Finn J P, Nguyen K-L, Han F, Zhou Z, Salusky I, Ayad I, Hu P
Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Clin Radiol. 2016 Aug;71(8):796-806. doi: 10.1016/j.crad.2016.03.020. Epub 2016 May 21.
The practice of contrast-enhanced magnetic resonance angiography (CEMRA) has changed significantly in the span of a decade. Concerns regarding gadolinium (Gd)-associated nephrogenic systemic fibrosis in those with severely impaired renal function spurred developments in low-dose CEMRA and non-contrast MRA as well as efforts to seek alternative MR contrast agents. Originally developed for MR imaging use, ferumoxytol (an ultra-small superparamagnetic iron oxide nanoparticle), is currently approved by the US Food and Drug Administration for the treatment of iron deficiency anaemia in adults with renal disease. Since its clinical availability in 2009, there has been rising interest in the scientific and clinical use of ferumoxytol as an MR contrast agent. The unique physicochemical and pharmacokinetic properties of ferumoxytol, including its long intravascular half-life and high r1 relaxivity, support a spectrum of MRI applications beyond the scope of Gd-based contrast agents. Moreover, whereas Gd is not found in biological systems, iron is essential for normal metabolism, and nutritional iron deficiency poses major public health challenges worldwide. Once the carbohydrate shell of ferumoxytol is degraded, the elemental iron at its core is incorporated into the reticuloendothelial system. These considerations position ferumoxytol as a potential game changer in the field of CEMRA and MRI. In this paper, we aim to summarise our experience with the cardiovascular applications of ferumoxytol and provide a brief synopsis of ongoing investigations on ferumoxytol-enhanced MR applications.
在十年的时间跨度里,对比增强磁共振血管造影(CEMRA)的实践发生了显著变化。对于肾功能严重受损者中钆(Gd)相关的肾源性系统性纤维化的担忧,推动了低剂量CEMRA和非对比MRA的发展,以及寻找替代MR造影剂的努力。 ferumoxytol(一种超小超顺磁性氧化铁纳米颗粒)最初是为MR成像用途而开发的,目前已获得美国食品药品监督管理局批准,用于治疗患有肾脏疾病的成人缺铁性贫血。自2009年临床可用以来,人们对ferumoxytol作为MR造影剂的科学和临床应用的兴趣不断增加。ferumoxytol独特的物理化学和药代动力学特性,包括其较长的血管内半衰期和高r1弛豫率,支持了一系列超出基于钆的造影剂范围的MRI应用。此外,虽然在生物系统中未发现钆,但铁是正常代谢所必需的,而营养性缺铁在全球范围内构成了重大的公共卫生挑战。一旦ferumoxytol的碳水化合物外壳降解,其核心的元素铁就会被纳入网状内皮系统。这些考虑因素使ferumoxytol成为CEMRA和MRI领域潜在的变革者。在本文中,我们旨在总结我们在ferumoxytol心血管应用方面的经验,并简要概述正在进行的关于ferumoxytol增强MR应用的研究。
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