1
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Van Doren L, Steinheiser M, Boykin K, Taylor KJ, Menendez M, Auerbach M. Expert consensus guidelines: Intravenous iron uses, formulations, administration, and management of reactions. Am J Hematol 2024; 99:1338-1348. [PMID: 38282557 DOI: 10.1002/ajh.27220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
Intravenous iron has become an essential component for the treatment of iron deficiency and iron deficiency anemia. Individuals administering Intravenous iron should have knowledge in intravenous iron administration, including a pre-infusion assessment to evaluate infusion reaction risks, pre- and post-infusion monitoring, identification of and management of infusion reactions, accurate documentation of these reactions, laboratory monitoring and recognition and management of treatment-emergent hypophosphatemia. This comprehensive consensus provides step-by-step guidance and tools for practitioners to promote safe delivery of intravenous iron, recognition, and management of infusion reactions and treatment-emergent hypophosphatemia.
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Affiliation(s)
- Layla Van Doren
- Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Kristen Boykin
- Florida Cancer Specialists and Research Institute, Florida, USA
| | | | - Monica Menendez
- FEM Iron Infusion Centers by Heme Onc Call, Miami, Florida, USA
| | - Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
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2
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Ekladious F, Saul D. A case of severe anaphylactic reaction after administration of diagnostic-dose ferumoxytol in a pediatric patient. Pediatr Radiol 2024:10.1007/s00247-024-05970-0. [PMID: 38907841 DOI: 10.1007/s00247-024-05970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024]
Abstract
We describe a case of anaphylaxis during administration of intravenous (IV) ferumoxytol as a magnetic resonance imaging (MRI) contrast agent in a 4-year-old patient with complicated past medical history including YARS genetic mutation with resultant liver failure and deceased donor liver transplantation, stage IV chronic kidney disease (CKD), and hypertension. The patient was noted to have labored breathing 4 min after initiation of ferumoxytol infusion and was subsequently rapidly intubated and returned to the intensive care unit (ICU) for monitoring. Anaphylactic reactions to therapeutic doses of ferumoxytol led to issuance of a black box warning by the FDA in 2015. Adverse reactions to lower-dose ferumoxytol used in diagnostic imaging, however, are rare and there has been a paucity of documented anaphylactic reactions in the literature.
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Affiliation(s)
- Fam Ekladious
- Thomas Jefferson University Hospital, 132 S 10th St, Suite 780-K Main, Philadelphia, PA, 19107, USA
| | - David Saul
- Nemours Children's Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA.
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3
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Wang J, Zhou Q, Dong Q, Shen J, Hao J, Li D, Xu T, Cai X, Bai W, Ying T, Li Y, Zhang L, Zhu Y, Wang L, Wu J, Zheng Y. Nanoarchitectonic Engineering of Thermal-Responsive Magnetic Nanorobot Collectives for Intracranial Aneurysm Therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2400408. [PMID: 38709208 DOI: 10.1002/smll.202400408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/11/2024] [Indexed: 05/07/2024]
Abstract
Stent-assisted coiling is a main treatment modality for intracranial aneurysms (IAs) in clinics, but critical challenges remain to be overcome, such as exogenous implant-induced stenosis and reliance on antiplatelet agents. Herein, an endovascular approach is reported for IA therapy without stent grafting or microcatheter shaping, enabled by active delivery of thrombin (Th) to target aneurysms using innovative phase-change material (PCM)-coated magnetite-thrombin (Fe3O4-Th@PCM) FTP nanorobots. The nanorobots are controlled by an integrated actuation system of dynamic torque-force hybrid magnetic fields. With robust intravascular navigation guided by real-time ultrasound imaging, nanorobotic collectives can effectively accumulate and retain in model aneurysms constructed in vivo, followed by controlled release of the encapsulated Th for rapid occlusion of the aneurysm upon melting the protective PCM (thermally responsive in a tunable manner) through focused magnetic hyperthermia. Complete and stable aneurysm embolization is confirmed by postoperative examination and 2-week postembolization follow-up using digital subtraction angiography (DSA), contrast-enhanced ultrasound (CEUS), and histological analysis. The safety of the embolization therapy is assessed through biocompatibility evaluation and histopathology assays. This strategy, seamlessly integrating secure drug packaging, agile magnetic actuation, and clinical interventional imaging, avoids possible exogenous implant rejection, circumvents cumbersome microcatheter shaping, and offers a promising option for IA therapy.
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Affiliation(s)
- Jienan Wang
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Qi Zhou
- School of Engineering, The University of Edinburgh, Edinburgh, EH9 3FB, UK
| | - Qi Dong
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200002, P. R. China
| | - Jian Shen
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Junnian Hao
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Dong Li
- Guangdong Provincial Key Laboratory of Robotics and Intelligent System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Tiantian Xu
- Guangdong Provincial Key Laboratory of Robotics and Intelligent System, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Xiaojun Cai
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Wenkun Bai
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Yuehua Li
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Li Zhang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, P. R. China
| | - Yueqi Zhu
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Longchen Wang
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Jianrong Wu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, P. R. China
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Li C, Li C, Zhou J, Wang Y, Wu H, Xu L, Li Y, Sui X, Jiang G, Li Y, Hu Z, Tian J, Yang F. Application of Epithelial Growth Factor Receptor-Targeted Magnetic Resonance Imaging and Near-Infrared II Dual-Modal Probe in Lung Cancer Diagnosis and Surgical Resection. Mol Pharm 2024. [PMID: 38686930 DOI: 10.1021/acs.molpharmaceut.3c01137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
There has been an increase in the use of molecular probe diagnostic techniques for lung cancer, and magnetic resonance imaging (MRI) offers specific advantages for diagnosing pulmonary carcinoma. Furthermore, advancements in near-infrared II (NIR-II) fluorescence have provided a new method for precise intraoperative tumor resection. However, few probes combine preoperative diagnosis with intraoperative imaging. This study aims to fill this research void by employing a dual-modal probe that targets the epidermal growth factor receptor for MR and NIR-II imaging, enabling the preoperative diagnosis of lung cancer using MRI and precise intraoperative tumor localization using NIR-II with a single probe. The imaging effects and targeting ability of the probe were confirmed in cell lines, mouse models, and clinical samples. The MR signal decreased within 24 h in the patient-derived xenograft mouse model. The average signal-to-background ratio of NIR-II reached 3.98 ± 0.27. The clinical sample also showed a decrease in the T2 signal using MRI, and the NIR-II optical signal-to-background ratio was 3.29. It is expected that this probe can improve the diagnostic rate of lung cancer using MRI and enable precise intraoperative tumor resection using NIR-II.
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Affiliation(s)
- Chao Li
- Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Changjian Li
- School of Engineering Medicine, Beihang University, Beijing 100191, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology, Beijing 100191, China
| | - Jian Zhou
- Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Yueqi Wang
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Hainan Wu
- School of Engineering Medicine, Beihang University, Beijing 100191, China
| | - Luzheng Xu
- Peking University Medical and Health Analysis Center, Beijing 100191, China
| | - Yifeng Li
- School of Engineering Medicine, Beihang University, Beijing 100191, China
| | - Xizhao Sui
- Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Guanchao Jiang
- Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Yun Li
- Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
| | - Zhenhua Hu
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Jie Tian
- School of Engineering Medicine, Beihang University, Beijing 100191, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology, Beijing 100191, China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Fan Yang
- Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
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Song X, Zheng M, Hu H, Chen L, Wang S, Ding Z, Fu G, Sun L, Zhao L, Zhang L, Xu B, Qiu Y. Pharmacokinetic Study of Ultrasmall Superparamagnetic Iron Oxide Nanoparticles HY-088 in Rats. Eur J Drug Metab Pharmacokinet 2024:10.1007/s13318-024-00884-6. [PMID: 38393637 DOI: 10.1007/s13318-024-00884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND OBJECTIVE HY-088 injection is an ultrasmall superparamagnetic iron oxide nanoparticle (USPIOs) composed of iron oxide crystals coated with polyacrylic acid (PAA) on the surface. The purpose of this study was to investigate the pharmacokinetics, tissue distribution, and mass balance of HY-088 injection. METHODS The pharmacokinetics of [55Fe]-HY-088 and [14C]-HY-088 were investigated in 48 SD rats by intravenous injection of 8.5 (low-dose group), 25.5 (medium-dose group), and 85 (high-dose group) mg/100 μCi/kg. Tissue distribution was studied by intravenous injection of 35 mg/100 μCi/kg in 48 SD rats, and its tissue distribution in vivo was obtained by ex vivo tissue assay. At the same time, [14C]-HY-088 was injected intravenously at a dose of 25.5 mg/100 μCi/kg into 16 SD rats, and its tissue distribution in vivo was studied by quantitative whole-body autoradiography. [14C]-HY-088 and [55Fe]-HY-088 were injected intravenously into 24 SD rats at a dose of 35 mg/100 μCi/kg, and their metabolism was observed. RESULTS In the pharmacokinetic study, [55Fe]-HY-088 reached the maximum observed concentration (Cmax) at 0.08 h in the low- and medium-dose groups of SD rats. [14C]-HY-088 reached Cmax at 0.08 h in the three groups of SD rats. The area under the concentration-time curve (AUC) of [55Fe]-HY-088 and [14C]-HY-088 increased with increasing dose. In the tissue distribution study, [55Fe]-HY-088 and [14C]-HY-088 were primarily distributed in the liver, spleen, and lymph nodes of both female and male rats. In the mass balance study conducted over 57 days, the radioactive content of 55Fe from [55Fe]-HY-088 was primarily found in the carcass, accounting for 86.42 ± 4.18% in females and 95.46 ± 6.42% in males. The radioactive recovery rates of [14C]-HY-088 in the urine of female and male rats were 52.99 ± 5.48% and 60.66 ± 2.23%, respectively. CONCLUSIONS Following single intravenous administration of [55Fe]-HY-088 and [14C]-HY-088 in SD rats, rapid absorption was observed. Both [55Fe]-HY-088 and [14C]-HY-088 were primarily distributed in the liver, spleen, and lymph nodes. During metabolism, the radioactivity of [55Fe]-HY-088 is mainly present in the carcass, whereas the 14C-labeled [14C]-HY-088 shell PAA is eliminated from the body mainly through the urine.
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Affiliation(s)
- Xin Song
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230013, China
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
- China Yangtze Delta Drug Advanced Research Institute, Nantong, 226133, China
| | - Minglan Zheng
- Yangtze River Delta Center for Drug Evaluation and Inspection of NMPA, Shanghai, 201210, China
| | - Heping Hu
- Sichuan Huiyu Seacross Pharmaceutical,. Co. Ltd, Sichaun, 610021, China
| | - Lei Chen
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
| | - Shuzhe Wang
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
| | - Zhao Ding
- Sichuan Huiyu Seacross Pharmaceutical,. Co. Ltd, Sichaun, 610021, China
| | - Guangyi Fu
- Sichuan Huiyu Seacross Pharmaceutical,. Co. Ltd, Sichaun, 610021, China
| | - Luyao Sun
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230013, China
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
- China Yangtze Delta Drug Advanced Research Institute, Nantong, 226133, China
| | - Liyuan Zhao
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230013, China
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
- China Yangtze Delta Drug Advanced Research Institute, Nantong, 226133, China
| | - Ling Zhang
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
| | - Bohua Xu
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China.
| | - Yunliang Qiu
- China State Institute of Pharmaceutical Industry, Shanghai InnorStar Biotech Co., Ltd., Shanghai, 201203, China.
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6
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Reiter C, Reiter G, Kräuter C, Scherr D, Schmidt A, Fuchsjäger M, Reiter U. Evaluation of left ventricular and left atrial volumetric function from native MR multislice 4D flow magnitude data. Eur Radiol 2024; 34:981-993. [PMID: 37580598 PMCID: PMC10853296 DOI: 10.1007/s00330-023-10017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To assess the feasibility, precision, and accuracy of left ventricular (LV) and left atrial (LA) volumetric function evaluation from native magnetic resonance (MR) multislice 4D flow magnitude images. MATERIALS & METHODS In this prospective study, 60 subjects without signs or symptoms of heart failure underwent 3T native cardiac MR multislice 4D flow and bSSFP-cine realtime imaging. LV and LA volumetric function parameters were evaluated from 4D flow magnitude (4D flow-cine) and bSSFP-cine data using standard software to obtain end-diastolic volume (EDV), end-systolic volume (ESV), ejection-fraction (EF), stroke-volume (SV), LV muscle mass (LVM), LA maximum volume, LA minimum volume, and LA total ejection fraction (LATEF). Stroke volumes derived from both imaging methods were further compared to 4D pulmonary artery flow-derived net forward volumes (NFV). Methods were compared by correlation and Bland-Altman analysis. RESULTS Volumetric function parameters from 4D flow-cine and bSSFP-cine showed high to very high correlations (r = 0.83-0.98). SV, LA volumes and LATEF did not differ between methods. LV end-diastolic and end-systolic volumes were slightly underestimated (EDV: -2.9 ± 5.8 mL; ESV: -2.3 ± 3.8 mL), EF was slightly overestimated (EF: 0.9 ± 2.6%), and LV mass was considerably overestimated (LVM: 39.0 ± 11.4 g) by 4D flow-cine imaging. SVs from both methods correlated very highly with NFV (r = 0.91 in both cases) and did not differ from NFV. CONCLUSION Native multislice 4D flow magnitude data allows precise evaluation of LV and LA volumetric parameters; however, apart from SV, LV volumetric parameters demonstrate bias and need to be referred to their respective normal values. CLINICAL RELEVANCE STATEMENT Volumetric function assessment from native multislice 4D flow magnitude images can be performed with routinely used clinical software, facilitating the application of 4D flow as a one-stop-shop functional cardiac MR exam, providing consistent, simultaneously acquired, volume and flow data. KEY POINTS • Native multislice 4D flow imaging allows evaluation of volumetric left ventricular and atrial function parameters. • Left ventricular and left atrial function parameters derived from native multislice 4D flow data correlate highly with corresponding standard cine-derived parameters. • Multislice 4D flow-derived volumetric stroke volume and net forward volume do not differ.
