Selective use of ferumoxytol-enhanced magnetic resonance angiography in patients with renal insufficiency: insights from a pilot study.

Abstract

The use of conventional contrast agents in computed tomography (CT) and magnetic resonance (MR) imaging is often limited in patients with chronic kidney disease (CKD) due to potential nephrotoxicity. Ferumoxytol, originally developed for iron supplementation, has emerged as a promising alternative MR contrast agent that is safer for patients with CKD. This study aims to present our center's experience with ferumoxytol as a contrast agent in CKD patients. We retrospectively reviewed 24 MR imaging studies of the chest, abdomen, and pelvis performed in CKD patients at our center. All patients were deemed suitable for ferumoxytol administration, receiving a dose of 4 mg/kg with post-injection monitoring. The imaging quality of the ascending, descending, suprarenal and infrarenal aortic segments was assessed by three independent observers using a qualitative scoring system (nondiagnostic, poor vascular definition, good vascular definition, and excellent vascular definition). Quantitative analyses, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and heterogeneity index, were also performed. No adverse reactions to ferumoxytol were observed. Of the 72 vascular segments evaluated, 90.8% of the images were rated as excellent vascular definition, and 9.2% were rated as good vascular definition. Inter-observer agreement was substantial (k = 0.647), with no statistically significant differences in ratings between observers. Ferumoxytol is a safe and effective alternative to conventional contrast agents for MR vascular imaging, particularly in patients with renal insufficiency. These findings support its selective use in appropriate clinical scenarios, offering a reliable imaging option for CKD patients.