Ferumoxytol dose optimization for three-dimensional whole-heart magnetic resonance imaging in patients with congenital heart disease.

IF 2.5 3区医学 Q2 PEDIATRICS

Pediatric Radiology Pub Date : 2026-10-01 Epub Date: 2026-07-07 DOI:10.1007/s00247-026-06706-y

Sukran Erdem, Tarique Hussain, Aya El Jerbi, Orhan Erdem, Lauren Thai, Lasya Gaur, Gerald F Greil, Tarek Alsaied, Sanja Dzelebdzic, Qing Zou

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引用次数: 0

Abstract

Background: Ferumoxytol is used off-label as a contrast agent for cardiovascular magnetic resonance (CMR). However, the dose-response relationship between ferumoxytol, longitudinal relaxation, and image quality in pediatric and young patients remains unclear.

Objective: To evaluate the effects of sequential ferumoxytol dose escalation on three-dimensional (3D) whole-heart (WH) image quality and blood-pool nulling inversion time (TI), a physiologic surrogate of post-contrast T1 shortening.

Materials and methods: In this prospective study, 45 patients with congenital heart disease underwent ferumoxytol-enhanced 3D WH CMR at 1.5 T using sequential dose regimens (1 mg/kg→2 mg/kg or 2 mg/kg→3 mg/kg). Right coronary artery (RCA) image quality and visible length, contrast-to-noise ratio (CNR), and image quality of the cardiac chambers and great vessels, as well as diagnostic completeness, were assessed. Blood-pool and myocardial nulling TI were measured using Look-Locker sequences. Baseline-adjusted change-score regression was the primary analysis, with mixed-effects ANCOVA performed to model TI behavior while accounting for repeated within-patient measurements.

Results: No significant differences were observed in CNR, RCA length, image quality, or diagnostic completeness between all doses (all P>0.05). Myocardial and blood-pool nulling TI shortened significantly with dose escalation (P≤0.02). Change in blood-pool TI after the second dose was strongly predicted by TI after the first dose (β=-0.63, P<0.001), whereas starting dose (1 mg/kg or 2 mg/kg) was not associated with TI change (P=0.70). At 1 mg/kg, prolonged myocardial nulling TI may encroach upon the systolic rest period.

Conclusions: Ferumoxytol-enhanced 3D WH imaging provides diagnostic-quality assessment across 1-3 mg/kg dosing. Dose-dependent TI shortening follows a nonlinear, saturating pattern, supporting optimized low-dose protocols.

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阿魏木糖醇用于先天性心脏病患者三维全心磁共振成像的剂量优化。

背景：阿魏木糖醇在标签外用作心血管磁共振（CMR）的造影剂。然而，阿魏木糖醇、纵向松弛和儿童和年轻患者图像质量之间的剂量-反应关系尚不清楚。目的：评价阿魏木醇序贯剂量增加对造影后T1缩短的生理指标——三维（3D）全心（WH）图像质量和血池零反转时间（TI）的影响。材料和方法：在这项前瞻性研究中，45例先天性心脏病患者采用顺序剂量方案（1mg /kg→2mg /kg或2mg /kg→3mg /kg），在1.5 T下接受阿韦木醇增强3D WH CMR。评估右冠状动脉（RCA）图像质量和可见长度、噪比（CNR）、心室和大血管图像质量及诊断完整性。采用Look-Locker序列测定血池和心肌零化TI。基线调整后的变化评分回归是主要分析，混合效应ANCOVA用于模拟TI行为，同时考虑患者内重复测量。结果：各剂量间CNR、RCA长度、图像质量、诊断完整性无显著差异（均P < 0.05）。心肌和血池零化TI随剂量增加而显著缩短（P≤0.02）。第二次给药后血池TI的变化与第一次给药后的TI有很强的相关性（β=-0.63, p）。结论：阿魏木糖醇增强3D WH成像在1-3 mg/kg给药时可提供诊断质量评估。剂量依赖性TI缩短遵循非线性饱和模式，支持优化的低剂量方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Radiology 医学-核医学

CiteScore

4.40

自引率

17.40%

发文量

300

审稿时长

3-6 weeks

期刊介绍： Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.