Journal article
Feasibility of ferumoxytol-enhanced neonatal and young infant cardiac MRI without general anesthesia
Journal of magnetic resonance imaging, Vol.45(5), pp.1407-1418
05/2017
DOI: 10.1002/jmri.25482
PMCID: PMC5373922
PMID: 27678106
Abstract
To assess the feasibility of ferumoxytol-enhanced anesthesia-free cardiac MRI in neonates and young infants for complex congenital heart disease (CHD).
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.
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).
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.
2 J. MAGN. RESON. IMAGING 2017;45:1407-1418.
Details
- Title: Subtitle
- Feasibility of ferumoxytol-enhanced neonatal and young infant cardiac MRI without general anesthesia
- Creators
- Lillian M Lai - Stanford UniversityJoseph Y Cheng - Stanford UniversityMarcus T Alley - Stanford UniversityTao Zhang - Stanford UniversityMichael Lustig - University of California, BerkeleyShreyas S Vasanawala - Stanford University
- Resource Type
- Journal article
- Publication Details
- Journal of magnetic resonance imaging, Vol.45(5), pp.1407-1418
- DOI
- 10.1002/jmri.25482
- PMID
- 27678106
- PMCID
- PMC5373922
- ISSN
- 1053-1807
- eISSN
- 1522-2586
- Grant note
- P41 RR009784 / NCRR NIH HHS R01 EB019241 / NIBIB NIH HHS R01 EB009690 / NIBIB NIH HHS
- Language
- English
- Date published
- 05/2017
- Academic Unit
- Radiology
- Record Identifier
- 9984318800502771
Metrics
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