteridol T1-weighted scans, DSC-MRI, and clinical presentation, four patterns of response to RCT were observed: regression, pseudoprogression, true progression, and mixed response.
  
  
  CONCLUSIONS
  We conclude that DSC-MRI with a blood pool agent such as ferumoxytol may provide a better monitor of tumor rCBV than DSC-MRI with gadoteridol. Lesions demonstrating increased enhancement on T1-weighted MRI coupled with low ferumoxytol rCBV are likely exhibiting pseudoprogression, whereas high rCBV with ferumoxytol is a better marker than gadoteridol for determining active tumor. These interesting pilot observations suggest that ferumoxytol may differentiate tumor progression from pseudoprogression and warrant further investigation.
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR 97239-3098, USA.
authors.forename: Seymur
authors.initials: S
authors.lastname: Gahramanov
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Raslan
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Muldoon
authors.forename: Bronwyn E
authors.initials: BE
authors.lastname: Hamilton
authors.forename: William D
authors.initials: WD
authors.lastname: Rooney
authors.forename: Csanad G
authors.initials: CG
authors.lastname: Varallyay
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Njus
authors.forename: Marianne
authors.initials: M
authors.lastname: Haluska
authors.forename: Edward A
authors.initials: EA
authors.lastname: Neuwelt
mesh_terms: D000328:Adult; D000368:Aged; D001810:Blood Volume; D001812:Blood-Brain Barrier; D001932:Brain Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D052203:Ferrosoferric Oxide; D005682:Gadolinium; D005909:Glioblastoma / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D006571:Heterocyclic Compounds; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D058185:Magnetite Nanoparticles; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium; D052203:Ferrosoferric Oxide
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