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Affiliation(s)
- Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
- Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria.
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Petronek MS, Teferi N, Lee CY, Magnotta VA, Allen BG. MRI Detection and Therapeutic Enhancement of Ferumoxytol Internalization in Glioblastoma Cells. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:189. [PMID: 38251153 PMCID: PMC10821426 DOI: 10.3390/nano14020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
Recently, the FDA-approved iron oxide nanoparticle, ferumoxytol, has been found to enhance the efficacy of pharmacological ascorbate (AscH-) in treating glioblastoma, as AscH- reduces the Fe3+ sites in the nanoparticle core. Given the iron oxidation state specificity of T2* relaxation mapping, this study aims to investigate the ability of T2* relaxation to monitor the reduction of ferumoxytol by AscH- with respect to its in vitro therapeutic enhancement. This study employed an in vitro glioblastoma MRI model system to investigate the chemical interaction of ferumoxytol with T2* mapping. Lipofectamine was utilized to facilitate ferumoxytol internalization and assess intracellular versus extracellular chemistry. In vitro T2* mapping successfully detected an AscH--mediated reduction of ferumoxytol (25.6 ms versus 2.8 ms for FMX alone). The T2* relaxation technique identified the release of Fe2+ from ferumoxytol by AscH- in glioblastoma cells. However, the high iron content of ferumoxytol limited T2* ability to differentiate between the external and internal reduction of ferumoxytol by AscH- (ΔT2* = +839% for external FMX and +1112% for internal FMX reduction). Notably, the internalization of ferumoxytol significantly enhances its ability to promote AscH- toxicity (dose enhancement ratio for extracellular FMX = 1.16 versus 1.54 for intracellular FMX). These data provide valuable insights into the MR-based nanotheranostic application of ferumoxytol and AscH- therapy for glioblastoma management. Future developmental efforts, such as FMX surface modifications, may be warranted to enhance this approach further.
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Affiliation(s)
- Michael S. Petronek
- Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA;
| | - Chu-Yu Lee
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA (V.A.M.)
| | - Vincent A. Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA (V.A.M.)
| | - Bryan G. Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA
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Van Doren L, Auerbach M. IV iron formulations and use in adults. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:622-629. [PMID: 38066930 PMCID: PMC10727060 DOI: 10.1182/hematology.2023000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Intravenous iron has become a major component of the therapeutic armamentarium for iron deficiency and iron deficiency anemia. The earliest formulations were associated with unacceptable toxicity. Newer formulations, with complex carbohydrate cores that bind elemental iron more tightly, allow the administration of full therapeutic doses in 15 to 60 minutes. Nonetheless, a folklore of danger, fueled by earlier formulations no longer available, continues to foment caution. Complement-mediated minor infusion reactions, referred to as complement activation-related pseudo-allergy, resolve without therapy. Inappropriate intervention with vasopressors and H1 blockers converts these minor reactions into hemodynamically significant adverse events. Four new formulations, low-molecular-weight iron dextran, ferumoxytol, ferric carboxymaltose, and ferric derisomaltose, all approved for the treatment of iron deficiency in a host of conditions, are now widely used with an excellent safety profile. Herein, the administration, safety, indications, and management of infusion reactions are discussed. Treatment-emergent hypophosphatemia, a newly recognized side effect for some formulations, is also reviewed. Based on the preponderance of published evidence, intravenous iron should be moved up-front for the treatment of iron deficiency and iron deficiency anemia in those conditions in which oral iron is suboptimal.
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Affiliation(s)
- Layla Van Doren
- Division of Hematology, Yale School of Medicine, New Haven, CT
| | - Michael Auerbach
- Division of Hematology, Georgetown School of Medicine, Baltimore, MD
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9
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Dasi A, Kring DN, Selvaraj B, Morgan P, Gerity C, Morgan EE, Krishnamurthy R, Krishnamurthy R. Brand ferumoxytol vs. generic ferumoxytol comparison across two dosing regimens: a cardiac MRI image quality study. Pediatr Radiol 2023; 53:2622-2632. [PMID: 37837456 DOI: 10.1007/s00247-023-05778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Ferumoxytol is becoming more widely used as an off-label blood-pool contrast agent for MR angiography (MRA) and four-dimensional (4D) flow imaging in pediatric cardiovascular disease. Brand and generic versions of ferumoxytol are available with no information on relative efficacy as a contrast agent and safety profiles. OBJECTIVE This study evaluates patient safety and image quality of comparable dosages of generic ferumoxytol (GF) versus brand ferumoxytol (BF) with the following hypotheses: (1) Reducing the contrast dosage from 3 to 2 mg/kg will not affect imaging quality and diagnostic accuracy of MRA and four-dimensional 4D flow. (2) GF and BF have similar image quality. (3) GF and BF have similar patient safety profiles. MATERIALS AND METHODS In an IRB-approved retrospective study, changes in vitals/clinical status between baseline, during infusion, and 30 min post-infusion were analyzed in 3 groups: group 1 (3 mg/kg BF, 216 patients, age: 19.29 ± 11.71 years ranging from 2 months to 62 years), group 2 (2 mg/kg BF, 47 patients, age: 15.35 ± 8.56 years ranging from 10 days to 41 years), and group 3 (2 mg/kg GF, 127 patients, age: 17.16 ± 12.18 years ranging from 6 days to 58 years). Both pediatric and adult patients with congenital heart disease (CHD) indications were included within the study. Adverse reactions were classified as mild, moderate, or severe. Quantitative analysis of MR image quality was performed with signal-to-noise ratio (SNR) on MRA and velocity-to-noise ratio (VNR) on 4D flow. Qualitative grading of imaging features was performed by 2 experienced observers. Two-way analysis of variance (ANOVA) and chi-square tests were used for comparison with a P value of ≤ 0.05 used for significance. RESULTS No statistical difference was found in clinical status and vital signs (P>0.05). No severe reactions were reported. 7.9% of GF patients experienced an adverse reaction compared to 2.3% with 3 mg/kg BF and 8.4% with 2 mg/kg BF. There was no statistical difference in SNR between the 3 groups (P>0.05). For 4D flow, 2 mg/kg GF demonstrated an increase in VNR compared to 2 mg/kg BF (P = 0.005). The qualitative scores for MRA and 4D flow were high (≥ 3) across all 3 groups. CONCLUSIONS No significant difference was identified between 2 mg/kg GF and BF in terms of safety profile and image quality. Given the small sample size of this study, further studies are required to confirm these results.
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Affiliation(s)
- Anoushka Dasi
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Donna N Kring
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bhavani Selvaraj
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Patricia Morgan
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher Gerity
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Eric E Morgan
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA.
- The Ohio State University, Columbus, OH, USA.
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Bissell MM, Raimondi F, Ait Ali L, Allen BD, Barker AJ, Bolger A, Burris N, Carhäll CJ, Collins JD, Ebbers T, Francois CJ, Frydrychowicz A, Garg P, Geiger J, Ha H, Hennemuth A, Hope MD, Hsiao A, Johnson K, Kozerke S, Ma LE, Markl M, Martins D, Messina M, Oechtering TH, van Ooij P, Rigsby C, Rodriguez-Palomares J, Roest AAW, Roldán-Alzate A, Schnell S, Sotelo J, Stuber M, Syed AB, Töger J, van der Geest R, Westenberg J, Zhong L, Zhong Y, Wieben O, Dyverfeldt P. 4D Flow cardiovascular magnetic resonance consensus statement: 2023 update. J Cardiovasc Magn Reson 2023; 25:40. [PMID: 37474977 PMCID: PMC10357639 DOI: 10.1186/s12968-023-00942-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.
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Affiliation(s)
- Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9NL, UK.
| | | | - Lamia Ait Ali
- Institute of Clinical Physiology CNR, Massa, Italy
- Foundation CNR Tuscany Region G. Monasterio, Massa, Italy
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, USA
| | - Ann Bolger
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nicholas Burris
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Carl-Johan Carhäll
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Albert Hsiao
- Department of Radiology, University of California, San Diego, CA, USA
| | - Kevin Johnson
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Liliana E Ma
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duarte Martins
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marci Messina
- Department of Radiology, Northwestern Medicine, Chicago, IL, USA
| | - Thekla H Oechtering
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Pim van Ooij
- Department of Radiology & Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cynthia Rigsby
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jose Rodriguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d´Hebron,Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red-CV, CIBER CV, Madrid, Spain
| | - Arno A W Roest
- Department of Pediatric Cardiology, Willem-Alexander's Children Hospital, Leiden University Medical Center and Center for Congenital Heart Defects Amsterdam-Leiden, Leiden, The Netherlands
| | | | - Susanne Schnell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Physics, Institute of Physics, University of Greifswald, Greifswald, Germany
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering - iHEALTH, Santiago, Chile
| | - Matthias Stuber
- Département de Radiologie Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ali B Syed
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rob van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Westenberg
- CardioVascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Zhong
- National Heart Centre Singapore, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yumin Zhong
- Department of Radiology, School of Medicine, Shanghai Children's Medical Center Affiliated With Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Oliver Wieben
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Petter Dyverfeldt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Huang A, Roberts GS, Roldán-Alzate A, Wieben O, Reeder SB, Oechtering TH. Reference values for 4D flow magnetic resonance imaging of the portal venous system. Abdom Radiol (NY) 2023; 48:2049-2059. [PMID: 37016247 PMCID: PMC10518803 DOI: 10.1007/s00261-023-03892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The purpose of this work was to establish normal reference values for 4D flow MRI-derived flow, velocity, and vessel diameters, and to define characteristic flow patterns in the portal venous system of healthy adult subjects. METHODS For this retrospective study, we screened all available 4D flow MRI exams of the upper abdomen in healthy adults acquired at our institution between 2012 and 2022 at either 1.5 T or 3.0 T MRI after ≥ 5 h fasting. Flow, velocity, and effective diameter were quantified in the 8 planes in the portal venous system (splenic vein, superior mesenteric vein, main, right, and left portal veins). Vessel delineation was manually adjusted over time. Reference ranges for were defined as the mean ± 2 standard deviations. Three readers noted helical and vortical flow on time-resolved pathline visualizations. Conservation of mass flow analysis was performed for quality assurance. RESULTS We included 44 healthy subjects (26 female, 18-74 years) in the analysis. We report reference values for mean and peak flow, mean velocity, and vessel diameter in the healthy portal vein using 4D flow MRI. Normal flow patterns in the portal vein included faint helical (66%) or linear flow (34%). Conservation of mass analysis demonstrated a relative error of 1.1 ± 4.6% standard deviation (SD) at the splenomesenteric confluence and - 1.4 ± 4.1% SD at the portal bifurcation. CONCLUSION We have reported normal hemodynamic values that are necessary baseline data for emerging clinical applications of 4D flow MRI in the portal venous system. Results are consistent with previously published values from smaller cohorts.
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Affiliation(s)
- Andrew Huang
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Thekla H Oechtering
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
- Department of Radiology and Nuclear Medicine, Universität zu Lübeck, Lübeck, Germany.
