title: Ferumoxytol as an off-label contrast agent in body 3T MR angiography: a pilot study in children.
abstract: BACKGROUND
  Ferumoxytol is an ultrasmall superparamagnetic iron oxide (USPIO) nanoparticle agent used to treat iron deficiency anemia in adults with chronic kidney disease.
  
  
  OBJECTIVE
  We aim to determine the feasibility of using ferumoxytol for clinical pediatric cardiac and vascular imaging.
  
  
  METHODS
  We retrospectively identified 23 consecutive children who underwent MRI with ferumoxytol (11 males; mean age: 7.4 years, range: 3 days-18 years), yielding 12 abdominal MR angiography and 15 cardiac MRI studies. Medical records were reviewed for the clinical indication, ferumoxytol dose, injection rate, sedation and any complication. A two-reader consensus scored the images on a five-point scale for overall image quality and delineation of various anatomical structures. Signal-to-background ratios for abdominal aorta and inferior vena cava for abdominal cases and blood pool-myocardium contrast ratios for cardiac cases were calculated. The confidence intervals for obtaining a score of three or above for each image parameter were calculated by using adjusted Wald method.
  
  
  RESULTS
  For abdominal MR angiography, average scores for overall image quality, as well as delineation of the hepatic artery, superior mesenteric artery, renal artery and veins were 4.5, 4.3, 4.3, 3.7 and 4.7, respectively. For cardiac exams, the average scores for overall image quality, systemic arteries, pulmonary arteries, pulmonary veins, valves and ventricles were 4.4, 4.6, 4.1, 4.8, 4.1 and 4.7, respectively. For all parameters, the lower bound for the proportion of cases to have a score of 3 or above was 65%. Signal-to-background ratios for aorta and abdominal veins averaged 86 +/- 74 and 86 +/- 77 for full-dose images, and 23 and 18 for half-dose images, respectively. Mean blood pool to myocardium contrast ratio was 3:3.
  
  
  CONCLUSIONS
  Ferumoxytol can provide excellent image quality for pediatric body MR angiography/MR venography at a dose of 1.5 or 3 mg Fe/kg. Further investigation should be directed toward understanding the lowest dose that can be administered.
authors.affiliation: Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Nichanan
authors.initials: N
authors.lastname: Ruangwattanapaisarn
authors.forename: Albert
authors.initials: A
authors.lastname: Hsiao
authors.forename: Shreyas S
authors.initials: SS
authors.lastname: Vasanawala
mesh_terms: D000293:Adolescent; D055424:Cardiac-Gated Imaging Techniques; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D052203:Ferrosoferric Oxide / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D056687:Off-Label Use; D010865:Pilot Projects; D012189:Retrospective Studies; D059629:Signal-To-Noise Ratio
chemical_list: D003287:Contrast Media; D052203:Ferrosoferric Oxide