title: High-resolution, whole-body vascular imaging with ferumoxytol as an alternative to gadolinium agents in a pediatric chronic kidney disease cohort.
abstract: BACKGROUND
  Exposure to gadolinium-based contrast agents (GBCA) in patients with chronic kidney disease (CKD) has been associated with the development of a potentially fatal disorder, nephrogenic systemic fibrosis (NSF). Although contrast-enhanced computed tomography (CT) is an alternative to magnetic resonance imaging (MRI), it carries the risk of radiation exposure and further reduction of residual renal function. Therefore we sought to assess the feasibility of ferumoxytol as an alternative to GBCA for contrast-enhanced MR angiography (MRA) in a pediatric cohort with CKD. Ferumoxytol is a parenteral iron supplement that contains ultrasmall superparamagnetic iron oxide (USPIO) and is a potent relaxivity agent for MRI.
  
  
  METHODS
  We describe the MRI findings in ten pediatric patients who needed detailed vascular mapping. Ferumoxytol (4 mg/kg) was administered intravenously for contrast-enhanced MRA. The patients tolerated the procedure without complications.
  
  
  RESULTS
  Resulting studies were highly diagnostic and were pivotal in guiding patient management. The images were notable for clear delineation of multiple vascular occlusions.
  
  
  CONCLUSIONS
  Given the concerns associated with the use of GBCAs in renal failure, ferumoxytol is an excellent alternative contrast agent in pediatric end stage renal disease (ESRD) patients. Future studies are needed in order to further evaluate safety and efficacy of ferumoxytol in this patient population.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, 90095, USA, anjali-nayak@ouhsc.edu.
authors.forename: Anjali B
authors.initials: AB
authors.lastname: Nayak
authors.forename: Aarti
authors.initials: A
authors.lastname: Luhar
authors.forename: Mark
authors.initials: M
authors.lastname: Hanudel
authors.forename: Barbara
authors.initials: B
authors.lastname: Gales
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Hall
authors.forename: J Paul
authors.initials: JP
authors.lastname: Finn
authors.forename: Isidro B
authors.initials: IB
authors.lastname: Salusky
authors.forename: Joshua
authors.initials: J
authors.lastname: Zaritsky
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D052203:Ferrosoferric Oxide; D005682:Gadolinium; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D005682:Gadolinium; D052203:Ferrosoferric Oxide