title: Incidental ferumoxytol artifacts in clinical brain MR imaging.
abstract: BACKGROUND
  Ferumoxytol (Feraheme) is a parenteral therapy approved for treatment of iron deficiency anemia. The product insert for ferumoxytol states that it may affect the diagnostic ability of MRI for up to 3 months. However, the expected effects may not be commonly recognized among clinical neuroradiologists. Our purpose is to describe the artifacts we have seen at our institution during routine clinical practice.
  
  
  METHODS
  We reviewed the patients at our institution that had brain MRI performed within 90 days of receiving intravenous ferumoxytol. The imaging was reviewed for specific findings, including diffusion-weighted imaging vascular susceptibility artifact, gradient-echo echo-planar T2*-weighted vascular susceptibility artifact, SWI/SWAN vascular susceptibility artifact, hypointense vascular signal on T2-weighted images, pre-gadolinium contrast vascular enhancement on magnetization-prepared rapid acquisition gradient echo (MPRAGE) imaging, and effects on post-gadolinium contrast T1 imaging.
  
  
  RESULTS
  Multiple artifacts were observed in patients having a brain MRI within 3 days of receiving intravenous ferumoxytol. These included susceptibility artifact on DWI, GRE, and SWAN/SWI imaging, pre-gadolinium contrast increased vascular signal on MPRAGE imaging, and decreased expected enhancement on post-gadolinium contrast T1-weighted imaging.
  
  
  CONCLUSIONS
  Ferumoxytol can create imaging artifacts which complicate clinical interpretation when brain MRI is performed within 3 days of administration. Recognition of the constellation of artifacts produced by ferumoxytol is important in order to obviate additional unnecessary examinations and mitigate errors in interpretation.
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Bowser
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Norbert G
authors.initials: NG
authors.lastname: Campeau
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Carr
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Felix E
authors.initials: FE
authors.lastname: Diehn
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDonald
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Miller
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. kaufmann.timothy@mayo.edu.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kaufmann
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D001921:Brain / Q000000981:diagnostic imaging* / Q000187:drug effects*; D003287:Contrast Media / Q000008:administration & dosage; D052203:Ferrosoferric Oxide / Q000008:administration & dosage*; D006801:Humans; D033162:Incidental Findings; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D052203:Ferrosoferric Oxide
keywords: Artifact; Brain; Ferumoxytol; MRI; Susceptibility