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Starekova J, Nagle SK, Schiebler ML, Reeder SB, Meduri VN. Pulmonary MRA During Pregnancy: Early Experience With Ferumoxytol. J Magn Reson Imaging 2023; 57:1815-1818. [PMID: 36315131 DOI: 10.1002/jmri.28504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Ferumoxytol, an intravenous iron supplement, is commonly used to treat anemia in pregnancy. Ferumoxytol-enhanced magnetic resonance angiography (Fe-MRA) is a viable off-label alternative to gadolinium-enhanced MRA for assessment of pulmonary embolism (PE) in pregnancy. PURPOSE To describe our clinical experience with Fe-MRA in pregnant women with suspected PE. STUDY TYPE Retrospective, observational, cohort. POPULATION A total of 98 Fe-MRA exams (consecutive sample) performed in 94 pregnant women. FIELD STRENGTH/SEQUENCE A 1.5 T and 3.0 T, 3D T1-weighted MRA. ASSESSMENT After IRB approval including a waiver of informed consent, electronic health records were reviewed retrospectively for all Fe-MRA exams performed at our institution in pregnant between January, 2017 and March, 2022. The Fe-MRA protocol included 3D-MRA for assessment of pulmonary arteries, and T1-weighted imaging for ancillary findings. Fe-MRA exam duration was measured from image time stamps. Fe-MRA exams were reviewed by three cardiovascular imagers using a 4-point Likert scale for image quality and confidence for PE diagnosis (score 4 = best, 1 = worst), and tabulation of ancillary findings. STATISTICAL TESTS Continuous data are presented as mean ± standard deviation. The overall image quality and confidence score is given as the mean of three readers. RESULTS The 98 Fe-MRA exams were performed in 94 pregnant women (age 30 ± 6, range 19-48 years, gestational week 23 ± 10, range 3-38 weeks), with four undergoing two Fe-MRA exams during their pregnancy. Median Fe-MRA exam durration was 8 minutes (interquantile range 6 minutes). Overall image quality score was 3.3 ± 0.9. Confidence score for diagnosing PE was 3.5 ± 0.8. One subject was positive for PE (1/94, 1%); 42 of the 94 (45%) subjects Fe-MRA had ancillary findings including hydronephrosis or pneumonia. CONCLUSION Ferumoxytol enhanced MRA is a radiation- and gadolinium-free alternative for diagnosis of PE during pregancy. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Jitka Starekova
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Scott K Nagle
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Venkata N Meduri
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
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Prasad PV, Li LP, Hack B, Leloudas N, Sprague SM. Quantitative Blood Oxygenation Level Dependent Magnetic Resonance Imaging for Estimating Intra-renal Oxygen Availability Demonstrates Kidneys Are Hypoxemic in Human CKD. Kidney Int Rep 2023; 8:1057-1067. [PMID: 37180507 PMCID: PMC10166744 DOI: 10.1016/j.ekir.2023.02.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Kidney blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) has shown great promise in evaluating relative oxygen availability. This method is quite efficacious in evaluating acute responses to physiological and pharmacologic maneuvers. Its outcome parameter, R2∗ is defined as the apparent spin-spin relaxation rate measured in the presence of magnetic susceptibility differences and it is measured using gradient echo MRI. Although associations between R2∗ and renal function decline have been described, it remains uncertain to what extent R2∗ is a true reflection of tissue oxygenation. This is primarily because of not taking into account the confounding factors, especially fractional blood volume (fBV) in tissue. Methods This case-control study included 7 healthy controls and 6 patients with diabetes and chronic kidney disease (CKD). Using data before and after administration of ferumoxytol, a blood pool MRI contrast media, the fBVs in kidney cortex and medulla were measured. Results This pilot study independently measured fBV in kidney cortex (0.23 ± 0.03 vs. 0.17 ± 0.03) and medulla (0.36 ± 0.08 vs. 0.25 ± 0.03) in a small number of healthy controls (n = 7) versus CKD (n = 6). These were then combined with BOLD MRI measurements to estimate oxygen saturation of hemoglobin (StO2) (0.87 ± 0.03 vs. 0.72 ± 0.10 in cortex; 0.82 ± 0.05 vs. 0.72 ± 0.06 in medulla) and partial pressure of oxygen in blood (bloodPO2) (55.4 ± 6.5 vs. 38.4 ± 7.6 mm Hg in cortex; 48.4 ± 6.2 vs. 38.1 ± 4.5 mm Hg in medulla) in control versus CKD. The results for the first time demonstrate that cortex is normoxemic in controls and moderately hypoxemic in CKD. In the medulla, it is mildly hypoxemic in controls and moderately hypoxemic in CKD. Whereas fBV, StO2, and bloodPO2 were strongly associated with estimated glomerular filtration rate (eGFR), R2∗ was not. Conclusion Our results support the feasibility of quantitatively assessing oxygen availability using noninvasive quantitative BOLD MRI that could be translated to the clinic.
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Affiliation(s)
- Pottumarthi V. Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lu-Ping Li
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Bradley Hack
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Nondas Leloudas
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Stuart M. Sprague
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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Adams LC, Jayapal P, Ramasamy SK, Morakote W, Yeom K, Baratto L, Daldrup-Link HE. Ferumoxytol-Enhanced MRI in Children and Young Adults: State of the Art. AJR Am J Roentgenol 2023; 220:590-603. [PMID: 36197052 PMCID: PMC10038879 DOI: 10.2214/ajr.22.28453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ferumoxytol is an ultrasmall iron oxide nanoparticle that was originally approved by the FDA in 2009 for IV treatment of iron deficiency in adults with chronic kidney disease. Subsequently, its off-label use as an MRI contrast agent increased in clinical practice, particularly in pediatric patients in North America. Unlike conventional MRI contrast agents that are based on the rare earth metal gadolinium (gadolinium-based contrast agents), ferumoxytol is biodegradable and carries no potential risk of nephrogenic systemic fibrosis. At FDA-approved doses, ferumoxytol shows no long-term tissue retention in patients with intact iron metabolism. Ferumoxytol provides unique MRI properties, including long-lasting vascular retention (facilitating high-quality vascular imaging) and retention in reticuloendothelial system tissues, thereby supporting a variety of applications beyond those possible with gadolinium-based contrast agents (GBCAs). This Clinical Perspective describes clinical and early translational applications of ferumoxytol-enhanced MRI in children and young adults through off-label use in a variety of settings, including vascular, cardiac, and cancer imaging, drawing on the institutional experience of the authors. In addition, we describe current advances in pre-clinical and clinical research using ferumoxytol in cellular and molecular imaging as well as the use of ferumoxytol as a novel potential cancer therapeutic agent.
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Affiliation(s)
- Lisa C. Adams
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Praveen Jayapal
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Shakthi Kumaran Ramasamy
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Wipawee Morakote
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Kristen Yeom
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Heike E. Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
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Ferumoxytol-enhanced MR demonstration of changes to internal placental structure in placenta accreta spectrum: Preliminary findings. Placenta 2023; 134:1-8. [PMID: 36807998 DOI: 10.1016/j.placenta.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The goal of this pilot study is to determine if ferumoxytol-enhanced MR might provide a new approach to the diagnosis of placenta accreta spectrum (PAS), and if so, to identify signs of PAS. METHODS Ten pregnant women were referred for MRI evaluation for PAS. MR studies consisted of pre-contrast SSFSE, SSFP, DWI, and ferumoxytol-enhanced sequences. Post-contrast images were rendered as MIP and MinIP images to separately display the maternal and fetal circulations respectively. Two readers examined the images for architectural changes to placentone (fetal cotyledon) that might distinguish PAS cases from normal. Attention was given to the size and morphology of the placentone, villous tree, and vascularity. In addition, the images were examined for evidence of fibrin/fibrinoid, intervillous thrombus, basal and chorionic plate bulges. Interobserver agreement was characterized with kappa coefficients and levels of confidence for feature identification was recorded on a 10-point scale. RESULTS At delivery, there were five normal placentas and five with PAS (one accreta, two increta, two percreta). The ten changes of placental architecture in PAS included: focal/regional expansion of placentone(s); lateral displacement and compression of the villous tree; disruption of a regular pattern of normal placentones; bulging of the basal plate; bulging of the chorionic plate; transplacental stem villi; linear/nodular bands at basal plate; non-tapering villous branches; intervillous hemorrhage; and dilated subplacental vessels. All these changes were more common in PAS; the first five achieved statistical significance in this small sample. The interobserver agreement and confidence for the identification of these features was good to excellent except for dilated subplacental vessels. DISCUSSION Ferumoxytol-enhanced MR imaging appears to depict derangements of the internal architecture of placentas with PAS, thereby suggesting a promising new strategy to diagnose PAS.
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Levitte S, Yarani R, Ganguly A, Martin L, Gubatan J, Nadel HR, Franc B, Gugig R, Syed A, Goyal A, Park KT, Thakor AS. Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program. J Clin Med 2023; 12:jcm12062386. [PMID: 36983386 PMCID: PMC10053508 DOI: 10.3390/jcm12062386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/05/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Systemic steroid exposure, while useful for the treatment of acute flares in inflammatory bowel disease (IBD), is associated with an array of side effects that are particularly significant in children. Technical advancements have enabled locoregional intraarterial steroid delivery directly into specific segments of the gastrointestinal tract, thereby maximizing tissue concentration while limiting systemic exposure. We investigated the feasibility of intraarterial steroid administration into the bowel in a cohort of nine pediatric patients who had IBD. This treatment approach provided symptom relief in all patients, with sustained relief (>2 weeks) in seven out of nine; no serious adverse effects occurred in any patient. In addition, we identified patterns of vascular morphologic changes indicative of a vasculopathy within the mesenteric circulation of inflamed segments of the bowel in pediatric patients with Crohn's disease, which correlated with disease activity. An analysis of publicly available transcriptomic studies identified vasculitis-associated molecular pathways activated in the endothelial cells of patients with active Crohn's disease, suggesting a possible shared transcriptional program between vasculitis and IBD. Intraarterial corticosteroid treatment is safe and has the potential to be widely accepted as a locoregional approach for therapy delivery directly into the bowel; however, this approach still warrants further consideration as a short-term "bridge" between therapy transitions for symptomatic IBD patients with refractory disease, as part of a broader steroid-minimizing treatment strategy.
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Affiliation(s)
- Steven Levitte
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USA
| | - Reza Yarani
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Abantika Ganguly
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Lynne Martin
- Department of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USA
| | - John Gubatan
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA 94304, USA
| | - Helen R Nadel
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
- Department of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USA
| | - Benjamin Franc
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Roberto Gugig
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USA
| | - Ali Syed
- Department of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USA
| | - Alka Goyal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USA
| | - K T Park
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USA
| | - Avnesh S Thakor
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
- Department of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USA
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The Role of Exosomes in Pancreatic Ductal Adenocarcinoma Progression and Their Potential as Biomarkers. Cancers (Basel) 2023; 15:cancers15061776. [PMID: 36980662 PMCID: PMC10046651 DOI: 10.3390/cancers15061776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC), the most common pancreatic malignancy, is an aggressive and lethal cancer with a dismal five-year survival rate. Despite remarkable improvements in cancer therapeutics, the clinical outcome of PDAC patients remains poor due to late diagnosis of the disease. This highlights the importance of early detection, wherein biomarker evaluation including exosomes would be helpful. Exosomes, small extracellular vesicles (sEVs), are cell-secreted entities with diameters ranging from 50 to 150 nm that deliver cellular contents (e.g., proteins, lipids, and nucleic acids) from parent cells to regulate the cellular processes of targeted cells. Recently, an increasing number of studies have reported that exosomes serve as messengers to facilitate stromal-immune crosstalk within the PDAC tumor microenvironment (TME), and their contents are indicative of disease progression. Moreover, evidence suggests that exosomes with specific surface markers are capable of distinguishing patients with PDAC from healthy individuals. Detectable exosomes in bodily fluids (e.g., blood, urine, saliva, and pancreatic juice) are omnipresent and may serve as promising biomarkers for improving early detection and evaluating patient prognosis. In this review, we shed light on the involvement of exosomes and their cargos in processes related to disease progression, including chemoresistance, angiogenesis, invasion, metastasis, and immunomodulation, and their potential as prognostic markers. Furthermore, we highlight feasible clinical applications and the limitations of exosomes in liquid biopsies as tools for early diagnosis as well as disease monitoring. Taking advantage of exosomes to improve diagnostic capacity may provide hope for PDAC patients, although further investigation is urgently needed.
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Davies SJ, DiNardo JA, Emani SM, Brown ML. A Review of Biventricular Repair for the Congenital Cardiac Anesthesiologist. Semin Cardiothorac Vasc Anesth 2023; 27:51-63. [PMID: 36470215 DOI: 10.1177/10892532221143880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The management of children with a borderline ventricle has been debated for many years. The pursuit of a biventricular repair in these children aims to avoid the long-term sequelae of single ventricle palliation. There is a lack of anesthesia literature relating to the care of this complex heterogenous patient population. Anesthesiologists caring for these patients should have an understanding on the many different forms of physiology and the impact on provision of anesthesia and hemodynamic parameters, the goals of biventricular staging and completion as well as the pre-operative, intra-operative, and post-operative considerations relating to this high-risk group of patients.
