PURPOSE: To assess the feasibility of ferumoxytol-enhanced anesthesia-free cardiac MRI in neonates and young infants for complex congenital heart disease (CHD). MATERIALS AND METHODS: With Institutional Review Board approval, 21 consecutive neonates and young infants (1 day to 11 weeks old; median age of 3 days) who underwent a rapid two-sequence (MR angiography [MRA] and four-dimensional [4D] flow) MRI protocol with intravenous ferumoxytol without sedation (n = 17) or light sedation (n = 4) at 3 Tesla (T) (except one case at 1.5T) between June 2014 and February 2016 were retrospectively identified. Medical records were reviewed for indication, any complications, if further diagnostic imaging was performed after MRI, and surgical findings. Two radiologists scored the images in two sessions on a 5-point scale for overall image quality and delineation of various anatomical structures. Confidence interval of proportions for likelihood of requiring additional diagnostic imaging after MRI was determined. For the possibility of reducing the protocol to a single rapid sequence, Wilcoxon-rank sum test was used to assess whether 4D flow and MRA significantly differed in anatomical delineation. RESULTS: One of 21 patients (4.8%, 80% confidence interval 0-11%) required additional imaging, a computed tomography angiography to assess lung parenchyma and peripheral pulmonary arteries. Only 1 of 13 patients (7.7%) with operative confirmation had a minor discrepancy between radiology and operative reports (80% confidence interval 0-17%). 4D flow was significantly superior to MRA (P < 0.05) for the evaluation of systemic arteries, valves, ventricular trabeculae, and overall quality. Using Cohen's kappa coefficient, there was good interobserver agreement for the evaluation of systemic arteries by 4D flow (κ = 0.782), and systemic veins and pulmonary arteries by MRA (κ > 0.6). Overall 4D flow measurements (mean κ = 0.64-0.74) had better internal agreement compared with MRA (mean κ = 0.30-0.64). CONCLUSION: Ferumoxytol-enhanced cardiac MRI, without anesthesia, is feasible for the evaluation of complex CHD in neonates and young infants, with a low likelihood of need for additional diagnostic studies. The decreased risk by avoiding anesthesia must be balanced against the potential for adverse reactions with ferumoxytol. LEVEL OF EVIDENCE: 2 J. MAGN. RESON. IMAGING 2017;45:1407-1418.
PURPOSE: To assess the feasibility of ferumoxytol-enhanced anesthesia-free cardiac MRI in neonates and young infants for complex congenital heart disease (CHD). MATERIALS AND METHODS: With Institutional Review Board approval, 21 consecutive neonates and young infants (1 day to 11 weeks old; median age of 3 days) who underwent a rapid two-sequence (MR angiography [MRA] and four-dimensional [4D] flow) MRI protocol with intravenous ferumoxytol without sedation (n = 17) or light sedation (n = 4) at 3 Tesla (T) (except one case at 1.5T) between June 2014 and February 2016 were retrospectively identified. Medical records were reviewed for indication, any complications, if further diagnostic imaging was performed after MRI, and surgical findings. Two radiologists scored the images in two sessions on a 5-point scale for overall image quality and delineation of various anatomical structures. Confidence interval of proportions for likelihood of requiring additional diagnostic imaging after MRI was determined. For the possibility of reducing the protocol to a single rapid sequence, Wilcoxon-rank sum test was used to assess whether 4D flow and MRA significantly differed in anatomical delineation. RESULTS: One of 21 patients (4.8%, 80% confidence interval 0-11%) required additional imaging, a computed tomography angiography to assess lung parenchyma and peripheral pulmonary arteries. Only 1 of 13 patients (7.7%) with operative confirmation had a minor discrepancy between radiology and operative reports (80% confidence interval 0-17%). 4D flow was significantly superior to MRA (P < 0.05) for the evaluation of systemic arteries, valves, ventricular trabeculae, and overall quality. Using Cohen's kappa coefficient, there was good interobserver agreement for the evaluation of systemic arteries by 4D flow (κ = 0.782), and systemic veins and pulmonary arteries by MRA (κ > 0.6). Overall 4D flow measurements (mean κ = 0.64-0.74) had better internal agreement compared with MRA (mean κ = 0.30-0.64). CONCLUSION:Ferumoxytol-enhanced cardiac MRI, without anesthesia, is feasible for the evaluation of complex CHD in neonates and young infants, with a low likelihood of need for additional diagnostic studies. The decreased risk by avoiding anesthesia must be balanced against the potential for adverse reactions with ferumoxytol. LEVEL OF EVIDENCE: 2 J. MAGN. RESON. IMAGING 2017;45:1407-1418.
Authors: Ruwan Kiringoda; Audrey E Thurm; Matthew E Hirschtritt; Deloris Koziol; Robert Wesley; Susan E Swedo; Naomi P O'Grady; Zenaide M N Quezado Journal: Arch Pediatr Adolesc Med Date: 2010-06
Authors: Adam L Dorfman; Kirsten C Odegard; Andrew J Powell; Peter C Laussen; Tal Geva Journal: J Cardiovasc Magn Reson Date: 2007 Impact factor: 5.364
Authors: Martin R Prince; Honglei Zhang; Michael Morris; Jennifer L MacGregor; Marc E Grossman; Jeffrey Silberzweig; Robert L DeLapaz; Henry J Lee; Cynthia M Magro; Anthony M Valeri Journal: Radiology Date: 2008-09 Impact factor: 11.105
Authors: Kanae Mukai; Nicholas S Burris; Vaikom S Mahadevan; Elyse D Foster; Karen G Ordovas; Michael D Hope Journal: Int J Cardiovasc Imaging Date: 2017-09-08 Impact factor: 2.357
Authors: Yoshiharu Ohno; Joon Beom Seo; Grace Parraga; Kyung Soo Lee; Warren B Gefter; Sean B Fain; Mark L Schiebler; Hiroto Hatabu Journal: Radiology Date: 2021-04-06 Impact factor: 29.146
Authors: Kim-Lien Nguyen; Fei Han; Ziwu Zhou; Daniel Z Brunengraber; Ihab Ayad; Daniel S Levi; Gary M Satou; Brian L Reemtsen; Peng Hu; J Paul Finn Journal: J Cardiovasc Magn Reson Date: 2017-04-03 Impact factor: 5.364
Authors: Ashok Joseph Theruvath; Maryam Aghighi; Michael Iv; Hossein Nejadnik; Jonathan Lavezo; Laura Jean Pisani; Heike Elisabeth Daldrup-Link Journal: Nanotheranostics Date: 2020-06-18
Authors: Julia Geiger; Fraser M Callaghan; Barbara E U Burkhardt; Emanuela R Valsangiacomo Buechel; Christian J Kellenberger Journal: Pediatr Radiol Date: 2020-12-11
Authors: Heike E Daldrup-Link; Ashok J Theruvath; Ali Rashidi; Michael Iv; Robbie G Majzner; Sheri L Spunt; Stuart Goodman; Michael Moseley Journal: Pediatr Radiol Date: 2021-05-27