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27.03.2019 | Magnetic Resonance | Ausgabe 7/2019 Open Access

European Radiology 7/2019

Ferumoxytol magnetic resonance angiography: a dose-finding study in patients with chronic kidney disease

European Radiology > Ausgabe 7/2019
Sokratis Stoumpos, Martin Hennessy, Alex T. Vesey, Aleksandra Radjenovic, Ram Kasthuri, David B. Kingsmore, Patrick B. Mark, Giles Roditi
Wichtige Hinweise

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The online version of this article (https://​doi.​org/​10.​1007/​s00330-019-06137-4) contains supplementary material, which is available to authorized users.

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Ferumoxytol is an alternative to gadolinium-based compounds as a vascular contrast agent for magnetic resonance angiography (MRA), particularly for patients with chronic kidney disease (CKD). However, dose-related efficacy data are lacking. We aimed to determine the optimal (minimum effective) dose of ferumoxytol for MRA in patients with CKD.


Ferumoxytol-enhanced MRA (FeMRA) was performed at 3.0 T in patients with CKD after dose increments up to a total of 4 mg/kg. Image quality was assessed by contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) in the abdominal aorta and inferior vena cava. Quadratic regression analyses were performed to estimate the effects of dose increments on CNR and SNR.


Twenty-three patients underwent FeMRA (mean age 60 [SD 13] years, 87% men, 48% had diabetic nephropathy) with cumulative doses of 0, 1, 2, 3 and 4 mg/kg of ferumoxytol. On regression analyses, a parabolic relationship was observed between ferumoxytol dose and signal with progressive signal loss using doses exceeding 4 mg/kg. A dose of 3 mg/kg achieved ≥ 75% of predicted peak CNR and SNR and images were deemed of excellent diagnostic quality.


In patients with CKD undergoing FeMRA, a dose of 3 mg/kg provides excellent arterial and venous enhancement. The benefits of increasing the dose to a theoretically optimal value of 4 mg/kg appear to be negligible and likely of minimal, if any, diagnostic value.

Key Points

• Ferumoxytol is used off-label as an MRI contrast agent but dose-related data are lacking.
• In patients with CKD requiring MR angiography, a dose of 3 mg/kg provides excellent vascular enhancement.

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