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Affiliation(s)
- Sean J Davies
- Department of Anesthesiology, Critical Care and Pain Medicine, 1862Boston Children's Hospital, Boston, MA, USA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, 1862Boston Children's Hospital, Boston, MA, USA
| | - Sitaram M Emani
- Department of Anesthesiology, Critical Care and Pain Medicine, 1862Boston Children's Hospital, Boston, MA, USA
| | - Morgan L Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, 1862Boston Children's Hospital, Boston, MA, USA
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19
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Gonzalez TV, Bookwalter CA, Foley TA, Rajiah PS. Multimodality imaging evaluation of arteriovenous fistulas and grafts: a clinical practice review. Cardiovasc Diagn Ther 2023; 13:196-211. [PMID: 36864955 PMCID: PMC9971293 DOI: 10.21037/cdt-22-439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/10/2023] [Indexed: 02/21/2023]
Abstract
Arteriovenous fistulas (AVFs) and grafts (AVGs) are the preferred forms of vascular access for hemodialysis in patients with severe renal dysfunction. Multimodality imaging plays an important role in the pre-procedural evaluation of these patients. Ultrasound is often used for pre-procedural vascular mapping in preparation for the creation of an AVF or AVG. Pre-procedural mapping includes a comprehensive evaluation of the arterial and venous vasculature including evaluation of vessel diameter, stenosis, course, presence of collateral veins, wall thickness and wall abnormalities. Computed tomography (CT), magnetic resonance imaging (MRI) or catheter angiography are used when sonography is not available or when further characterization of sonographic abnormalities is required. Following the procedure, routine surveillance imaging is not recommended. If there are any clinical concerns or if physical examination is inconclusive, further evaluation with ultrasound is warranted. Ultrasound allows for assessment of vascular access site maturation by evaluating the time-averaged blood flow and helping characterize the outflow vein in the case of an AVF. CT and MRI can play a complementary role to ultrasound. Vascular access site complications include non-maturation, aneurysm, pseudoaneurysm, thrombosis, stenosis, steal phenomena or occlusion typically of the outflow vein, infection, bleeding and rarely angiosarcoma. In this article, we review the role of multimodality imaging in the pre- and post-procedural evaluation of patients with AVF and AVG. Additionally, novel technologies of vascular access site creation using endovascular techniques and upcoming non-invasive imaging techniques for evaluation of AVFs and AVGs are discussed.
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Affiliation(s)
| | | | - Thomas A Foley
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Kliewer MA, Bagley AR, Reeder SB, Iruretagoyena JI, Bockoven CG, Fritsch MK. Normal placental structural anatomy: ultrasound and doppler features elucidated with US-MR image fusion and ferumoxytol-enhanced MRI. Abdom Radiol (NY) 2023; 48:744-751. [PMID: 36462034 DOI: 10.1007/s00261-022-03758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To elucidate ultrasound features of normal placental anatomy through correlation of gray-scale and ultrasound Doppler with ferumoxytol-enhanced MRI features using US-MR image fusion. METHODS All patients referred to MR for ultrasound findings worrisome for PAS (placenta accreta spectrum) were included in this retrospective study. MR studies included a ferumoxytol-enhanced T1-weighted MRI. Ultrasound imaging included gray-scale, color Doppler, power Doppler, and spectral Doppler techniques. After the MR, US-MRI fusion was performed by co-registering a MR acquisition to real-time US, which allowed precise, point-to-point correlation of placental features. RESULTS Fourteen patients at risk for PAS were studied using the US-MR image fusion. At delivery, there were six cases without PAS (gestational age range: 24 weeks 3 days to 34 weeks 0 days), and these composed the study cohort. Placental features that were on high signal intensity on post-ferumoxytol acquisitions represent spaces with maternal blood flow and corresponded to hypoechoic areas on ultrasound created by a paucity of reflective interfaces (villi). Color and spectral Doppler allowed the separation of maternal and fetal circulations in individual perfusional domains and demonstrated spiral artery inflow, circulation around the villous tree, and return of blood flow to the basal plate. Recognizable histopathologic features by ultrasound included the central cavity, villous tree, and venous return channels. CONCLUSION Internal placental architecture can be discerned on ultrasound. This anatomy can be correlated and confirmed with ferumoxytol-MR through US-MR fusion. Understanding this structural anatomy on ultrasound could serve as a basis to identify normal and abnormal placental features.
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Affiliation(s)
- Mark A Kliewer
- Department of Radiology, University of Wisconsin - Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-3252, USA.
| | - Anjuli R Bagley
- Department of Radiology, The University of Vermont, 111 Colchester Avenue, Main Campus, McClure, Level 1, Burlington, VT, 05401-1473, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin - Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-3252, USA
| | - Jesus Igor Iruretagoyena
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Medical School, 4th Floor McConnell Hall, 1010 Mound St, Madison, WI, 53715, USA
| | - Crystal G Bockoven
- Department of Pathology and Laboratory Medicine, University of WI-Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-8550, USA
| | - Michael K Fritsch
- Department of Pathology and Laboratory Medicine, University of WI-Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-8550, USA
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21
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Bitonto V, Garello F, Scherberich A, Filippi M. Prussian Blue Staining to Visualize Iron Oxide Nanoparticles. Methods Mol Biol 2023; 2566:321-332. [PMID: 36152263 DOI: 10.1007/978-1-0716-2675-7_26] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Iron deposits in cells and tissues can be detected by ex vivo histological examination through the Prussian blue (PB) staining. This practical, inexpensive, and highly sensitive technique involves the treatment of fixed tissue sections and cells with acid solutions of ferrocyanides that combine with ferric ion forming a bright blue pigment (i.e., ferric ferrocyanide). The staining can be applied to visualize iron oxide nanoparticles (IONPs), versatile magnetic nanosystems that are used in various biomedical applications and whose localization is usually required at a higher resolution than that enabled by in vivo tracking techniques.
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Affiliation(s)
- Valeria Bitonto
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy
| | - Francesca Garello
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy
| | - Arnaud Scherberich
- Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | - Miriam Filippi
- Soft Robotics Laboratory, ETH Zurich, Zurich, Switzerland.
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22
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Kliewer MA, Bockoven CG, Reeder SB, Bagley AR, Fritsch MK. Ferumoxytol-enhanced magnetic resonance imaging with volume rendering: A new approach for the depiction of internal placental structure in vivo. Placenta 2023; 131:104-110. [PMID: 36577278 DOI: 10.1016/j.placenta.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Placental function is vitally important, but placental assessment is limited by current imaging methods in vivo. The goal of this study is to determine if ferumoxytol-enhanced MR studies might be used to depict placental structure during pregnancy. METHODS Ten pregnant women were referred for MRI evaluation of abnormal placentation. The study group was composed five of these patients whose placentas were normal at pathology. MR studies consisted of pre-contrast SSFSE (single-shot fast spin-echo), SSFP (steady-state free procession), diffusion, and ferumoxytol-enhanced acquisitions. The post-contrast sequences were compared to pre-contrast SSFSE, SSFP, and diffusion acquisitions for features of correspondence. MR images were also compared to histopathology for anatomic landmarks including the three-ring pattern of the functional vascular exchange unit (the placentone) created by this central cavity surrounded by a ring of clustered villi, and an outer ring of dispersed villi corresponding to the maternal venous outflow channel. The measured sizes of these features on MR were compared to reported sizes. RESULTS Post-ferumoxytol images showed enhancement of the maternal blood within the placenta, notably the intervillous space and the myometrial vessels. The unenhanced fetal vessels were most visible on the MinIP (minimum intensity projection) images; the enhanced maternal vessels were most visible on the MIP (maximum intensity projection) images. Composite MIP/MinIP images show the relation of maternal and fetal circulations. The signal intensities replicate the relative contributions from enhanced maternal blood and unenhanced chorionic villi. DISCUSSION Ferumoxytol-enhanced MR imaging can depict the internal anatomy of the placenta in vivo of clarity and detail. This could represent a new diagnostic approach to placental disorders.
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Affiliation(s)
- Mark A Kliewer
- Department of Radiology, University of Wisconsin - Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-3252, USA.
| | - Crystal G Bockoven
- Department of Pathology and Laboratory Medicine, University of Wisconsin - Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-8550, USA.
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin - Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-3252, USA.
| | - Anjuli R Bagley
- The University of Vermont, Department of Radiology, 111 Colchester Avenue Main Campus, McClure, Level 1, Burlington, VT, 05401-1473, USA.
| | - Michael K Fritsch
- Department of Pathology and Laboratory Medicine, University of Wisconsin - Madison, E3/311, 600 Highland Avenue, Madison, WI, 53792-8550, USA.
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23
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Yang K, Shang Y, Yang N, Pan S, Jin J, He Q. Application of nanoparticles in the diagnosis and treatment of chronic kidney disease. Front Med (Lausanne) 2023; 10:1132355. [PMID: 37138743 PMCID: PMC10149997 DOI: 10.3389/fmed.2023.1132355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
With the development of nanotechnology, nanoparticles have been used in various industries. In medicine, nanoparticles have been used in the diagnosis and treatment of diseases. The kidney is an important organ for waste excretion and maintaining the balance of the internal environment; it filters various metabolic wastes. Kidney dysfunction may result in the accumulation of excess water and various toxins in the body without being discharged, leading to complications and life-threatening conditions. Based on their physical and chemical properties, nanoparticles can enter cells and cross biological barriers to reach the kidneys and therefore, can be used in the diagnosis and treatment of chronic kidney disease (CKD). In the first search, we used the English terms "Renal Insufficiency, Chronic" [Mesh] as the subject word and terms such as "Chronic Renal Insufficiencies," "Chronic Renal Insufficiency," "Chronic Kidney Diseases," "Kidney Disease, Chronic," "Renal Disease, Chronic" as free words. In the second search, we used "Nanoparticles" [Mesh] as the subject word and "Nanocrystalline Materials," "Materials, Nanocrystalline," "Nanocrystals," and others as free words. The relevant literature was searched and read. Moreover, we analyzed and summarized the application and mechanism of nanoparticles in the diagnosis of CKD, application of nanoparticles in the diagnosis and treatment of renal fibrosis and vascular calcification (VC), and their clinical application in patients undergoing dialysis. Specifically, we found that nanoparticles can detect CKD in the early stages in a variety of ways, such as via breath sensors that detect gases and biosensors that detect urine and can be used as a contrast agent to avoid kidney damage. In addition, nanoparticles can be used to treat and reverse renal fibrosis, as well as detect and treat VC in patients with early CKD. Simultaneously, nanoparticles can improve safety and convenience for patients undergoing dialysis. Finally, we summarize the current advantages and limitations of nanoparticles applied to CKD as well as their future prospects.
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Affiliation(s)
- Kaibi Yang
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yiwei Shang
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Yang
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shujun Pan
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Jin
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- *Correspondence: Juan Jin,
| | - Qiang He
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- Qiang He,
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24
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Seiter DP, Nguyen SM, Morgan TK, Mao L, Dudley DM, O’connor DH, Murphy ME, Ludwig KD, Chen R, Dhyani A, Zhu A, Schotzko ML, Brunner KG, Shah DM, Johnson KM, Golos TG, Wieben O. Ferumoxytol dynamic contrast enhanced magnetic resonance imaging identifies altered placental cotyledon perfusion in rhesus macaques†. Biol Reprod 2022; 107:1517-1527. [PMID: 36018823 PMCID: PMC9752971 DOI: 10.1093/biolre/ioac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/12/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Identification of placental dysfunction in early pregnancy with noninvasive imaging could be a valuable tool for assessing maternal and fetal risk. Dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) can be a powerful tool for interrogating placenta health. After inoculation with Zika virus or sham inoculation at gestation age (GA) 45 or 55 days, animals were imaged up to three times at GA65, GA100, and GA145. DCE MRI images were acquired at all imaging sessions using ferumoxytol, an iron nanoparticle-based contrast agent, and analyzed for placental intervillous blood flow, number of perfusion domains, and perfusion domain volume. Cesarean section was performed at GA155, and the placenta was photographed and dissected for histopathology. Photographs were used to align cotyledons with estimated perfusion domains from MRI, allowing comparison of estimated cotyledon volume to pathology. Monkeys were separated into high and low pathology groups based on the average number of pathologies present in the placenta. Perfusion domain flow, volume, and number increased through gestation, and total blood flow increased with gestation for both low pathology and high pathology groups. A statistically significant decrease in perfusion domain volume associated with pathology was detected at all gestational ages. Individual perfusion domain flow comparisons demonstrated a statistically significant decrease with pathology at GA100 and GA145, but not GA65. Since ferumoxytol is currently used to treat anemia during human pregnancy and as an off-label MRI contrast agent, future transition of this work to human pregnancy may be possible.
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Affiliation(s)
- Daniel P Seiter
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Sydney M Nguyen
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Terry K Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Dawn M Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - David H O’connor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Megan E Murphy
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kai D Ludwig
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Ruiming Chen
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Archana Dhyani
- Department of Computer Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Ante Zhu
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Michele L Schotzko
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin G Brunner
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Dinesh M Shah
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Thaddeus G Golos
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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25
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Park D, Lobbous M, Nabors LB, Markert JM, Kim J. Undesired impact of iron supplement on MRI assessment of post-treatment glioblastoma. CNS Oncol 2022; 11:CNS90. [PMID: 36408899 PMCID: PMC9830595 DOI: 10.2217/cns-2021-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Glioblastoma (GBM) is the most common malignant adult brain and has a poor prognosis. Routine post-treatment MRI evaluations are required to assess treatment response and disease progression. We present a case of an 83-year-old female who underwent MRI assessment of post-treatment GBM after intravenous iron replacement therapy, ferumoxytol. The brain MRI revealed unintended alteration of MRI signal characteristics from the iron containing agent which confounded diagnostic interpretation and subsequently, the treatment planning. Ferumoxytol injection prior to contrast enhanced MRI must be screened in post-treatment GBM patients to accurately evaluate tumor activity.
