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Background <p>Ferumoxytol is used off-label as a contrast agent for cardiovascular magnetic resonance (CMR). However, the dose–response relationship between ferumoxytol, longitudinal relaxation, and image quality in pediatric and young patients remains unclear.</p> Objective <p>To evaluate the effects of sequential ferumoxytol dose escalation on three-dimensional (3D) whole-heart (WH) image quality and blood-pool nulling inversion time (TI), a physiologic surrogate of post-contrast T1 shortening.</p> Materials and methods <p>In this prospective study, 45 patients with congenital heart disease underwent ferumoxytol-enhanced 3D WH CMR at 1.5&#xa0;T using sequential dose regimens (1 mg/kg→2&#xa0;mg/kg or 2 mg/kg→3&#xa0;mg/kg). Right coronary artery (RCA) image quality and visible length, contrast-to-noise ratio (CNR), and image quality of the cardiac chambers and great vessels, as well as diagnostic completeness, were assessed. Blood-pool and myocardial nulling TI were measured using Look-Locker sequences. Baseline-adjusted change-score regression was the primary analysis, with mixed-effects ANCOVA performed to model TI behavior while accounting for repeated within-patient measurements.</p> Results <p>No significant differences were observed in CNR, RCA length, image quality, or diagnostic completeness between all doses (all <i>P</i>&gt;0.05). Myocardial and blood-pool nulling TI shortened significantly with dose escalation (<i>P</i>≤0.02). Change in blood-pool TI after the second dose was strongly predicted by TI after the first dose (<i>β</i>=−0.63, <i>P</i>&lt;0.001), whereas starting dose (1&#xa0;mg/kg or 2&#xa0;mg/kg) was not associated with TI change (<i>P</i>=0.70). At 1&#xa0;mg/kg, prolonged myocardial nulling TI may encroach upon the systolic rest period.</p> Conclusions <p>Ferumoxytol-enhanced 3D WH imaging provides diagnostic-quality assessment across 1–3&#xa0;mg/kg dosing. Dose-dependent TI shortening follows a nonlinear, saturating pattern, supporting optimized low-dose protocols.</p> Graphical abstract <p></p>

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Ferumoxytol dose optimization for three-dimensional whole-heart magnetic resonance imaging in patients with congenital heart disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • Sukran Erdem,
  • Tarique Hussain,
  • Aya El Jerbi,
  • Orhan Erdem,
  • Lauren Thai,
  • Lasya Gaur,
  • Gerald F. Greil,
  • Tarek Alsaied,
  • Sanja Dzelebdzic,
  • Qing Zou

摘要

Background

Ferumoxytol is used off-label as a contrast agent for cardiovascular magnetic resonance (CMR). However, the dose–response relationship between ferumoxytol, longitudinal relaxation, and image quality in pediatric and young patients remains unclear.

Objective

To evaluate the effects of sequential ferumoxytol dose escalation on three-dimensional (3D) whole-heart (WH) image quality and blood-pool nulling inversion time (TI), a physiologic surrogate of post-contrast T1 shortening.

Materials and methods

In this prospective study, 45 patients with congenital heart disease underwent ferumoxytol-enhanced 3D WH CMR at 1.5 T using sequential dose regimens (1 mg/kg→2 mg/kg or 2 mg/kg→3 mg/kg). Right coronary artery (RCA) image quality and visible length, contrast-to-noise ratio (CNR), and image quality of the cardiac chambers and great vessels, as well as diagnostic completeness, were assessed. Blood-pool and myocardial nulling TI were measured using Look-Locker sequences. Baseline-adjusted change-score regression was the primary analysis, with mixed-effects ANCOVA performed to model TI behavior while accounting for repeated within-patient measurements.

Results

No significant differences were observed in CNR, RCA length, image quality, or diagnostic completeness between all doses (all P>0.05). Myocardial and blood-pool nulling TI shortened significantly with dose escalation (P≤0.02). Change in blood-pool TI after the second dose was strongly predicted by TI after the first dose (β=−0.63, P<0.001), whereas starting dose (1 mg/kg or 2 mg/kg) was not associated with TI change (P=0.70). At 1 mg/kg, prolonged myocardial nulling TI may encroach upon the systolic rest period.

Conclusions

Ferumoxytol-enhanced 3D WH imaging provides diagnostic-quality assessment across 1–3 mg/kg dosing. Dose-dependent TI shortening follows a nonlinear, saturating pattern, supporting optimized low-dose protocols.

Graphical abstract