Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI

Liam Timms; Tianyi Zhou; Ju Qiao; Codi Gharagouzloo; Vishala Mishra; Rita Maria Lahoud; John W Chen; Mukesh Harisinghani; Srinivas Sridhar

doi:10.1155/2024/9763364

Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI

Int J Biomed Imaging. 2024 Apr 13:2024:9763364. doi: 10.1155/2024/9763364. eCollection 2024.

Authors

Liam Timms¹, Tianyi Zhou¹, Ju Qiao², Codi Gharagouzloo³, Vishala Mishra⁴, Rita Maria Lahoud⁴, John W Chen⁴, Mukesh Harisinghani⁴, Srinivas Sridhar^{1

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Affiliations

¹ Department of Physics, Northeastern University, Boston, MA, USA.
² Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA.
³ Gordon Center for Medical Imaging, Massachusetts General Hospital, Boston, MA, USA.
⁴ Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
⁵ Department of Chemical Engineering, Northeastern University, Boston, MA, USA.
⁶ Department of Bioengineering, Northeastern University, Boston, MA, USA.
⁷ Theranano LLC, Newton, MA, USA.

Abstract

Background: Ferumoxytol (Ferahame, AMAG Pharmaceuticals, Waltham, MA) is increasingly used off-label as an MR contrast agent due to its relaxivity and safety profiles. However, its potent T2^∗ relaxivity limits achievable T1-weighted positive contrast and leads to artifacts in standard MRI protocols. Optimization of protocols for ferumoxytol deployment is necessary to realize its potential.

Methods: We present first-in-human clinical results of the Quantitative Ultrashort Time-to-Echo Contrast Enhanced (QUTE-CE) MRA technique using the superparamagnetic iron oxide nanoparticle agent ferumoxytol for vascular imaging of the head/brain in 15 subjects at 3.0T. The QUTE-CE MRA method was implemented on a 3T scanner using a stack-of-spirals 3D Ultrashort Time-to-Echo sequence. Time-of-flight MRA and standard TE T1-weighted (T1w) images were also collected. For comparison, gadolinium-enhanced blood pool phase images were obtained retrospectively from clinical practice. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and intraluminal signal heterogeneity (ISH) were assessed and compared across approaches with Welch's two-sided t-test.

Results: Fifteen volunteers (54 ± 17 years old, 9 women) participated. QUTE-CE MRA provided high-contrast snapshots of the arterial and venous networks with lower intraluminal heterogeneity. QUTE-CE demonstrated significantly higher SNR (1707 ± 226), blood-tissue CNR (1447 ± 189), and lower ISH (0.091 ± 0.031) compared to ferumoxytol T1-weighted (551 ± 171; 319 ± 144; 0.186 ± 0.066, respectively) and time-of-flight (343 ± 104; 269 ± 82; 0.190 ± 0.016, respectively), with p < 0.001 in each comparison. The high CNR increased the depth of vessel visualization. Vessel lumina were captured with lower heterogeneity.

Conclusion: Quantitative Ultrashort Time-to-Echo Contrast-Enhanced MR angiography provides approximately 5-fold superior contrast with fewer artifacts compared to other contrast-enhanced vascular imaging techniques using ferumoxytol or gadolinium, and to noncontrast time-of-flight MR angiography, for clinical vascular imaging. This trial is registered with NCT03266848.

Associated data

ClinicalTrials.gov/NCT03266848

Grants and funding

R41 DA043974/DA/NIDA NIH HHS/United States