Ferumoxytol enhanced black-blood cardiovascular magnetic resonance imaging

Kim-Lien Nguyen,Eun-Ah Park,Peng Hu,J Paul Finn,Takegawa Yoshida

doi:10.1186/s12968-017-0422-y

Abstract

BackgroundBright-blood and black-blood cardiovascular magnetic resonance (CMR) techniques are frequently employed together during a clinical exam because of their complementary features. While valuable, existing black-blood CMR approaches are flow dependent and prone to failure. We aim to assess the effectiveness and reliability of ferumoxytol enhanced (FE) Half-Fourier Single-shot Turbo Spin-echo (HASTE) imaging without magnetization preparation pulses to yield uniform intra-luminal blood signal suppression by comparing FE-HASTE with pre-ferumoxytol HASTE imaging.MethodsThis study was IRB-approved and HIPAA compliant. Consecutive patients who were referred for FE-CMR between June 2013 and February 2017 were enrolled. Qualitative image scores reflecting the degree and reliability of blood signal suppression were based on a 3-point Likert scale, with 3 reflecting perfect suppression. For quantitative evaluation, homogeneity indices (defined as standard deviation of the left atrial signal intensity) and signal-to-noise ratios (SNR) for vascular lumens and cardiac chambers were measured.ResultsOf the 340 unique patients who underwent FE-CMR, HASTE was performed in 257. Ninety-three patients had both pre-ferumoxytol HASTE and FE-HASTE, and were included in this analysis. Qualitative image scores reflecting the degree and reliability of blood signal suppression were significantly higher for FE-HASTE images (2.9 [IQR 2.8–3.0] vs 1.8 [IQR 1.6–2.1], p < 0.001). Inter-reader agreement was moderate (k = 0.50, 95% CI 0.45–0.55). Blood signal suppression was more complete on FE-HASTE images than on pre-ferumoxytol HASTE, as indicated by lower mean homogeneity indices (24.5 [IQR 18.0–32.8] vs 108.0 [IQR 65.0–170.4], p < 0.001) and lower blood pool SNR for all regions (5.6 [IQR 3.2–10.0] vs 21.5 [IQR 12.5–39.4], p < 0.001).ConclusionFE-HASTE black-blood imaging offers an effective, reliable, and simple approach for flow independent blood signal suppression. The technique holds promise as a fast and routine complement to bright-blood cardiovascular imaging with ferumoxytol.

Highlights

Bright-blood and black-blood cardiovascular magnetic resonance (CMR) techniques are frequently employed together during a clinical exam because of their complementary features
The purpose of our study is to evaluate the potential of ferumoxytol to generate reliable, flow independent, black-blood Half-Fourier Single-shot Turbo Spin-echo (HASTE) images, as a complement to brightblood CMR angiography of the thorax, without the need for any magnetization preparation schemes, by comparing it with pre-ferumoxytol HASTE imaging
Qualitative analysis Compared to pre-ferumoxytol HASTE, the image quality scores reflecting effectiveness and reliability of blood signal suppression for ferumoxytol enhanced (FE)-HASTE images were significantly higher (p < 0.001, Fig. 2)

Summary

Introduction

Bright-blood and black-blood cardiovascular magnetic resonance (CMR) techniques are frequently employed together during a clinical exam because of their complementary features. We aim to assess the effectiveness and reliability of ferumoxytol enhanced (FE) Half-Fourier Single-shot Turbo Spin-echo (HASTE) imaging without magnetization preparation pulses to yield uniform intra-luminal blood signal suppression by comparing FE-HASTE with pre-ferumoxytol HASTE imaging. While the intensity and uniformity of luminal enhancement serve as the benchmark for bright blood CMR angiography, the completeness and uniformity of blood pool signal suppression set the Because of its speed, simplicity, and resistance to motion artifact, Half-Fourier Single-shot Turbo Spin-echo (HASTE) [3] imaging is widely used to complement bright blood techniques in CMR imaging [1]. Nguyen et al Journal of Cardiovascular Magnetic Resonance (2017) 19:106 flowing blood can persist For this reason, a dual inversion recovery magnetization preparation scheme is typically used to null the magnetization of blood which enters the imaging slice between the inversion and the readout [4]. A flow-independent black-blood CMR technique would be desirable

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