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Affiliation(s)
- Dahye Park
- School of Medicine, University of Alabama at Birmingham, AL 35233, USA
| | - Mina Lobbous
- Department of Neurology, Division of Neuro-oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Louis B Nabors
- Department of Neurology, Division of Neuro-oncology, University of Alabama at Birmingham, AL 35233, USA
| | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, AL 35233, USA
| | - Jinsuh Kim
- Department of Radiology & Imaging Sciences, Division of Neuroradiology, Emory University, GA 30322, USA,Author for correspondence:
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Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121810. [PMID: 36553257 PMCID: PMC9777095 DOI: 10.3390/children9121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
Cardiac magnetic resonance imaging and angiography have a crucial role in the diagnostic evaluation and follow up of pediatric and adult patients with congenital heart disease. Although much of the information required of advanced imaging studies can be provided by standard gadolinium-enhanced magnetic resonance imaging, the limitations of precise bolus timing, long scan duration, complex imaging protocols, and the need to image small structures limit more widespread use of this modality. Recent experience with off-label diagnostic use of ferumoxytol has helped to mitigate some of these barriers. Approved by the U.S. FDA for intravenous treatment of anemia, ferumoxytol is an ultrasmall superparamagnetic iron oxide nanoparticle that has a long blood pool residence time and high relaxivity. Once metabolized by macrophages, the iron core is incorporated into the reticuloendothelial system. In this work, we aim to summarize the evolution of ferumoxytol-enhanced cardiovascular magnetic resonance imaging and angiography and highlight its many applications for congenital heart disease.
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27
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Kollar SE, Udine ML, Mandell JG, Cross RR, Loke YH, Olivieri LJ. Impact of ferumoxytol vs gadolinium on 4D flow cardiovascular magnetic resonance measurements in small children with congenital heart disease. J Cardiovasc Magn Reson 2022; 24:58. [PMID: 36352454 PMCID: PMC9648014 DOI: 10.1186/s12968-022-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) allows for time-resolved three-dimensional phase-contrast (4D Flow) analysis of congenital heart disease (CHD). Higher spatial resolution in small infants requires thinner slices, which can degrade the signal. Particularly in infants, the choice of contrast agent (ferumoxytol vs. gadolinium) may influence 4D Flow CMR accuracy. Thus, we investigated the accuracy of 4D Flow CMR measurements compared to gold standard 2D flow phase contrast (PC) measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients with shunt lesions. METHODS This was a retrospective study consisting of CMR studies from complex CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D Flow and standard two-dimensional phase contrast (2D-PC) flow collected. 4D Flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins, and pulmonary veins. 4D Flow accuracy was defined as percent difference or correlation against conventional measurements (2D-PC) from the same vessels. Subgroup analysis was performed on two-ventricular vs single-ventricular CHD, arterial vs venous flow, as well as low flows (defined as < 1.5 L/min) in 1V CHD. RESULTS Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.6 vs. 2.3 ± 1.9 years, p = 0.70), patient body surface area (0.50 ± 0.2 vs. 0.52 ± 0.2 m2, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6 mm, p = 0.22). Ten CMR studies with single ventricular CHD were included. Overall, ferumoxytol-enhanced 4D flow CMR measurements demonstrated less percent difference to 2D-PC when compared to gadolinium-enhanced 4D Flow CMR studies. In subgroup analyses of arterial vs. venous flows (high velocity vs. low velocity) and low flow in single ventricle CHD, ferumoxytol-enhanced 4D Flow CMR measurements had stronger correlation to 2D-PC CMR. The contrast-to-noise ratio (CNR) in ferumoxytol-enhanced studies was higher than the CNR in gadolinium-enhanced studies. CONCLUSIONS Ferumoxytol-enhanced 4D Flow CMR has improved accuracy when compared to gadolinium 4D Flow CMR, particularly for infants with small vessels in CHD.
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Affiliation(s)
- Sarah E Kollar
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA.
| | - Michelle L Udine
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Jason G Mandell
- Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Russell R Cross
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Laura J Olivieri
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
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Goolaub DS, Xu J, Schrauben EM, Marini D, Kingdom JC, Sled JG, Seed M, Macgowan CK. Volumetric Fetal Flow Imaging With Magnetic Resonance Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:2941-2952. [PMID: 35604966 DOI: 10.1109/tmi.2022.3176814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Fetal development relies on a complex circulatory network. Accurate assessment of flow distribution is important for understanding pathologies and potential therapies. In this paper, we demonstrate a method for volumetric imaging of fetal flow with magnetic resonance imaging (MRI). Fetal MRI faces challenges: small vascular structures, unpredictable motion, and inadequate traditional cardiac gating methods. Here, orthogonal multislice stacks are acquired with accelerated multidimensional radial phase contrast (PC) MRI. Slices are reconstructed into flow sensitive time-series images with motion correction and image-based cardiac gating. They are then combined into a dynamic volume using slice-to-volume reconstruction (SVR) while resolving interslice spatiotemporal coregistration. Compared to prior methods, this approach achieves higher spatiotemporal resolution ( 1×1×1 mm3, ~30 ms) with reduced scan time - important features for the quantification of flow through small fetal structures. Validation is demonstrated in adults by comparing SVR with 4D radial PCMRI (flow bias and limits of agreement: -1.1 ml/s and [-11.8 9.6] ml/s). Feasibility is demonstrated in late gestation fetuses by comparing SVR with 2D Cartesian PCMRI (flow bias and limits of agreement: -0.9 ml/min/kg and [-39.7 37.8] ml/min/kg). With SVR, we demonstrate complex flow pathways (such as parallel flow streams in the proximal inferior vena cava, preferential shunting of blood from the ductus venosus into the left atrium, and blood from the brain leaving the heart through the main pulmonary artery) for the first time in human fetal circulation. This method allows for comprehensive evaluation of the fetal circulation and enables future studies of fetal physiology.
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29
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Oechtering TH, Roberts GS, Panagiotopoulos N, Wieben O, Roldán-Alzate A, Reeder SB. Abdominal applications of quantitative 4D flow MRI. Abdom Radiol (NY) 2022; 47:3229-3250. [PMID: 34837521 PMCID: PMC9135957 DOI: 10.1007/s00261-021-03352-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 01/18/2023]
Abstract
4D flow MRI is a quantitative MRI technique that allows the comprehensive assessment of time-resolved hemodynamics and vascular anatomy over a 3-dimensional imaging volume. It effectively combines several advantages of invasive and non-invasive imaging modalities like ultrasound, angiography, and computed tomography in a single MRI acquisition and provides an unprecedented characterization of velocity fields acquired non-invasively in vivo. Functional and morphological imaging of the abdominal vasculature is especially challenging due to its complex and variable anatomy with a wide range of vessel calibers and flow velocities and the need for large volumetric coverage. Despite these challenges, 4D flow MRI is a promising diagnostic and prognostic tool as many pathologies in the abdomen are associated with changes of either hemodynamics or morphology of arteries, veins, or the portal venous system. In this review article, we will discuss technical aspects of the implementation of abdominal 4D flow MRI ranging from patient preparation and acquisition protocol over post-processing and quality control to final data analysis. In recent years, the range of applications for 4D flow in the abdomen has increased profoundly. Therefore, we will review potential clinical applications and address their clinical importance, relevant quantitative and qualitative parameters, and unmet challenges.
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Affiliation(s)
- Thekla H. Oechtering
- University of Wisconsin, Department of Radiology, Madison, WI, United States,Universität zu Lübeck, Department of Radiology, Luebeck, Germany
| | - Grant S. Roberts
- University of Wisconsin, Department of Medical Physics, Madison, WI, United States
| | - Nikolaos Panagiotopoulos
- University of Wisconsin, Department of Radiology, Madison, WI, United States,Universität zu Lübeck, Department of Radiology, Luebeck, Germany
| | - Oliver Wieben
- University of Wisconsin, Department of Radiology, Madison, WI, United States,University of Wisconsin, Department of Medical Physics, Madison, WI, United States
| | - Alejandro Roldán-Alzate
- University of Wisconsin, Department of Radiology, Madison, WI, United States,University of Wisconsin, Department of Mechanical Engineering, Madison, WI, United States,University of Wisconsin, Department of Biomedical Engineering, Madison, WI, United States
| | - Scott B. Reeder
- University of Wisconsin, Department of Radiology, Madison, WI, United States,University of Wisconsin, Department of Medical Physics, Madison, WI, United States,University of Wisconsin, Department of Mechanical Engineering, Madison, WI, United States,University of Wisconsin, Department of Biomedical Engineering, Madison, WI, United States,University of Wisconsin, Department of Emergency Medicine, Madison, WI, United States
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30
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Pediatric magnetic resonance angiography: to contrast or not to contrast. Pediatr Radiol 2022:10.1007/s00247-022-05467-8. [PMID: 35953543 DOI: 10.1007/s00247-022-05467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/26/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
Magnetic resonance (MR) angiography and MR venography imaging with contrast and non-contrast techniques are widely used for pediatric vascular imaging. However, as with any MRI examination, imaging the pediatric population can be challenging because of patient motion, which sometimes requires sedation. There are multiple benefits of non-contrast MR angiographic techniques, including the ability to repeat sequences if motion is present, the decreased need for sedation, and avoidance of potential risks associated with gadolinium administration and radiation exposure. Thus, MR angiography is an attractive alternative to CT or conventional catheter-based angiography in pediatric populations. Contrast-enhanced MR angiographic techniques have the advantage of increased signal to noise. Blood pool imaging allows long imaging times that result in high-spatial-resolution imaging, and thus high-quality diagnostic images. This article outlines the technique details, indications, benefits and downsides of non-contrast-enhanced and contrast-enhanced MR angiographic techniques to assist in protocol decision-making.
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31
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Jalili MH, Yu T, Hassani C, Prosper AE, Finn JP, Bedayat A. Contrast-enhanced MR Angiography without Gadolinium-based Contrast Material: Clinical Applications Using Ferumoxytol. Radiol Cardiothorac Imaging 2022; 4:e210323. [PMID: 36059381 PMCID: PMC9434982 DOI: 10.1148/ryct.210323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 04/25/2023]
Abstract
Vascular imaging can be challenging because of the wide variability of contrast dynamics in different vascular territories and potential safety concerns in patients with renal insufficiency or allergies. Off-label diagnostic use of ferumoxytol, a superparamagnetic iron nanoparticle approved for therapy, is a promising alternative to gadolinium-based contrast agents for MR angiography (MRA). Ferumoxytol has exhibited a reassuring safety profile when used within the dose range recommended for diagnostic imaging. Because of its prolonged and stable intravascular residence, ferumoxytol can be used in its steady-state distribution for a wide variety of imaging indications, including some where conventional MRA is unreliable. In this article, authors discuss some of the major vascular applications of ferumoxytol and highlight how it may be used to provide highly diagnostic images and improve the quality, workflow, and reliability of vascular imaging. Keywords: MR Angiography, MRI Contrast Agent, Cardiac, Vascular © RSNA, 2022.
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32
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Compact pediatric cardiac magnetic resonance imaging protocols. Pediatr Radiol 2022:10.1007/s00247-022-05447-y. [PMID: 35821442 DOI: 10.1007/s00247-022-05447-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
Cardiac MRI is in many respects an ideal modality for pediatric cardiovascular imaging, enabling a complete noninvasive assessment of anatomy, morphology, function and flow in one radiation-free and potentially non-contrast exam. Nonetheless, traditionally lengthy and complex imaging acquisition strategies have often limited its broader use beyond specialized centers. In this review, the author presents practical cardiac MRI imaging protocols to facilitate the performance of succinct yet successful exams that provide the most salient clinical data for the majority of congenital and acquired pediatric cardiac disease. In addition, the author reviews newer and evolving techniques that permit more rapid but similarly diagnostic MRI, including compressed sensing and artificial intelligence/machine learning reconstruction, four-dimensional flow acquisition and blood pool contrast agents. With the modern armamentarium of cardiac MRI methods, the goal of compact yet comprehensive exams in children can now be realized.
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33
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Ultrasmall Superparamagnetic Particles of Iron Oxide and Cardiac Magnetic Resonance: Novel Imaging in Everyday Conditions. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myocardial inflammation has been hypothesised to be the common underlying mechanism through which several cardiovascular diseases develop and progress. Cardiac magnetic resonance (CMR) has become a powerful non-invasive tool that enables the direct visualisation of the myocardium. The emerging use of ultrasmall superparamagnetic particles of iron oxide (USPIO) and their magnetic properties is gaining a lot of research interest. USPIO-enhanced CMR can provide valuable information, as it allows for the identification of active inflammation in the myocardium, a process that has been hypothesised to be the substrate for adverse remodelling and, eventually, heart failure. In this review, we summarise the properties of USPIO and their role in cardiac magnetic resonance imaging as well as their clinical applications.
