title: Contrast-enhanced magnetic resonance venography in pediatric patients with chronic kidney disease: initial experience with ferumoxytol.
abstract: Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) particle that is FDA-approved for parenteral treatment of iron deficiency anemia in adults with chronic kidney disease. Because of the association between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with severe chronic kidney disease, we sought to evaluate the diagnostic role of ferumoxytol-enhanced MR venography in children with chronic kidney disease. Twenty children underwent 22 high-resolution ferumoxytol-enhanced MR venography examinations at 3.0 T. High-resolution 3-D contrast-enhanced imaging was performed at a minimum of 3 time points following injection of ferumoxytol at a total dose of 4 mg/kg. Two blinded pediatric radiologists independently scored six named veins on ferumoxytol-enhanced MR venography examinations according to a three-point subjective score, where a score ≥2 was considered diagnostic. Additionally, all relevant venous structures in the included field of view were analyzed for occlusive or non-occlusive thrombosis, compression and presence of collaterals. All patients underwent ferumoxytol-enhanced MR venography successfully and without adverse event. The overall scores of the reviewing radiologists for all venous structures were 2.7-2.9. In all cases, the reviewers were confident basing their diagnoses on the ferumoxytol-enhanced MR venography findings. In 12 of 22 examinations, findings on follow-up imaging or invasive procedures were available to correlate with the findings on ferumoxytol-enhanced MR venography. There was complete concordance between the findings from follow-up imaging and invasive procedures with findings from ferumoxytol-enhanced MR venography. Ferumoxytol holds promise as a powerful alternative to gadolinium-based contrast agents for reliable, high-resolution MR venography in children with chronic kidney disease.
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Aarti
authors.initials: A
authors.lastname: Luhar
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Radiology and Medicine, David Geffen School of Medicine at University of California at Los Angeles, Peter V. Ueberroth Bldg., Suite 3371, 10945 Le Conte Ave., Los Angeles, CA, 90095, USA. pfinn@mednet.ucla.edu.
authors.forename: J Paul
authors.initials: JP
authors.lastname: Finn
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Ghahremani
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Griggs
authors.affiliation: Department of Pediatrics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Zaritsky
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Isidro
authors.initials: I
authors.lastname: Salusky
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D052203:Ferrosoferric Oxide / Q000008:administration & dosage*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D052203:Ferrosoferric Oxide
keywords: Children; Chronic kidney disease; Ferumoxytol; Magnetic resonance venography; Vascular mapping