慢性肾脏病患儿的对比增强磁共振静脉成像:使用铁羧麦芽糖的初步经验
Contrast-enhanced magnetic resonance venography in pediatric patients with chronic kidney disease: initial experience with ferumoxytol.
作者信息
Luhar Aarti, Khan Sarah, Finn J Paul, Ghahremani Shahnaz, Griggs Rachel, Zaritsky Joshua, Salusky Isidro, Hall Theodore R
机构信息
Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
Department of Radiology and Medicine, David Geffen School of Medicine at University of California at Los Angeles, Peter V. Ueberroth Bldg., Suite 3371, 10945 Le Conte Ave., Los Angeles, CA, 90095, USA.
出版信息
Pediatr Radiol. 2016 Aug;46(9):1332-40. doi: 10.1007/s00247-016-3605-z. Epub 2016 Apr 8.
Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) particle that is FDA-approved for parenteral treatment of iron deficiency anemia in adults with chronic kidney disease. Because of the association between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with severe chronic kidney disease, we sought to evaluate the diagnostic role of ferumoxytol-enhanced MR venography in children with chronic kidney disease. Twenty children underwent 22 high-resolution ferumoxytol-enhanced MR venography examinations at 3.0 T. High-resolution 3-D contrast-enhanced imaging was performed at a minimum of 3 time points following injection of ferumoxytol at a total dose of 4 mg/kg. Two blinded pediatric radiologists independently scored six named veins on ferumoxytol-enhanced MR venography examinations according to a three-point subjective score, where a score ≥2 was considered diagnostic. Additionally, all relevant venous structures in the included field of view were analyzed for occlusive or non-occlusive thrombosis, compression and presence of collaterals. All patients underwent ferumoxytol-enhanced MR venography successfully and without adverse event. The overall scores of the reviewing radiologists for all venous structures were 2.7-2.9. In all cases, the reviewers were confident basing their diagnoses on the ferumoxytol-enhanced MR venography findings. In 12 of 22 examinations, findings on follow-up imaging or invasive procedures were available to correlate with the findings on ferumoxytol-enhanced MR venography. There was complete concordance between the findings from follow-up imaging and invasive procedures with findings from ferumoxytol-enhanced MR venography. Ferumoxytol holds promise as a powerful alternative to gadolinium-based contrast agents for reliable, high-resolution MR venography in children with chronic kidney disease.
铁羧麦芽糖是一种超小型超顺磁性氧化铁(USPIO)颗粒,已获美国食品药品监督管理局(FDA)批准,用于肠胃外治疗患有慢性肾病的成人缺铁性贫血。鉴于重度慢性肾病患者使用钆基造影剂与肾源性系统性纤维化之间存在关联,我们试图评估铁羧麦芽糖增强磁共振静脉血管造影在患有慢性肾病的儿童中的诊断作用。20名儿童在3.0T磁场下接受了22次高分辨率铁羧麦芽糖增强磁共振静脉血管造影检查。在注射总剂量为4mg/kg的铁羧麦芽糖后,至少在3个时间点进行了高分辨率三维对比增强成像。两名盲法儿科放射科医生根据三分主观评分标准,对铁羧麦芽糖增强磁共振静脉血管造影检查中的六条指定静脉进行独立评分,评分≥2被视为具有诊断意义。此外,对所包含视野内的所有相关静脉结构进行分析,以确定是否存在闭塞性或非闭塞性血栓形成、压迫以及侧支血管的存在情况。所有患者均成功接受了铁羧麦芽糖增强磁共振静脉血管造影检查,且未出现不良事件。阅片放射科医生对所有静脉结构的总体评分为2.7 - 2.9。在所有病例中,阅片者都有信心基于铁羧麦芽糖增强磁共振静脉血管造影检查结果做出诊断。在22次检查中的12次检查中,有随访成像或侵入性检查的结果可与铁羧麦芽糖增强磁共振静脉血管造影检查结果进行对比。随访成像和侵入性检查的结果与铁羧麦芽糖增强磁共振静脉血管造影检查的结果完全一致。对于患有慢性肾病的儿童,铁羧麦芽糖有望成为钆基造影剂的有力替代品,用于可靠的高分辨率磁共振静脉血管造影。