MR venography using an intravascular contrast agent: results from a multicenter phase 2 study of dosage

Iron oxide nanoparticles: Diagnostic, therapeutic and theranostic applications

Many different iron oxide nanoparticles have been evaluated over the years, for a wide variety of biomedical applications. We here summarize the synthesis, surface functionalization and characterization of iron oxide nanoparticles, as well as their (pre-) clinical use in diagnostic, therapeutic and theranostic settings. Diagnostic applications include liver, lymph node, inflammation and vascular imaging, employing mostly magnetic resonance imaging but recently also magnetic particle imaging. Therapeutic applications encompass iron supplementation in anemia and advanced cancer treatments, such as modulation of macrophage polarization, magnetic fluid hyperthermia and magnetic drug targeting. Because of their properties, iron oxide nanoparticles are particularly useful for theranostic purposes. Examples of such setups, in which diagnosis and therapy are intimately combined and in which iron oxide nanoparticles are used, are image-guided drug delivery, image-guided and microbubble-mediated opening of the blood-brain barrier, and theranostic tissue engineering. Together, these directions highlight the versatility and the broad applicability of iron oxide nanoparticles, and indicate the integration in future medical practice of multiple iron oxide nanoparticle-based materials.

"Magnus nano-bullets" as T1/T2 based dual-modal for in vitro and in vivo MRI visualization

Tissue specific T₁/T₂ dual contrast abilities for magnetic resonance imaging (MRI) have great significance in initial detection of cancer lesions. Herein, we developed a novel kind of Magnus nano-bullets (Mn-DTPA-F-MSNs) distinguished by magnetic (Fe₃O₄-NPs) head combined with mesoporous (SiO₂) persist body, respectively. Subsequently, modify mesoporous SiO₂ group and finally loaded with Mn²⁺. These Magnus nano-bullets have relaxivity value (r₁ = 5.12 mM^-1 s^-1) and relaxivity value (r₂ = 265.32 mM^-1 s^-1); they were > 2 folds in comparison to control at 3.0 T. Meanwhile, Magnus nano-bullets also offered significant enhancements for the detection of Glutathione (GSH), a biomarker that has been showed a redox responsive T₁-weighted MRI effect in vitro and in vivo evaluations with good biocompatibility. Therefore, our finding endorses that Magnus nano-bullets offer a "smart" and tremendous strategy for greater GSH responsive T₁/T₂ dual MRI image probes for future biomedical applications.

Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla

BACKGROUND

The aim was to investigate the feasibility of a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BBTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and a variable flip angle turbo-spin-echo readout, for the diagnosis of acute deep vein thrombosis (DVT) at 1.5 T.

METHODS

BBTI was conducted in 15 healthy subjects and 30 acute DVT patients. Contrast-enhanced CMR venography (CE-CMRV) was conducted for comparison and only performed in the patients. Apparent contrast-to-noise ratios between the thrombus and the muscle/lumen were calculated to determine whether BBTI could provide an adequate thrombus signal for diagnosis. Two blinded readers assessed the randomized BBTI images from all participants and made independent decisions on the presence or absence of thrombus at the segment level. Images obtained by CE-CMRV were also randomized and assessed by the two readers. Using the consensus CE-CMRV as a reference, the sensitivity, specificity, positive and negative predictive values, and accuracy of BBTI, as well as its diagnostic agreement with CE-CMRV, were calculated. Additionally, diagnostic confidence and interobserver diagnostic agreement were evaluated.

RESULTS

The thrombi in the acute phase exhibited iso- or hyperintense signals on the BBTI images. All the healthy subjects were correctly identified from the participants based on the segment level. The diagnostic confidence of BBTI was comparable to that of CE-CMRV (3.69 ± 0.52 vs. 3.70 ± 0.47). High overall sensitivity (95.2%), SP (98.6%), positive predictive value (96.0%), negative predictive value (98.3%), and accuracy (97.7%), as well as excellent diagnostic and interobserver agreements, were achieved using BBTI.

CONCLUSION

BBTI is a reliable, contrast-free technique for the diagnosis of acute DVT at 1.5 T.

Alternatives to GBCA: Are We There Yet?

Gadolinium has been widely used as the contrast agent of choice for magnetic resonance imaging (MRI). However, gadolinium administration is not always desired due to its inherent enhancement properties and potential side effects (nephrogenic systemic fibrosis). This article reviews gadolinium alternatives, iron-, and manganese- based agents, and their current clinical usage for contrast-enhanced MRI examinations.

