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. 2022 Mar;52(3):501-512.
doi: 10.1007/s00247-021-05225-2. Epub 2021 Dec 22.

High-resolution three‑dimensional contrast‑enhanced magnetic resonance venography in children: comparison of gadofosveset trisodium with ferumoxytol

Puja Shahrouki  1 , Sarah N Khan  1 , Takegawa Yoshida  1 , Paul J Iskander  1   2   3 , Shahnaz Ghahremani  1   2 , J Paul Finn  4
Affiliations

High-resolution three‑dimensional contrast‑enhanced magnetic resonance venography in children: comparison of gadofosveset trisodium with ferumoxytol

Puja Shahrouki et al. Pediatr Radiol. 2022 Mar.

Abstract

Background: Gadofosveset is a gadolinium-based blood pool contrast agent that was approved by the United States Food and Drug Administration in 2008. Its unanticipated withdrawal from production in 2016 created a void in the blood pool agent inventory and highlighted the need for an alternative agent with comparable imaging properties.

Objective: The purpose of our study is to compare the diagnostic image quality, vascular contrast-to-noise ratio (CNR) and temporal signal characteristics of gadofosveset trisodium and ferumoxytol at similar molar doses for high-resolution, three-dimensional (3-D) magnetic resonance (MR) venography in children.

Materials and methods: The medical records and imaging data sets of patients who underwent high-resolution 3-D gadofosveset-enhanced MR venography (GE-MRV) or ferumoxytol-enhanced MR venography (FE-MRV) were retrospectively reviewed. Two groups of 20 pediatric patients (age- and weight-matched with one patient common to both groups; age range: 2 days-15 years) who underwent high-resolution 3-D GE-MRV or FE-MRV at similar molar doses were identified and analyzed. Qualitative analysis of image quality and vessel definition was performed by two blinded pediatric radiologists. Interobserver agreement was assessed with the AC1 (first-order agreement coefficient) statistic. Signal-to-noise ratio (SNR) and CNR of the inferior vena cava and aorta were measured in the steady-state venous phase. Medical records were retrospectively reviewed for any adverse reactions associated with either contrast agent.

Results: Measured SNR and CNR of the inferior vena cava were higher for FE-MRV than GE-MRV (P = 0.034 and P < 0.001, respectively). The overall image quality score and individual vessel scores of FE-MRV were equal to or greater than GE-MRV (P = 0.084), with good interobserver agreement (AC1 = 0.657). The venous signal on FE-MRV was stable over the longest interval measured (1 h, 13 min and 46 s), whereas venous signal on GE-MRV showed more variability and earlier loss of signal. No adverse reactions were noted in any patient with either contrast agent.

Conclusion: Ferumoxytol produces more uniform and stable enhancement throughout the entire venous circulation in children than gadofosveset, offering a wider time window for optimal image acquisition. FE-MRV offers a near-ideal approach to high-resolution venography in children at all levels of anatomical complexity.

Keywords: Children; Congenital heart disease; Ferumoxytol; Gadofosveset; Magnetic resonance imaging; Magnetic resonance venography.

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Conflict of interest statement

