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Ferumoxytol-enhanced MRI for surveillance of pediatric cerebral arteriovenous malformations.

Publication ,  Journal Article
Huang, Y; Singer, TG; Iv, M; Lanzman, B; Nair, S; Stadler, JA; Wang, J; Edwards, MSB; Grant, GA; Cheshier, SH; Yeom, KW
Published in: J Neurosurg Pediatr
October 1, 2019

OBJECTIVE: Children with intracranial arteriovenous malformations (AVMs) undergo digital DSA for lesion surveillance following their initial diagnosis. However, DSA carries risks of radiation exposure, particularly for the growing pediatric brain and over lifetime. The authors evaluated whether MRI enhanced with a blood pool ferumoxytol (Fe) contrast agent (Fe-MRI) can be used for surveillance of residual or recurrent AVMs. METHODS: A retrospective cohort was assembled of children with an established AVM diagnosis who underwent surveillance by both DSA and 3-T Fe-MRI from 2014 to 2016. Two neuroradiologists blinded to the DSA results independently assessed Fe-enhanced T1-weighted spoiled gradient recalled acquisition in steady state (Fe-SPGR) scans and, if available, arterial spin labeling (ASL) perfusion scans for residual or recurrent AVMs. Diagnostic confidence was examined using a Likert scale. Sensitivity, specificity, and intermodality reliability were determined using DSA studies as the gold standard. Radiation exposure related to DSA was calculated as total dose area product (TDAP) and effective dose. RESULTS: Fifteen patients were included in this study (mean age 10 years, range 3-15 years). The mean time between the first surveillance DSA and Fe-MRI studies was 17 days (SD 47). Intermodality agreement was excellent between Fe-SPGR and DSA (κ = 1.00) but poor between ASL and DSA (κ = 0.53; 95% CI 0.18-0.89). The sensitivity and specificity for detecting residual AVMs using Fe-SPGR were 100% and 100%, and using ASL they were 72% and 100%, respectively. Radiologists reported overall high diagnostic confidence using Fe-SPGR. On average, patients received two surveillance DSA studies over the study period, which on average equated to a TDAP of 117.2 Gy×cm2 (95% CI 77.2-157.4 Gy×cm2) and an effective dose of 7.8 mSv (95% CI 4.4-8.8 mSv). CONCLUSIONS: Fe-MRI performed similarly to DSA for the surveillance of residual AVMs. Future multicenter studies could further investigate the efficacy of Fe-MRI as a noninvasive alternative to DSA for monitoring AVMs in children.

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Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

October 1, 2019

Volume

24

Issue

4

Start / End Page

407 / 414

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3213 Paediatrics
  • 3209 Neurosciences
  • 1114 Paediatrics and Reproductive Medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Huang, Y., Singer, T. G., Iv, M., Lanzman, B., Nair, S., Stadler, J. A., … Yeom, K. W. (2019). Ferumoxytol-enhanced MRI for surveillance of pediatric cerebral arteriovenous malformations. J Neurosurg Pediatr, 24(4), 407–414. https://doi.org/10.3171/2019.5.PEDS1957
Huang, Yuhao, Timothy G. Singer, Michael Iv, Bryan Lanzman, Siddharth Nair, James A. Stadler, Jia Wang, et al. “Ferumoxytol-enhanced MRI for surveillance of pediatric cerebral arteriovenous malformations.J Neurosurg Pediatr 24, no. 4 (October 1, 2019): 407–14. https://doi.org/10.3171/2019.5.PEDS1957.
Huang Y, Singer TG, Iv M, Lanzman B, Nair S, Stadler JA, et al. Ferumoxytol-enhanced MRI for surveillance of pediatric cerebral arteriovenous malformations. J Neurosurg Pediatr. 2019 Oct 1;24(4):407–14.
Huang, Yuhao, et al. “Ferumoxytol-enhanced MRI for surveillance of pediatric cerebral arteriovenous malformations.J Neurosurg Pediatr, vol. 24, no. 4, Oct. 2019, pp. 407–14. Pubmed, doi:10.3171/2019.5.PEDS1957.
Huang Y, Singer TG, Iv M, Lanzman B, Nair S, Stadler JA, Wang J, Edwards MSB, Grant GA, Cheshier SH, Yeom KW. Ferumoxytol-enhanced MRI for surveillance of pediatric cerebral arteriovenous malformations. J Neurosurg Pediatr. 2019 Oct 1;24(4):407–414.

Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

October 1, 2019

Volume

24

Issue

4

Start / End Page

407 / 414

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3213 Paediatrics
  • 3209 Neurosciences
  • 1114 Paediatrics and Reproductive Medicine