Casp3/7-Instructed Intracellular Aggregation of Fe3O4 Nanoparticles Enhances T2 MR Imaging of Tumor Apoptosis

Large magnetic nanoparticles or aggregates are advantageous in their magnetic resonance properties over ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles (NPs), but the former are cleared faster from the blood pool. Therefore, the "smart" strategy of intracellular aggregation of USPIO NPs is required for enhanced T2-weighted MR imaging. Herein, employing an enzyme-instructed condensation reaction, we rationally designed a small molecule Ac-Asp-Glu-Val-Asp-Cys(StBu)-Lys-CBT (1) to covalently modify USPIO NPs to prepare monodispersive Fe3O4@1 NPs. In vitro results showed that Fe3O4@1 NPs could be subjected to caspase 3 (Casp3)-instructed aggregation. T2 phantom MR imaging showed that the transverse molar relaxivity (r2) of Fe3O4@1 NPs with Casp3 or apoptotic HepG2 cells was significantly larger than those of control groups. In vivo tumor MR imaging results indicated that Fe3O4@1 NPs could be specifically applied for enhanced T2 MR imaging of tumor apoptosis. We propose that the enzyme-instructed intracellular aggregation of Fe3O4 NPs could be a novel strategy for the design of "smart" probes for efficient T2 MR imaging of in vivo biomarkers.

MR venography with true fast imaging with steady-state precession for suspected lower-limb deep vein thrombosis

PURPOSE

To compare true fast imaging with steady-state precession (FISP) magnetic resonance (MR) venography for suspected deep vein thrombosis (DVT) with contrast agent-enhanced venography.

MATERIALS AND METHODS

This was a prospective study of randomly selected patients with a clinical suspicion of DVT of the lower limb. Standard contrast venography was performed and compared with MR venography from the inferior vena cava to the feet in 24 patients with use of true FISP sequences (repetition time, 3.74 msec; echo time, 1.8 msec). Two radiologists independently read the MR venography and contrast venography studies. Segment visibility, secondary signs of DVT, and additional diagnoses were noted.

RESULTS

MR venography demonstrated all venous segments in the pelvis and thigh. When results were analyzed on a per-patient basis, there was good agreement between contrast venography and MR venography (kappa = 0.64; 95% CI, 0.33-0.94; P = .0001). When the venous system was analyzed on a segmental basis, there was very good agreement between contrast venography and MR venography (kappa = 0.81; 95% CI, 0.68-0.94; P = .0001). The sensitivity and specificity for DVT detection were 100% for the iliac and popliteal segments and 100% and 98%, 68% and 94%, and 87% and 98%, respectively, for the femoral, below-knee, and all veins. Eleven of 14 patients without DVT had an alternative diagnosis suggested by MR venography.

CONCLUSIONS

MR venography with axial true FISP allows noninvasive rapid diagnosis of acute DVT in the iliac, femoral, popliteal, and calf muscle veins. MR venography is much less reliable in the tibial or peroneal veins. It may demonstrate a nonvenous cause of a patient's symptoms.

Lower Extremity Deep Venous Thrombosis: Evaluation with Ferumoxytol-enhanced MR Imaging and Dual-Contrast Mechanism—Preliminary Experience

Institutional review board approval and informed consent were obtained for this HIPAA-compliant study, whose purpose was to prospectively evaluate the use of a dual-contrast mechanism in conjunction with an iron oxide blood pool contrast agent, ferumoxytol, to depict deep venous thrombosis (DVT). Nine patients with lower extremity DVT detected with duplex ultrasonography (US) were imaged with magnetic resonance (MR) imaging and ferumoxytol. Three techniques, including precontrast two-dimensional time-of-flight (TOF) imaging, ferumoxytol-enhanced bright-blood imaging, and ferumoxytol-enhanced dark-blood imaging, were applied. Image quality for precontrast and ferumoxytol-enhanced images was analyzed by using a four-point scale. Thrombus was depicted as a filling defect within the blood pool on bright-blood images and as bright tissue that appeared highly contrasted against a dark background on dark-blood images. Image quality of ferumoxytol-enhanced images was uniformly superior to that of precontrast TOF images (P = .007). Compared with precontrast TOF images, ferumoxytol-enhanced bright-blood images had higher contrast-to-noise ratios (CNRs) between thrombus and blood (P = .051), whereas ferumoxytol-enhanced dark-blood images showed significantly higher CNRs between thrombus and surrounding muscle (P = .008). Ferumoxytol-enhanced MR imaging can depict DVT with a dual-contrast mechanism and show the extent of thrombus.

Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT

OBJECTIVE

The purpose of this study was to assess the individual and combined usefulness of MRI techniques in cases of acute pulmonary embolism and to compare the usefulness of these techniques with that of 16-MDCT.

SUBJECTS AND METHODS

Sixty-two patients with symptoms indicating acute pulmonary embolism underwent an MRI protocol that progressed from real-time MRI through MR perfusion imaging to MR angiography. The results were compared with those of 16-MDCT, which was the reference standard. Thoracic incidental diagnoses other than pulmonary embolism also were sought with CT and MRI.

RESULTS

Pulmonary embolism was diagnosed with CT in 19 patients for totals of 90 lobar, 245 segmental, and 434 subsegmental arteries. On a per-patient basis, the sensitivities of real-time MRI, MR angiography, MR perfusion imaging, and the combined protocol were 85%, 77%, 100%, and 100%, respectively. The specificities were 98%, 100%, 91%, and 93%. The kappa values in a comparison of the MR techniques with CT were 0.89, 0.87, 0.86, and 0.9. On a per-embolus basis, the sensitivities of real-time MRI, MR angiography, and MR perfusion imaging for lobar pulmonary embolism were 79%, 62%, and 100%. The sensitivities for segmental pulmonary embolism were 86%, 83%, and 97%, respectively. MR perfusion imaging had a sensitivity of 93% for subsegmental pulmonary embolism. Eight of nine incidental findings revealed on CT were also subsequently diagnosed with real-time MRI. MRI failed to reveal a case of emphysema. Mean MRI examination time was 9 minutes 56 seconds.

CONCLUSION

The combined MR protocol is both reliable and sensitive in comparison with 16-MDCT in the diagnosis of pulmonary embolism. MR perfusion imaging is sensitive for the detection of pulmonary embolism, whereas real-time MR and MR angiography are specific.

The utility of superparamagnetic contrast agents in MRI: theoretical consideration and applications in the cardiovascular system

This review will discuss the in vivo physical chemical relaxation properties of superparamagnetic iron oxide particles. Various parameters such as size, magnetization, compartmentalization and water exchange effects and how these alter the behavior of the iron oxide particles in an in vitro vs an in vivo situation with special reference to the cardiovascular system will be exemplified. Furthermore, applications using iron oxide particles for vascular, perfusion and viability imaging as well as assessment of the inflammatory status of a given tissue will be discussed.

Phase I Clinical Evaluation of Citrate-coated Monocrystalline Very Small Superparamagnetic Iron Oxide Particles as a New Contrast Medium for Magnetic Resonance Imaging

RATIONALE AND OBJECTIVES

To evaluate the safety and pharmacokinetics of a newly developed MR contrast medium consisting of very small superparamagnetic iron oxide particles (VSOP) coated with citrate (VSOP-C184) in a clinical phase I trial.

METHODS

A total of 18 healthy subjects received either VSOP-C184 (core diameter: 4 nm; total diameter: 7 +/- 0.15 nm; relaxivities in water at 0.47 T (T1) 18.7 and (T2) 30 L/(mmol*seconds)) at doses of 0.015, 0.045, or 0.075 mmol Fe/kg (n = 5 per dose) or placebo (n = 1 per dose) as intravenous injections. Physical status and vital parameters were recorded, blood samples were collected for clinical chemistry and relaxometry (0.94 T), and urinalyses were performed before and for up to 2 weeks after administration.

RESULTS

No serious adverse events occurred. The most pronounced adverse events occurred in 2 subjects of the highest dose group 45-50 minutes after injection. These were a drop in blood pressure and a drop in oxygen saturation, which were considered to be possibly drug-related and rapidly resolved without medication. Otherwise, no relevant changes in vital and laboratory parameters were observed. The parameters of iron metabolism exhibited short-term, dose-related changes. The injection of VSOP-C184 decreased T1 relaxation time of blood below 100 milliseconds for 18 minutes after a dose of 0.045 mmol [corrected] Fe/kg and for 60 minutes after 0.075 mmol [corrected] Fe/kg.

CONCLUSIONS

The favorable data on the safety, tolerability, and efficacy of VSOP-C184 justify further clinical phase II and III trials as a contrast medium for MRI.