Feasibility of ferumoxytol-enhanced neonatal and young infant cardiac MRI without general anesthesia.
To assess the feasibility of ferumoxytol-enhanced anesthesia-free cardiac MRI in neonates and young infants for complex congenital heart disease (CHD).



With Institutional Review Board approval, 21 consecutive neonates and young infants (1 day to 11 weeks old; median age of 3 days) who underwent a rapid two-sequence (MR angiography [MRA] and four-dimensional [4D] flow) MRI protocol with intravenous ferumoxytol without sedation (n = 17) or light sedation (n = 4) at 3 Tesla (T) (except one case at 1.5T) between June 2014 and February 2016 were retrospectively identified. Medical records were reviewed for indication, any complications, if further diagnostic imaging was performed after MRI, and surgical findings. Two radiologists scored the images in two sessions on a 5-point scale for overall image quality and delineation of various anatomical structures. Confidence interval of proportions for likelihood of requiring additional diagnostic imaging after MRI was determined. For the possibility of reducing the protocol to a single rapid sequence, Wilcoxon-rank sum test was used to assess whether 4D flow and MRA significantly differed in anatomical delineation.



One of 21 patients (4.8%, 80% confidence interval 0-11%) required additional imaging, a computed tomography angiography to assess lung parenchyma and peripheral pulmonary arteries. Only 1 of 13 patients (7.7%) with operative confirmation had a minor discrepancy between radiology and operative reports (80% confidence interval 0-17%). 4D flow was significantly superior to MRA (P < 0.05) for the evaluation of systemic arteries, valves, ventricular trabeculae, and overall quality. Using Cohen's kappa coefficient, there was good interobserver agreement for the evaluation of systemic arteries by 4D flow (κ = 0.782), and systemic veins and pulmonary arteries by MRA (κ > 0.6). Overall 4D flow measurements (mean κ = 0.64-0.74) had better internal agreement compared with MRA (mean κ = 0.30-0.64).



Ferumoxytol-enhanced cardiac MRI, without anesthesia, is feasible for the evaluation of complex CHD in neonates and young infants, with a low likelihood of need for additional diagnostic studies. The decreased risk by avoiding anesthesia must be balanced against the potential for adverse reactions with ferumoxytol.



2 J. MAGN. RESON. IMAGING 2017;45:1407-1418.
Department of Radiology, Stanford University, Stanford, California, USA.
Lillian M
LM
Lai
Department of Radiology, Stanford University, Stanford, California, USA.
Joseph Y
JY
Cheng
Department of Radiology, Stanford University, Stanford, California, USA.
Marcus T
MT
Alley
Department of Radiology, Stanford University, Stanford, California, USA.
Tao
T
Zhang
Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA.
Michael
M
Lustig
Department of Radiology, Stanford University, Stanford, California, USA.
Shreyas S
SS
Vasanawala
D000768:Anesthesia, General; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D052203:Ferrosoferric Oxide / Q000737:chemistry*; D006321:Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies
D003287:Contrast Media; D052203:Ferrosoferric Oxide
4D flow; anesthesia-free; cardiac MRI; congenital heart disease; ferumoxytol
Arch Pediatr Adolesc Med. 2010 Jun;164(6):554-60
20530306
Magn Reson Imaging. 2016 Feb;34(2):152-8
26518061
Eur J Radiol. 2013 Jul;82(7):1067-82
22196744
Radiographics. 2007 Jan-Feb;27(1):5-18
17234995
Anesth Analg. 2011 Nov;113(5):1170-9
21965351
J Cardiovasc Magn Reson. 2007;9(5):793-8
17891617
J Magn Reson Imaging. 2015 Oct;42(4):870-86
25708923
Radiology. 2008 Sep;248(3):807-16
18710976
N Engl J Med. 2011 Apr 14;364(15):1387-90
21388302
Am J Hematol. 2010 May;85(5):315-9
20201089
Radiology. 1990 Jun;175(3):621-8
2343107
Radiology. 2012 Aug;264(2):414-22
22550309
Magn Reson Med. 2016 May;75(5):2107-11
26890830
J Magn Reson Imaging. 2016 Jun;43(6):1355-68
26646061
Neuropsychopharmacology. 2014 Sep;39(10):2275-87
24910347
Anesthesiology. 2009 Apr;110(4):796-804
19293700
JAMA Pediatr. 2013 Aug 1;167(8):700-7
23754213
J Cardiovasc Comput Tomogr. 2013 Nov-Dec;7(6):354-60
24331930
Pediatr Cardiol. 2014 Aug;35(6):1067-71
24710844
J Magn Reson Imaging. 2014 Jul;40(1):113-8
24130008
Radiology. 2007 Mar;242(3):873-81
17325072
Anesth Analg. 2011 Nov;113(5):1143-51
21415431
Semin Thorac Cardiovasc Surg. 2008 Winter;20(4):393-9
19251181
Eur Radiol. 2006 Feb;16 Suppl 2:B15-23
16802439
Clin Ther. 2014 Jan 1;36(1):70-83
24315802
IRB. 2011 Sep-Oct;33(5):1-6
22043743
Pediatr Radiol. 2012 Nov;42(11):1339-46
22885603
Pediatr Radiol. 2012 Feb;42(2):183-7
21861089
Invest Radiol. 2016 Apr;51(4):221-7
26656202