Abstract
Cardiovascular Magnetic Resonance (CMR) has become a primary tool for non-invasive assessment of cardiovascular anatomy, pathology and function. Existing contrast agents have been utilised for the identification of infarction, fibrosis, perfusion deficits and for angiography. Novel ultrasmall superparamagnetic particles of iron oxide (USPIO) contrast agents that are taken up by inflammatory cells can detect cellular inflammation non-invasively using CMR, potentially aiding the diagnosis of inflammatory medical conditions, guiding their treatment and giving insight into their pathophysiology. In this review we describe the utilization of USPIO as a novel contrast agent in vascular disease.
Highlights
Inflammation is central to many cardiovascular pathophysiological processes including atherosclerosis, myocardial infarction and heart failure
Atherosclerotic plaque Given the central role of macrophage biology in the pathogenesis of atherosclerosis, ultrasmall superparamagnetic particles of iron oxide (USPIO) have an obvious application in the investigation of atherosclerotic disease
Another potential confounding factor is that macrophages of different subsets or with different activation status take up USPIO at different rates
Summary
Inflammation is central to many cardiovascular pathophysiological processes including atherosclerosis, myocardial infarction and heart failure. As a result of their smaller size, USPIOs are less readily recognized by phagocytic cells and persist in the circulation for longer than other iron particles (plasma half-life 14–30 h in humans) [10, 11] They are capable of passing through capillary walls, to be taken up by tissue-resident macrophages and neutrophils (Fig. 1) [12,13,14]. Drawn regions of interest have been used to allow comparison of signal intensity of the target tissue with that of control tissue discrete focal areas of USPIO accumulation, and focal inflammation, may be missed Tissue properties, such as the presence of oedema or haemorrhage, can alter image intensities on T2* sequences, and so pre- and post-contrast images need to be compared to delineate the impact of USPIO accumulation. This accumulation can affect neighbouring structures, and care must be taken not mistake blooming artefact for USPIO uptake
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