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34
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Tham E, Sestito M, Markovich B, Garland-Kledzik M. Current and future imaging modalities in gastric cancer. J Surg Oncol 2022; 125:1123-1134. [PMID: 35481912 DOI: 10.1002/jso.26875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
Abstract
Gastric adenocarcinoma treatment can include endoscopic mucosal resection, surgery, chemotherapy, radiation, and palliative measures depending on staging. Both invasive and noninvasive staging techniques have been used to dictate the best treatment pathway. Here, we review the current imaging modalities used in gastric cancer as well as novel techniques to accurately stage and screen these patients.
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Affiliation(s)
- Elwin Tham
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Michael Sestito
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brian Markovich
- Department of Diagnostic Radiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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35
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Malik DG, Rath TJ, Urcuyo Acevedo JC, Canoll PD, Swanson KR, Boxerman JL, Quarles CC, Schmainda KM, Burns TC, Hu LS. Advanced MRI Protocols to Discriminate Glioma From Treatment Effects: State of the Art and Future Directions. FRONTIERS IN RADIOLOGY 2022; 2:809373. [PMID: 37492687 PMCID: PMC10365126 DOI: 10.3389/fradi.2022.809373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 07/27/2023]
Abstract
In the follow-up treatment of high-grade gliomas (HGGs), differentiating true tumor progression from treatment-related effects, such as pseudoprogression and radiation necrosis, presents an ongoing clinical challenge. Conventional MRI with and without intravenous contrast serves as the clinical benchmark for the posttreatment surveillance imaging of HGG. However, many advanced imaging techniques have shown promise in helping better delineate the findings in indeterminate scenarios, as posttreatment effects can often mimic true tumor progression on conventional imaging. These challenges are further confounded by the histologic admixture that can commonly occur between tumor growth and treatment-related effects within the posttreatment bed. This review discusses the current practices in the surveillance imaging of HGG and the role of advanced imaging techniques, including perfusion MRI and metabolic MRI.
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Affiliation(s)
- Dania G. Malik
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
| | - Tanya J. Rath
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
| | - Javier C. Urcuyo Acevedo
- Mathematical Neurooncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, United States
| | - Peter D. Canoll
- Departments of Pathology and Cell Biology, Columbia University, New York, NY, United States
| | - Kristin R. Swanson
- Mathematical Neurooncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, United States
| | - Jerrold L. Boxerman
- Department of Diagnostic Imaging, Brown University, Providence, RI, United States
| | - C. Chad Quarles
- Department of Neuroimaging Research & Barrow Neuroimaging Innovation Center, Barrow Neurologic Institute, Phoenix, AZ, United States
| | - Kathleen M. Schmainda
- Department of Biophysics & Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Terry C. Burns
- Departments of Neurologic Surgery and Neuroscience, Mayo Clinic, Rochester, MN, United States
| | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
- Mathematical Neurooncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, United States
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36
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Harvell-Smith S, Tung LD, Thanh NTK. Magnetic particle imaging: tracer development and the biomedical applications of a radiation-free, sensitive, and quantitative imaging modality. NANOSCALE 2022; 14:3658-3697. [PMID: 35080544 DOI: 10.1039/d1nr05670k] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Magnetic particle imaging (MPI) is an emerging tracer-based modality that enables real-time three-dimensional imaging of the non-linear magnetisation produced by superparamagnetic iron oxide nanoparticles (SPIONs), in the presence of an external oscillating magnetic field. As a technique, it produces highly sensitive radiation-free tomographic images with absolute quantitation. Coupled with a high contrast, as well as zero signal attenuation at-depth, there are essentially no limitations to where that can be imaged within the body. These characteristics enable various biomedical applications of clinical interest. In the opening sections of this review, the principles of image generation are introduced, along with a detailed comparison of the fundamental properties of this technique with other common imaging modalities. The main feature is a presentation on the up-to-date literature for the development of SPIONs tailored for improved imaging performance, and developments in the current and promising biomedical applications of this emerging technique, with a specific focus on theranostics, cell tracking and perfusion imaging. Finally, we will discuss recent progress in the clinical translation of MPI. As signal detection in MPI is almost entirely dependent on the properties of the SPION employed, this work emphasises the importance of tailoring the synthetic process to produce SPIONs demonstrating specific properties and how this impacts imaging in particular applications and MPI's overall performance.
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Affiliation(s)
- Stanley Harvell-Smith
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT, UK.
- UCL Healthcare Biomagnetic and Nanomaterials Laboratories, University College London, 21 Albemarle Street, London W1S 4BS, UK
| | - Le Duc Tung
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT, UK.
- UCL Healthcare Biomagnetic and Nanomaterials Laboratories, University College London, 21 Albemarle Street, London W1S 4BS, UK
| | - Nguyen Thi Kim Thanh
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT, UK.
- UCL Healthcare Biomagnetic and Nanomaterials Laboratories, University College London, 21 Albemarle Street, London W1S 4BS, UK
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37
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Huang Y, Hsu JC, Koo H, Cormode DP. Repurposing ferumoxytol: Diagnostic and therapeutic applications of an FDA-approved nanoparticle. Am J Cancer Res 2022; 12:796-816. [PMID: 34976214 PMCID: PMC8692919 DOI: 10.7150/thno.67375] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
Ferumoxytol is an intravenous iron oxide nanoparticle formulation that has been approved by the U.S. Food and Drug Administration (FDA) for treating anemia in patients with chronic kidney disease. In recent years, ferumoxytol has also been demonstrated to have potential for many additional biomedical applications due to its excellent inherent physical properties, such as superparamagnetism, biocatalytic activity, and immunomodulatory behavior. With good safety and clearance profiles, ferumoxytol has been extensively utilized in both preclinical and clinical studies. Here, we first introduce the medical needs and the value of current iron oxide nanoparticle formulations in the market. We then focus on ferumoxytol nanoparticles and their physicochemical, diagnostic, and therapeutic properties. We include examples describing their use in various biomedical applications, including magnetic resonance imaging (MRI), multimodality imaging, iron deficiency treatment, immunotherapy, microbial biofilm treatment and drug delivery. Finally, we provide a brief conclusion and offer our perspectives on the current limitations and emerging applications of ferumoxytol in biomedicine. Overall, this review provides a comprehensive summary of the developments of ferumoxytol as an agent with diagnostic, therapeutic, and theranostic functionalities.
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38
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Pediatric cardiothoracic vasculitis: multimodality imaging review. Pediatr Radiol 2022; 52:1895-1909. [PMID: 35790558 PMCID: PMC9256530 DOI: 10.1007/s00247-022-05431-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 10/27/2022]
Abstract
The pediatric vasculitides are a relatively uncommon and heterogeneous group of disorders characterized by vessel inflammation, often with cardiothoracic involvement. Diagnosis and monitoring are often clinically challenging because of the nonspecific symptoms and laboratory markers. Thus, imaging has assumed increasing importance for early detection of disease activity, extent and complications as well as long-term monitoring pre- and post-treatment. Herein, we review the major pediatric vasculitides with frequent chest manifestations, including Takayasu arteritis, Kawasaki disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, Behçet disease and potential mimics. We highlight key clinical features and management considerations, emphasizing the central role of imaging.
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39
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de Bortoli T, Boehm-Sturm P, Koch SP, Nieminen-Kelhä M, Wessels L, Mueller S, Ielacqua GD, Klohs J, Vajkoczy P, Hecht N. Three-Dimensional Iron Oxide Nanoparticle-Based Contrast-Enhanced Magnetic Resonance Imaging for Characterization of Cerebral Arteriogenesis in the Mouse Neocortex. Front Neurosci 2021; 15:756577. [PMID: 34899163 PMCID: PMC8662986 DOI: 10.3389/fnins.2021.756577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Subsurface blood vessels in the cerebral cortex have been identified as a bottleneck in cerebral perfusion with the potential for collateral remodeling. However, valid techniques for non-invasive, longitudinal characterization of neocortical microvessels are still lacking. In this study, we validated contrast-enhanced magnetic resonance imaging (CE-MRI) for in vivo characterization of vascular changes in a model of spontaneous collateral outgrowth following chronic cerebral hypoperfusion. Methods: C57BL/6J mice were randomly assigned to unilateral internal carotid artery occlusion or sham surgery and after 21 days, CE-MRI based on T2*-weighted imaging was performed using ultra-small superparamagnetic iron oxide nanoparticles to obtain subtraction angiographies and steady-state cerebral blood volume (ss-CBV) maps. First pass dynamic susceptibility contrast MRI (DSC-MRI) was performed for internal validation of ss-CBV. Further validation at the histological level was provided by ex vivo serial two-photon tomography (STP). Results: Qualitatively, an increase in vessel density was observed on CE-MRI subtraction angiographies following occlusion; however, a quantitative vessel tracing analysis was prone to errors in our model. Measurements of ss-CBV reliably identified an increase in cortical vasculature, validated by DSC-MRI and STP. Conclusion: Iron oxide nanoparticle-based ss-CBV serves as a robust, non-invasive imaging surrogate marker for neocortical vessels, with the potential to reduce and refine preclinical models targeting the development and outgrowth of cerebral collateralization.
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Affiliation(s)
- Till de Bortoli
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Philipp Boehm-Sturm
- Center for Stroke Research Berlin (CSB), Berlin, Germany.,Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan P Koch
- Center for Stroke Research Berlin (CSB), Berlin, Germany.,Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Melina Nieminen-Kelhä
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Lars Wessels
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Susanne Mueller
- Center for Stroke Research Berlin (CSB), Berlin, Germany.,Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Giovanna D Ielacqua
- Institute for Biomedical Engineering, University of Zurich and ETH Zürich, Zurich, Switzerland
| | - Jan Klohs
- Institute for Biomedical Engineering, University of Zurich and ETH Zürich, Zurich, Switzerland
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Berlin, Germany
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40
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Hu S, Chen H, Zhou F, Liu J, Qian Y, Hu K, Yan J, Gu Z, Guo Z, Zhang F, Gu N. Superparamagnetic core-shell electrospun scaffolds with sustained release of IONPs facilitating in vitro and in vivo bone regeneration. J Mater Chem B 2021; 9:8980-8993. [PMID: 34494055 DOI: 10.1039/d1tb01261d] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bone tissue engineering (BTE) is a promising approach to recover insufficient bone in dental implantations. However, the clinical application of BTE scaffolds is limited by their low mechanical strength and lack of osteoinduction. In an attempt to circumvent these limitations and improve osteogenesis, we introduced magnetic iron oxide nanoparticles (IONPs) into a core-shell porous electrospun scaffold and evaluated their impact on the physical, mechanical, and biological properties of the scaffold. We used poly(lactic-co-glycolic acid)/polycaprolactone/beta-tricalcium phosphate (PPT) scaffolds with and without γ-Fe2O3 encapsulation, namely PPT-Fe scaffolds and PPT scaffolds, respectively. The γ-Fe2O3 used in the PPT-Fe scaffolds was coated with polyglucose sorbitol carboxymethylether and was biocompatible. Structurally, PPT-Fe scaffolds showed uniform iron distribution encapsulated within the resorbable PPT scaffolds, and these scaffolds supported sustainable iron release. Furthermore, compared with PPT scaffolds, PPT-Fe scaffolds showed significantly better physical and mechanical properties, including wettability, superparamagnetism, hardness, tensile strength, and elasticity modulus. In vitro tests of rat adipose-derived mesenchymal stem cells (rADSCs) seeded onto the scaffolds showed increased expression of integrin β1, alkaline phosphatase, and osteogenesis-related genes. In addition, enhanced in vivo bone regeneration was observed after implanting PPT-Fe scaffolds in rat calvarial bone defects. Thus, we can conclude that the incorporation of IONPs into porous scaffolds for long-term release can provide a new strategy for BTE scaffold optimization and is a promising approach that can offer enhanced osteogenic capacity in clinical applications.
