Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI

Background. Ferumoxytol (Ferahame, AMAG Pharmaceuticals, Waltham, MA) is increasingly used off-label as an MR contrast agent due to its relaxivity and safety profiles. However, its potent T2∗ relaxivity limits achievable T1-weighted positive contrast and leads to artifacts in standard MRI protocols....

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Main Authors: Liam Timms, Tianyi Zhou, Ju Qiao, Codi Gharagouzloo, Vishala Mishra, Rita Maria Lahoud, John W. Chen, Mukesh Harisinghani, Srinivas Sridhar
Format: Article
Language:English
Published: Wiley 2024-01-01
Series:International Journal of Biomedical Imaging
Online Access:http://dx.doi.org/10.1155/2024/9763364
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author Liam Timms
Tianyi Zhou
Ju Qiao
Codi Gharagouzloo
Vishala Mishra
Rita Maria Lahoud
John W. Chen
Mukesh Harisinghani
Srinivas Sridhar
author_facet Liam Timms
Tianyi Zhou
Ju Qiao
Codi Gharagouzloo
Vishala Mishra
Rita Maria Lahoud
John W. Chen
Mukesh Harisinghani
Srinivas Sridhar
author_sort Liam Timms
collection DOAJ
description Background. Ferumoxytol (Ferahame, AMAG Pharmaceuticals, Waltham, MA) is increasingly used off-label as an MR contrast agent due to its relaxivity and safety profiles. However, its potent T2∗ relaxivity limits achievable T1-weighted positive contrast and leads to artifacts in standard MRI protocols. Optimization of protocols for ferumoxytol deployment is necessary to realize its potential. Methods. We present first-in-human clinical results of the Quantitative Ultrashort Time-to-Echo Contrast Enhanced (QUTE-CE) MRA technique using the superparamagnetic iron oxide nanoparticle agent ferumoxytol for vascular imaging of the head/brain in 15 subjects at 3.0T. The QUTE-CE MRA method was implemented on a 3T scanner using a stack-of-spirals 3D Ultrashort Time-to-Echo sequence. Time-of-flight MRA and standard TE T1-weighted (T1w) images were also collected. For comparison, gadolinium-enhanced blood pool phase images were obtained retrospectively from clinical practice. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and intraluminal signal heterogeneity (ISH) were assessed and compared across approaches with Welch’s two-sided t-test. Results. Fifteen volunteers (54±17 years old, 9 women) participated. QUTE-CE MRA provided high-contrast snapshots of the arterial and venous networks with lower intraluminal heterogeneity. QUTE-CE demonstrated significantly higher SNR (1707±226), blood-tissue CNR (1447±189), and lower ISH (0.091±0.031) compared to ferumoxytol T1-weighted (551±171; 319±144; 0.186±0.066, respectively) and time-of-flight (343±104; 269±82; 0.190±0.016, respectively), with p<0.001 in each comparison. The high CNR increased the depth of vessel visualization. Vessel lumina were captured with lower heterogeneity. Conclusion. Quantitative Ultrashort Time-to-Echo Contrast-Enhanced MR angiography provides approximately 5-fold superior contrast with fewer artifacts compared to other contrast-enhanced vascular imaging techniques using ferumoxytol or gadolinium, and to noncontrast time-of-flight MR angiography, for clinical vascular imaging. This trial is registered with NCT03266848.
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spelling doaj-art-c4ef611ae23e44d3ab1167d0f828c2db2025-02-03T01:29:25ZengWileyInternational Journal of Biomedical Imaging1687-41962024-01-01202410.1155/2024/9763364Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRILiam Timms0Tianyi Zhou1Ju Qiao2Codi Gharagouzloo3Vishala Mishra4Rita Maria Lahoud5John W. Chen6Mukesh Harisinghani7Srinivas Sridhar8Department of PhysicsDepartment of PhysicsDepartment of Mechanical and Industrial EngineeringGordon Center for Medical ImagingDepartment of RadiologyDepartment of RadiologyDepartment of RadiologyDepartment of RadiologyDepartment of PhysicsBackground. Ferumoxytol (Ferahame, AMAG Pharmaceuticals, Waltham, MA) is increasingly used off-label as an MR contrast agent due to its relaxivity and safety profiles. However, its potent T2∗ relaxivity limits achievable T1-weighted positive contrast and leads to artifacts in standard MRI protocols. Optimization of protocols for ferumoxytol deployment is necessary to realize its potential. Methods. We present first-in-human clinical results of the Quantitative Ultrashort Time-to-Echo Contrast Enhanced (QUTE-CE) MRA technique using the superparamagnetic iron oxide nanoparticle agent ferumoxytol for vascular imaging of the head/brain in 15 subjects at 3.0T. The QUTE-CE MRA method was implemented on a 3T scanner using a stack-of-spirals 3D Ultrashort Time-to-Echo sequence. Time-of-flight MRA and standard TE T1-weighted (T1w) images were also collected. For comparison, gadolinium-enhanced blood pool phase images were obtained retrospectively from clinical practice. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and intraluminal signal heterogeneity (ISH) were assessed and compared across approaches with Welch’s two-sided t-test. Results. Fifteen volunteers (54±17 years old, 9 women) participated. QUTE-CE MRA provided high-contrast snapshots of the arterial and venous networks with lower intraluminal heterogeneity. QUTE-CE demonstrated significantly higher SNR (1707±226), blood-tissue CNR (1447±189), and lower ISH (0.091±0.031) compared to ferumoxytol T1-weighted (551±171; 319±144; 0.186±0.066, respectively) and time-of-flight (343±104; 269±82; 0.190±0.016, respectively), with p<0.001 in each comparison. The high CNR increased the depth of vessel visualization. Vessel lumina were captured with lower heterogeneity. Conclusion. Quantitative Ultrashort Time-to-Echo Contrast-Enhanced MR angiography provides approximately 5-fold superior contrast with fewer artifacts compared to other contrast-enhanced vascular imaging techniques using ferumoxytol or gadolinium, and to noncontrast time-of-flight MR angiography, for clinical vascular imaging. This trial is registered with NCT03266848.http://dx.doi.org/10.1155/2024/9763364
spellingShingle Liam Timms
Tianyi Zhou
Ju Qiao
Codi Gharagouzloo
Vishala Mishra
Rita Maria Lahoud
John W. Chen
Mukesh Harisinghani
Srinivas Sridhar
Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI
International Journal of Biomedical Imaging
title Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI
title_full Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI
title_fullStr Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI
title_full_unstemmed Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI
title_short Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI
title_sort super high contrast uspio enhanced cerebrovascular angiography using ultrashort time to echo mri
url http://dx.doi.org/10.1155/2024/9763364
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