Hampilos Perry J, Luppi Andre, Ghoshhajra Brian, Gee Michael S, Harisinghani Mukesh, Hedgire Sandeep
Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
Int J Cardiovasc Imaging. 2025 Jan 27. doi: 10.1007/s10554-025-03337-6.
The use of conventional contrast agents in computed tomography (CT) and magnetic resonance (MR) imaging is often limited in patients with chronic kidney disease (CKD) due to potential nephrotoxicity. Ferumoxytol, originally developed for iron supplementation, has emerged as a promising alternative MR contrast agent that is safer for patients with CKD. This study aims to present our center's experience with ferumoxytol as a contrast agent in CKD patients. We retrospectively reviewed 24 MR imaging studies of the chest, abdomen, and pelvis performed in CKD patients at our center. All patients were deemed suitable for ferumoxytol administration, receiving a dose of 4 mg/kg with post-injection monitoring. The imaging quality of the ascending, descending, suprarenal and infrarenal aortic segments was assessed by three independent observers using a qualitative scoring system (nondiagnostic, poor vascular definition, good vascular definition, and excellent vascular definition). Quantitative analyses, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and heterogeneity index, were also performed. No adverse reactions to ferumoxytol were observed. Of the 72 vascular segments evaluated, 90.8% of the images were rated as excellent vascular definition, and 9.2% were rated as good vascular definition. Inter-observer agreement was substantial (k = 0.647), with no statistically significant differences in ratings between observers. Ferumoxytol is a safe and effective alternative to conventional contrast agents for MR vascular imaging, particularly in patients with renal insufficiency. These findings support its selective use in appropriate clinical scenarios, offering a reliable imaging option for CKD patients.
由于潜在的肾毒性，慢性肾脏病（CKD）患者在计算机断层扫描（CT）和磁共振成像（MR）中使用传统造影剂常常受到限制。最初用于补铁的铁羧麦芽糖已成为一种有前景的替代MR造影剂，对CKD患者更安全。本研究旨在介绍我们中心使用铁羧麦芽糖作为CKD患者造影剂的经验。我们回顾性分析了本中心对CKD患者进行的24例胸部、腹部和盆腔的MR成像研究。所有患者均被认为适合使用铁羧麦芽糖，给予4mg/kg的剂量并在注射后进行监测。由三名独立观察者使用定性评分系统（无法诊断、血管清晰度差、血管清晰度良好和血管清晰度极佳）对升主动脉、降主动脉、肾上腺上和肾上腺下主动脉段的成像质量进行评估。还进行了包括信噪比（SNR）、对比噪声比（CNR）和异质性指数在内的定量分析。未观察到对铁羧麦芽糖的不良反应。在评估的72个血管段中，90.8%的图像被评为血管清晰度极佳，9.2%被评为血管清晰度良好。观察者间一致性较高（k = 0.647），观察者之间的评分无统计学显著差异。对于MR血管成像，铁羧麦芽糖是传统造影剂的一种安全有效的替代品，尤其适用于肾功能不全患者。这些发现支持在适当的临床场景中选择性使用铁羧麦芽糖，为CKD患者提供了一种可靠的成像选择。