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Affiliation(s)
- Shuying Hu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Prosthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China.
| | - Hanbang Chen
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Prosthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China.
| | - Fang Zhou
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Prosthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China.
| | - Jun Liu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Prosthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China.
| | - Yunzhu Qian
- Center of Stomatology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Ke Hu
- Laboratory of Oral Regenerative Medicine Technology, School of Biomedical Engineering and Informatics, Department of Biomedical Engineering, Nanjing Medical University, Nanjing 210000, China
| | - Jia Yan
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Prosthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China.
| | - Zhuxiao Gu
- Jiangsu Key Laboratory for Science and Applications of Molecular Ferroelectrics, Southeast University, Nanjing 211189, China
| | - Zhaobin Guo
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, 21218, USA
| | - Feimin Zhang
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Prosthodontics, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China.
| | - Ning Gu
- State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
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41
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Labusca L, Herea DD, Emanuela Minuti A, Stavila C, Danceanu C, Plamadeala P, Chiriac H, Lupu N. Magnetic Nanoparticles and Magnetic Field Exposure Enhances Chondrogenesis of Human Adipose Derived Mesenchymal Stem Cells But Not of Wharton Jelly Mesenchymal Stem Cells. Front Bioeng Biotechnol 2021; 9:737132. [PMID: 34733830 PMCID: PMC8558412 DOI: 10.3389/fbioe.2021.737132] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: Iron oxide based magnetic nanoparticles (MNP) are versatile tools in biology and medicine. Adipose derived mesenchymal stem cells (ADSC) and Wharton Jelly mesenchymal stem cells (WJMSC) are currently tested in different strategies for regenerative regenerative medicine (RM) purposes. Their superiority compared to other mesenchymal stem cell consists in larger availability, and superior proliferative and differentiation potential. Magnetic field (MF) exposure of MNP-loaded ADSC has been proposed as a method to deliver mechanical stimulation for increasing conversion to musculoskeletal lineages. In this study, we investigated comparatively chondrogenic conversion of ADSC-MNP and WJMSC with or without MF exposure in order to identify the most appropriate cell source and differentiation protocol for future cartilage engineering strategies. Methods: Human primary ADSC and WJMSC from various donors were loaded with proprietary uncoated MNP. The in vitro effect on proliferation and cellular senescence (beta galactosidase assay) in long term culture was assessed. In vitro chondrogenic differentiation in pellet culture system, with or without MF exposure, was assessed using pellet histology (Safranin O staining) as well as quantitative evaluation of glycosaminoglycan (GAG) deposition per cell. Results: ADSC-MNP complexes displayed superior proliferative capability and decreased senescence after long term (28 days) culture in vitro compared to non-loaded ADSC and to WJMSC-MNP. Significant increase in chondrogenesis conversion in terms of GAG/cell ratio could be observed in ADSC-MNP. MF exposure increased glycosaminoglycan deposition in MNP-loaded ADSC, but not in WJMSC. Conclusion: ADSC-MNP display decreased cellular senescence and superior chondrogenic capability in vitro compared to non-loaded cells as well as to WJMSC-MNP. MF exposure further increases ADSC-MNP chondrogenesis in ADSC, but not in WJMSC. Loading ADSC with MNP can derive a successful procedure for obtaining improved chondrogenesis in ADSC. Further in vivo studies are needed to confirm the utility of ADSC-MNP complexes for cartilage engineering.
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Affiliation(s)
- Luminita Labusca
- National Institute of Research and Development for Technical Physics, Iasi, Romania
- Orthopedics and Traumatology Clinic County Emergency Hospital Saint Spiridon, Iasi, Romania
| | - Dumitru-Daniel Herea
- National Institute of Research and Development for Technical Physics, Iasi, Romania
| | - Anca Emanuela Minuti
- National Institute of Research and Development for Technical Physics, Iasi, Romania
- Faculty of Physics, Alexandru Ioan Cuza University, Iasi, Romania
| | - Cristina Stavila
- National Institute of Research and Development for Technical Physics, Iasi, Romania
- Faculty of Physics, Alexandru Ioan Cuza University, Iasi, Romania
| | - Camelia Danceanu
- National Institute of Research and Development for Technical Physics, Iasi, Romania
- Faculty of Physics, Alexandru Ioan Cuza University, Iasi, Romania
| | - Petru Plamadeala
- Pathology Department County Children Emergency Hospital Saint Mary, Iasi, Romania
| | - Horia Chiriac
- National Institute of Research and Development for Technical Physics, Iasi, Romania
| | - Nicoleta Lupu
- National Institute of Research and Development for Technical Physics, Iasi, Romania
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Ludewig P, Graeser M, Forkert ND, Thieben F, Rández-Garbayo J, Rieckhoff J, Lessmann K, Förger F, Szwargulski P, Magnus T, Knopp T. Magnetic particle imaging for assessment of cerebral perfusion and ischemia. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2021; 14:e1757. [PMID: 34617413 DOI: 10.1002/wnan.1757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 02/04/2023]
Abstract
Stroke is one of the leading worldwide causes of death and sustained disability. Rapid and accurate assessment of cerebral perfusion is essential to diagnose and successfully treat stroke patients. Magnetic particle imaging (MPI) is a new technology with the potential to overcome some limitations of established imaging modalities. It is an innovative and radiation-free imaging technique with high sensitivity, specificity, and superior temporal resolution. MPI enables imaging and diagnosis of stroke and other neurological pathologies such as hemorrhage, tumors, and inflammatory processes. MPI scanners also offer the potential for targeted therapies of these diseases. Due to lower field requirements, MPI scanners can be designed as resistive magnets and employed as mobile devices for bedside imaging. With these advantages, MPI could accelerate and improve the diagnosis and treatment of neurological disorders. This review provides a basic introduction to MPI, discusses its current use for stroke imaging, and addresses future applications, including the potential for clinical implementation. This article is categorized under: Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Therapeutic Approaches and Drug Discovery > Nanomedicine for Neurological Disease.
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Affiliation(s)
- Peter Ludewig
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Graeser
- Section for Biomedical Imaging at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany.,Fraunhofer Research Institute for Individualized and Cell-based Medicine, Lübeck, Germany.,Institute for Medical Engineering, University of Lübeck, Lübeck, Germany
| | - Nils D Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Florian Thieben
- Section for Biomedical Imaging at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Javier Rández-Garbayo
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Rieckhoff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lessmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fynn Förger
- Section for Biomedical Imaging at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Patryk Szwargulski
- Section for Biomedical Imaging at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Tim Magnus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Knopp
- Section for Biomedical Imaging at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
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Baki A, Wiekhorst F, Bleul R. Advances in Magnetic Nanoparticles Engineering for Biomedical Applications-A Review. Bioengineering (Basel) 2021; 8:134. [PMID: 34677207 PMCID: PMC8533261 DOI: 10.3390/bioengineering8100134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022] Open
Abstract
Magnetic iron oxide nanoparticles (MNPs) have been developed and applied for a broad range of biomedical applications, such as diagnostic imaging, magnetic fluid hyperthermia, targeted drug delivery, gene therapy and tissue repair. As one key element, reproducible synthesis routes of MNPs are capable of controlling and adjusting structure, size, shape and magnetic properties are mandatory. In this review, we discuss advanced methods for engineering and utilizing MNPs, such as continuous synthesis approaches using microtechnologies and the biosynthesis of magnetosomes, biotechnological synthesized iron oxide nanoparticles from bacteria. We compare the technologies and resulting MNPs with conventional synthetic routes. Prominent biomedical applications of the MNPs such as diagnostic imaging, magnetic fluid hyperthermia, targeted drug delivery and magnetic actuation in micro/nanorobots will be presented.
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Affiliation(s)
- Abdulkader Baki
- Fraunhofer Institute for Microengineering and Microsystems IMM, Carl-Zeiss-Straße 18-20, 55129 Mainz, Germany;
| | - Frank Wiekhorst
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany;
| | - Regina Bleul
- Fraunhofer Institute for Microengineering and Microsystems IMM, Carl-Zeiss-Straße 18-20, 55129 Mainz, Germany;
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Kawassaki RK, Romano M, Dietrich N, Araki K. Titanium and Iron Oxide Nanoparticles for Cancer Therapy: Surface Chemistry and Biological Implications. FRONTIERS IN NANOTECHNOLOGY 2021. [DOI: 10.3389/fnano.2021.735434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Currently, cancer is among the most challenging diseases due to its ability to continuously evolve into a more complex muldimentional system, in addition to its high capability to spread to other organs and tissues. In this context, the relevance of nanobiomaterials (NBMs) for the development of new more effective and less harmful treatments is increasing. NBMs provide the possibility of combining several functionalities on a single system, expectedly in a synergic way, to better perform the treatment and cure. However, the control of properties such as colloidal stability, circulation time, pharmacokinetics, and biodistribution, assuring the concentration in specific target tissues and organs, while keeping all desired properties, tends to be dependent on subtle changes in surface chemistry. Hence, the behavior of such materials in different media/environments is of uttermost relevance and concern since it can compromise their efficiency and safety on application. Given the bright perspectives, many efforts have been focused on the development of nanomaterials fulfilling the requirements for real application. These include robust and reproducible preparation methods to avoid aggregation while preserving the interaction properties. The possible impact of nanomaterials in different forms of diagnosis and therapy has been demonstrated in the past few years, given the perspectives on how revolutionary they can be in medicine and health. Considering the high biocompatibility and suitability, this review is focused on titanium dioxide– and iron oxide–based nanoagents highlighting the current trends and main advancements in the research for cancer therapies. The effects of phenomena, such as aggregation and agglomeration, the formation of the corona layer, and how they can compromise relevant properties of nanomaterials and their potential applicability, are also addressed. In short, this review summarizes the current understanding and perspectives on such smart nanobiomaterials for diagnostics, treatment, and theranostics of diseases.
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Frater JL. Trends in iron deficiency anemia research 2001-2020: A bibliometric analysis. World J Meta-Anal 2021; 9:389-404. [DOI: 10.13105/wjma.v9.i4.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/17/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iron deficiency anemia has a worldwide impact on individual health and national and international economies, with an estimated one-third of the world population being iron deficient.
AIM To evaluate the iron deficiency literature published between 2001-2020 with an emphasis on: (1) Identification of collaborative research networks most active in this field; (2) Research topics of greatest importance; and (3) Analysis of the most-cited papers published between 2001-2020 and the most cited papers in 5-year intervals during this period to assess for emerging trends in research in this area.
METHODS A search of Clarivate Analytics World of Science Core Collection was performed for the topic “iron deficiency anemia”, limited to document type (article or review), language (English), and time span (2001-2020). The following data were extracted from these articles: Year of publication, journal, study design, country of first author, and number of citations. The metadata derived from the search were used to identify publication trends in iron deficiency anemia research and their distribution in countries/regions and institutions. Network visualization by VOSviewer (Leiden University) was performed to identify international collaborative groups and research hotspots.
RESULTS The search identified 4828 publications. Three international collaborative networks were identified: United States, Canada, and India; Turkey, China, and Japan; and England and other European countries. Five research areas were hotspots: Epidemiologic aspects of iron deficiency anemia, biochemical aspects of iron deficiency anemia, clinical evaluation of causes of iron deficiency anemia, causes of iron deficiency anemia, and bioavailability of dietary iron. Subset analysis of the top-10 overall cited papers, and the top-10 cited papers for each 5-year increment beginning in 2001 showed that the largest number of highly cited papers were from the field of epidemiology, the smallest number from the field of bioavailability of dietary iron.
CONCLUSION The literature on iron deficiency anemia has a high citation rate compared to studies of other topics using similar methodology and is heavily biased toward studies from the United States and epidemiologic studies.
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Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University, St. Louis, MO 63110, United States
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van Zandwijk JK, Simonis FFJ, Heslinga FG, Hofmeijer EIS, Geelkerken RH, ten Haken B. Comparing the signal enhancement of a gadolinium based and an iron-oxide based contrast agent in low-field MRI. PLoS One 2021; 16:e0256252. [PMID: 34403442 PMCID: PMC8370648 DOI: 10.1371/journal.pone.0256252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022] Open
Abstract
Recently, there has been a renewed interest in low-field MRI. Contrast agents (CA) in MRI have magnetic behavior dependent on magnetic field strength. Therefore, the optimal contrast agent for low-field MRI might be different from what is used at higher fields. Ultra-small superparamagnetic iron-oxides (USPIOs), commonly used as negative CA, might also be used for generating positive contrast in low-field MRI. The purpose of this study was to determine whether an USPIO or a gadolinium based contrast agent is more appropriate at low field strengths. Relaxivity values of ferumoxytol (USPIO) and gadoterate (gadolinium based) were used in this research to simulate normalized signal intensity (SI) curves within a concentration range of 0–15 mM. Simulations were experimentally validated on a 0.25T MRI scanner. Simulations and experiments were performed using spin echo (SE), spoiled gradient echo (SGE), and balanced steady-state free precession (bSSFP) sequences. Maximum achievable SIs were assessed for both CAs in a range of concentrations on all sequences. Simulations at 0.25T showed a peak in SIs at low concentrations ferumoxytol versus a wide top at higher concentrations for gadoterate in SE and SGE. Experiments agreed well with the simulations in SE and SGE, but less in the bSSFP sequence due to overestimated relaxivities in simulations. At low magnetic field strengths, ferumoxytol generates similar signal enhancement at lower concentrations than gadoterate.