None

Figures

Fig. 1
Fig. 1
A 14-year-old girl with familial malabsorption syndrome requiring total parenteral nutrition. a–c Coronal gadofosveset-enhanced magnetic resonance angiography was performed at 3.0 T in the arterial (a), early venous (b) and late venous (c) phases to assess sites for central venous catheter placement. Thin maximum intensity projection images demonstrate occlusion of right internal jugular and left subclavian veins (black arrows), and stenosis of the right innominate vein and superior vena cava (white arrows) with anterior neck venous collaterals (arrowheads). Note the persistently good venous enhancement in the late venous phase
Fig. 2
Fig. 2
A 12-year-old boy with chronic renal failure requiring venous access. a–c Coronal ferumoxytol-enhanced magnetic resonance venography at 3.0 T in steady-state (33 min after injection) shows occlusion of the bilateral subclavian veins, innominate veins, right internal jugular vein and superior vena cava (arrows). Select thin maximum intensity projection reconstructions are shown. Note the uniformly high vascular signal throughout the venous system. Note the extensive venous collateralization in the neck, chest, abdomen and pelvis (arrowheads)
Fig. 3
Fig. 3
A 10-year-old boy post liver transplantation with extensive venous thrombosis. a–c Coronal gadofosveset-enhanced magnetic resonance angiography was performed in the arterial (a), early venous (b) and late venous (c) phases at 3.0 T to assess sites for central venous catheter placement. There is occlusion of the bilateral internal jugular veins, subclavian veins, innominate veins and distal superior vena cava (white arrows) with extensive chest wall and anterior neck collaterals (white arrowheads). The infrarenal inferior vena cava is occluded (black arrow) with dilated paravertebral collaterals (black arrowheads). Note the persistently good enhancement of the proximal inferior vena cava in early (22 s) and late (1 min, 41 s) venous phases
Fig. 4
Fig. 4
A 10-year-old girl with portal hypertension and splenomegaly. a, b Coronal ferumoxytol-enhanced magnetic resonance venography was performed at 3.0 T. The patient has gross splenomegaly shown on thin maximum intensity projection (MIP) (a) and a large spontaneous splenorenal shunt (arrows) shown on thick MIP (b). Note the uniform and high intravascular signal at 12 min post contrast injection
Fig. 5
Fig. 5
A 2-day-old boy with a history of truncus arteriosus. a–c Coronal thin maximum intensity projection images from gadofosveset-enhanced magnetic resonance angiography in the arterial (a), early venous (b) and late venous (c) phases at 3.0 T. The first pass arterial signal is high, but the venous signal is markedly lower in both early and late venous phases. The linear structure in the aorta is an umbilical artery catheter (arrow)
Fig. 6
Fig. 6
A 3-day-old boy with hypoplastic aortic arch and coarctation. a–c Coronal thin maximum intensity projection images from ferumoxytol-enhanced magnetic resonance angiography in the arterial (a), early venous (b) and late venous (c) phases at 3.0 T. Note the stable intravascular signal in the 43-min interval between the early and late venous phases
Fig. 7
Fig. 7
An 8-month-old boy post Norwood procedure and Glenn shunt for hypoplastic left heart syndrome, with abnormal venous anatomy. a–c Coronal thin maximum intensity projection (MIP) images from ferumoxytol-enhanced magnetic resonance angiography in the arterial (a), early venous (b) and late venous (c) phases at 3.0 T. Note the stable intravascular signal in the 37-min interval between the early and late venous phases. d Coronal thin MIP image shows an infrarenal left interior vena cava (IVC) (arrow) that crosses the midline to join the infrahepatic IVC. There is extensive venous collateralization (arrowhead) due to occlusion of the right superior vena cava, bilateral subclavian veins and right internal jugular vein
Fig. 8
Fig. 8
A 4-year-old boy with end-stage renal disease on hemodialysis. a–c Coronal ferumoxytol-enhanced magnetic resonance angiography was performed at 3.0 T to evaluate access sites for central venous catheter placement. Thin maximum intensity projection images are shown in the arterial (a), early venous (b) and late venous (c) phases. Note the stable intravascular signal in the 19-min interval between the early and late venous phases
Fig. 9
Fig. 9
A 3-day-old girl with Shone syndrome. a, b Coronal contrast-enhanced magnetic resonance (MR) angiography was performed with gadofosveset at 3.0 T to evaluate vascular anatomy. The arterial phase (a) and venous phase (b) show good vascular enhancement. Note the left superior vena cava (arrow in b). c–e The same patient was imaged with coronal ferumoxytol-enhanced MR angiography at 3.0 T 2 years after surgery that included a Norwood procedure and bilateral Glenn shunts. The neo-aorta (arrow in c) and left Glenn shunt (arrow in e) are seen. Note the stable intravascular signal from first pass through 5 min post contrast
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