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Affiliation(s)
- Jordy K. van Zandwijk
- Magnetic Detection & Imaging, TechMed Centre, University of Twente, Enschede, Netherlands
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands
- * E-mail:
| | - Frank F. J. Simonis
- Magnetic Detection & Imaging, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Friso G. Heslinga
- Magnetic Detection & Imaging, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Elfi I. S. Hofmeijer
- Magnetic Detection & Imaging, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Robert H. Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands
- Multimodality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Bennie ten Haken
- Magnetic Detection & Imaging, TechMed Centre, University of Twente, Enschede, Netherlands
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Giotta Lucifero A, Baldoncini M, Bruno N, Galzio R, Hernesniemi J, Luzzi S. Shedding the Light on the Natural History of Intracranial Aneurysms: An Updated Overview. ACTA ACUST UNITED AC 2021; 57:medicina57080742. [PMID: 34440948 PMCID: PMC8400479 DOI: 10.3390/medicina57080742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
The exact molecular pathways underlying the multifactorial natural history of intracranial aneurysms (IAs) are still largely unknown, to the point that their understanding represents an imperative challenge in neurovascular research. Wall shear stress (WSS) promotes the genesis of IAs through an endothelial dysfunction causing an inflammatory cascade, vessel remodeling, phenotypic switching of the smooth muscle cells, and myointimal hyperplasia. Aneurysm growth is supported by endothelial oxidative stress and inflammatory mediators, whereas low and high WSS determine the rupture in sidewall and endwall IAs, respectively. Angioarchitecture, age older than 60 years, female gender, hypertension, cigarette smoking, alcohol abuse, and hypercholesterolemia also contribute to growth and rupture. The improvements of aneurysm wall imaging techniques and the implementation of target therapies targeted against inflammatory cascade may contribute to significantly modify the natural history of IAs. This narrative review strives to summarize the recent advances in the comprehension of the mechanisms underlying the genesis, growth, and rupture of IAs.
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Affiliation(s)
- Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Matías Baldoncini
- Department of Neurological Surgery, Hospital San Fernando, Buenos Aires 1646, Argentina;
| | - Nunzio Bruno
- Division of Neurosurgery, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, 48032 Cotignola, Italy;
| | - Juha Hernesniemi
- Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou 450000, China;
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence:
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Wang X, Guo S, Li Z, Luo Q, Dai Y, Zhang H, Ye Y, Gong Q, Luo K. Amphiphilic branched polymer-nitroxides conjugate as a nanoscale agent for potential magnetic resonance imaging of multiple objects in vivo. J Nanobiotechnology 2021; 19:205. [PMID: 34243760 PMCID: PMC8272293 DOI: 10.1186/s12951-021-00951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/01/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In order to address the potential toxicity of metal-based magnetic resonance imaging (MRI) contrast agents (CAs), a concept of non-metallic MRI CAs has emerged. Currently, paramagnetic nitroxides (such as (2,2,5,5-tetramethylpyrrolidine-1-oxyl, PROXYL), (2,2,6,6-tetramethylpiperidine-1-oxide, TEMPO), etc.) are being extensively studied because their good stability and imaging mechanism are similar to metal-based contrast agents (such as Gd3+ chelate-based clinical CAs). However, a lower relaxivity and rapid in vivo metabolism of nitroxides remain to be addressed. Previous studies have demonstrated that the construction of macromolecular nitroxides contrast agents (mORCAs) is a promising solution through macromolecularization of nitroxides (i.e., use of large molecules to carry nitroxides). Macromolecular effects not only increase the stability of nitroxides by limiting their exposure to reductive substances in the body, but also improve the overall 1H water relaxation by increasing the concentration of nitroxides and slowing the molecular rotation speed. RESULTS Branched pDHPMA-mPEG-Ppa-PROXYL with a high molecular weight (MW = 160 kDa) and a nitroxides content (0.059 mmol/g) can form a nanoscale (~ 28 nm) self-assembled aggregate in a water environment and hydrophobic PROXYL can be protected by a hydrophilic outer layer to obtain strong reduction resistance in vivo. Compared with a small molecular CA (3-Carboxy-PROXYL (3-CP)), Branched pDHPMA-mPEG-Ppa-PROXYL displays three prominent features: (1) its longitudinal relaxivity (0.50 mM- 1 s- 1) is about three times that of 3-CP (0.17 mM- 1 s- 1); (2) the blood retention time of nitroxides is significantly increased from a few minutes of 3-CP to 6 h; (3) it provides long-term and significant enhancement in MR imaging of the tumor, liver, kidney and cardiovascular system (heart and aortaventralis), and this is the first report on nitroxides-based MRI CAs for imaging the cardiovascular system. CONCLUSIONS As a safe and efficient candidate metal-free magnetic resonance contrast agent, Branched pDHPMA-mPEG-Ppa-PROXYL is expected to be used not only in imaging the tumor, liver and kidney, but also the cardiovascular system, which expands the application scope of these CAs.
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Affiliation(s)
- Xiaoming Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences (UCAS), No. 104 Pipashan Main Street, Yuzhong District, 400014, Chongqing, China
| | - Shiwei Guo
- Department of Pharmacy of the Affiliated Hospital of Southwest Medical University, Southwest Medical University, Sichuan Province, 646000, Luzhou, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, 646000, Luzhou, People's Republic of China
| | - Zhiqian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Qiang Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yan Dai
- Department of Pharmacy of the Affiliated Hospital of Southwest Medical University, Southwest Medical University, Sichuan Province, 646000, Luzhou, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, 646000, Luzhou, People's Republic of China
| | - Hu Zhang
- Amgen Bioprocessing Centre, Keck Graduate Institute Claremont, 91711, Claremont, CA, USA
| | - Yun Ye
- Department of Pharmacy of the Affiliated Hospital of Southwest Medical University, Southwest Medical University, Sichuan Province, 646000, Luzhou, People's Republic of China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041, Chengdu, China
| | - Kui Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041, Chengdu, China.
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Zucker EJ, Sandino CM, Kino A, Lai P, Vasanawala SS. Free-breathing Accelerated Cardiac MRI Using Deep Learning: Validation in Children and Young Adults. Radiology 2021; 300:539-548. [PMID: 34128724 DOI: 10.1148/radiol.2021202624] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Obtaining ventricular volumetry and mass is key to most cardiac MRI but challenged by long multibreath-hold acquisitions. Purpose To assess the image quality and performance of a highly accelerated, free-breathing, two-dimensional cine cardiac MRI sequence incorporating deep learning (DL) reconstruction compared with reference standard balanced steady-state free precession (bSSFP). Materials and Methods A DL algorithm was developed to reconstruct custom 12-fold accelerated bSSFP cardiac MRI cine images from coil sensitivity maps using 15 iterations of separable three-dimensional convolutions and data consistency steps. The model was trained, validated, and internally tested in 10, two, and 10 adult human volunteers, respectively, based on vendor partner-supplied fully sampled bSSFP acquisitions. For prospective external clinical validation, consecutive children and young adults undergoing cardiac MRI from September through December 2019 at a single children's hospital underwent both conventional and highly accelerated short-axis bSSFP cine acquisitions in one MRI examination. Two radiologists scored overall and volumetric three-dimensional mesh image quality of all short-axis stacks on a five-point Likert scale and manually segmented endocardial and epicardial contours. Scan times and image quality were compared using the Wilcoxon rank sum test. Measurement agreement was assessed with intraclass correlation coefficient and Bland-Altman analysis. Results Fifty participants (mean age, 16 years ± 4 [standard deviation]; range, 5-30 years; 29 men) were evaluated. The mean prescribed acquisition times of accelerated scans (non-breath-held) and bSSFP (excluding breath-hold time) were 0.9 minute ± 0.3 versus 3.0 minutes ± 1.9 (P < .001). Overall and three-dimensional mesh image quality scores were, respectively, 3.8 ± 0.6 versus 4.3 ± 0.6 (P < .001) and 4.0 ± 1.0 versus 4.4 ± 0.8 (P < .001). Raters had strong agreement between all bSSFP and DL measurements, with intraclass correlation coefficients of 0.76 to 0.97, near-zero mean differences, and narrow limits of agreement. Conclusion With slightly lower image quality yet much faster speed, deep learning reconstruction may allow substantially shorter acquisition times of cardiac MRI compared with conventional balanced steady-state free precession MRI performed for ventricular volumetry. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Evan J Zucker
- From the Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305 (E.J.Z., A.K., S.S.V.); Department of Electrical Engineering, Stanford University, Stanford, Calif (C.M.S.); and Global MR Applications and Workflow, GE Healthcare, Menlo Park, Calif (P.L.)
| | - Christopher M Sandino
- From the Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305 (E.J.Z., A.K., S.S.V.); Department of Electrical Engineering, Stanford University, Stanford, Calif (C.M.S.); and Global MR Applications and Workflow, GE Healthcare, Menlo Park, Calif (P.L.)
| | - Aya Kino
- From the Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305 (E.J.Z., A.K., S.S.V.); Department of Electrical Engineering, Stanford University, Stanford, Calif (C.M.S.); and Global MR Applications and Workflow, GE Healthcare, Menlo Park, Calif (P.L.)
| | - Peng Lai
- From the Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305 (E.J.Z., A.K., S.S.V.); Department of Electrical Engineering, Stanford University, Stanford, Calif (C.M.S.); and Global MR Applications and Workflow, GE Healthcare, Menlo Park, Calif (P.L.)
| | - Shreyas S Vasanawala
- From the Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305 (E.J.Z., A.K., S.S.V.); Department of Electrical Engineering, Stanford University, Stanford, Calif (C.M.S.); and Global MR Applications and Workflow, GE Healthcare, Menlo Park, Calif (P.L.)
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50
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Colbert CM, Thomas MA, Yan R, Radjenovic A, Finn JP, Hu P, Nguyen KL. Estimation of fractional myocardial blood volume and water exchange using ferumoxytol-enhanced magnetic resonance imaging. J Magn Reson Imaging 2021; 53:1699-1709. [PMID: 33382176 PMCID: PMC8297410 DOI: 10.1002/jmri.27494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/07/2023] Open
Abstract
Fractional myocardial blood volume (fMBV) estimated using ferumoxytol-enhanced magnetic resonance imaging (MRI) (FE-MRI) has the potential to capture a hemodynamic response to myocardial hypoperfusion during contrast steady state without reliance on gadolinium chelates. Ferumoxytol has a long intravascular half-life and its use for steady-state MRI is off-label. The aim of this prospective study was to optimize and evaluate a two-compartment model for estimation of fMBV based on FE-MRI. Nine healthy swine and one swine with artificially induced single-vessel coronary stenosis underwent MRI on a 3.0 T clinical magnet. Myocardial longitudinal spin-lattice relaxation rate (R1) was measured using the 5(3)3(3)3 modified Look-Locker inversion recovery (MOLLI) sequence before and at contrast steady state following seven ferumoxytol infusions (0.125-4.0 mg/kg). fMBV and water exchange were estimated using a two-compartment model. Model-fitted fMBV was compared to simple fast-exchange fMBV approximation and percent change in pre- and postferumoxytol R1. Dose undersampling schemes were investigated to reduce acquisition duration. Variation in fMBV was assessed using one-way analysis of variance. Fast-exchange fMBV and ferumoxytol dose undersampling were evaluated using Bland-Altman analysis. Healthy normal swine showed a mean mid-ventricular fMBV of 7.2 ± 1.4% and water exchange rate of 11.3 ± 5.1 s-1 . There was intersubject variation in fMBV (p < 0.05) without segmental variation (p = 0.387). fMBV derived from eight-dose and four-dose sampling schemes had no significant bias (mean difference = 0.07, p = 0.541, limits of agreement -1.04% [-1.45, -0.62%] to 1.18% [0.77, 1.59%]). Pixel-wise fMBV in one swine model with coronary artery stenosis showed elevated fMBV in ischemic segments (apical anterior: 11.90 ± 4.00%, apical septum: 16.10 ± 5.71%) relative to remote segments (apical inferior: 9.59 ± 3.35%, apical lateral: 9.38 ± 2.35%). A two-compartment model based on FE-MRI using the MOLLI sequence may enable estimation of fMBV in studies of ischemic heart disease. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Caroline M. Colbert
- Physics and Biology in Medicine Graduate Program, David
Geffen School of Medicine at UCLA
| | - Michael A. Thomas
- Division of Cardiology, David Geffen School of Medicine at
UCLA and VA Greater Los Angeles Healthcare System
| | - Ran Yan
- Bioengineering Graduate Program, Henry Samueli School of
Engineering and Applied Science at UCLA
| | - Aleksandra Radjenovic
- Institute of Cardiovascular & Medical Sciences, College
of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - J. Paul Finn
- Physics and Biology in Medicine Graduate Program, David
Geffen School of Medicine at UCLA
- Diagnostic Cardiovascular Imaging Laboratory, Department of
Radiological Sciences, David Geffen School of Medicine at UCLA
| | - Peng Hu
- Physics and Biology in Medicine Graduate Program, David
Geffen School of Medicine at UCLA
- Bioengineering Graduate Program, Henry Samueli School of
Engineering and Applied Science at UCLA
- Diagnostic Cardiovascular Imaging Laboratory, Department of
Radiological Sciences, David Geffen School of Medicine at UCLA
| | - Kim-Lien Nguyen
- Physics and Biology in Medicine Graduate Program, David
Geffen School of Medicine at UCLA
- Division of Cardiology, David Geffen School of Medicine at
UCLA and VA Greater Los Angeles Healthcare System
- Diagnostic Cardiovascular Imaging Laboratory, Department of
Radiological Sciences, David Geffen School of Medicine at UCLA
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