Comparison of ferumoxytol- and gadolinium chelate-enhanced MRI for assessment of sarcomas in children and adolescents. European radiology Siedek, F., Muehe, A. M., Theruvath, A. J., Avedian, R., Pribnow, A., Spunt, S. L., Liang, T., Farrell, C., Daldrup-Link, H. E. 2019

Abstract

OBJECTIVES: We compared the value of ferumoxytol (FMX)- and gadolinium (Gd)-enhanced MRI for assessment of sarcomas in paediatric/adolescent patients and hypothesised that tumour size and morphological features can be equally well assessed with both protocols.METHODS: We conducted a retrospective study of paediatric/adolescent patients with newly diagnosed bone or soft tissue sarcomas and both pre-treatment FMX- and Gd-MRI scans, which were maximal 4 weeks apart. Both protocols included T1- and T2-weighted sequences. One reader assessed tumour volumes, signal-to-noise ratios (SNR) of the primary tumour and adjacent tissues and contrast-to-noise ratios (CNR) ofFMX- and Gd-MRI scans. Additionally, four readers scored FMX- and Gd-MRI scansaccording to15 diagnostic parameters, using a Likert scale. The results were pooled across readers and compared between FMX- and Gd-MRI scans. Statistical methods included multivariate analyses with different models.RESULTS: Twenty-two patients met inclusion criteria (16 males, 6 females; mean age 15.3 ± 5.0). Tumour volume was not significantly different on T1-LAVA (p = 0.721), T1-SE (p = 0.290) and T2-FSE (p = 0.609)sequences. Compared to Gd-MRI, FMX-MRI demonstrated significantly lower tumour SNR on T1-LAVA (p < 0.001), equal tumour SNR on T1-SE (p = 0.104) and T2-FSE (p = 0.305), significantly higher tumour-to-marrow CNR (p < 0.001) on T2-FSE as well as significantly highertumour-to-liver (p = 0.021) and tumour-to-vessel (p = 0.003) CNR on T1-LAVAimages. Peritumoural and marrow oedema enhancedsignificantly more on Gd-MRIcompared to FMX-MRI (p < 0.001/p = 0.002, respectively). Tumour thrombi and neurovascular bundle involvement were assessed with a significantly higher confidence on FMX-MRI (both p < 0.001).CONCLUSIONS: FMX-MRI provides equal assessment of the extent of bone and soft tissue sarcomas compared to Gd-MRI with improvedtumour delineation and improved evaluation of neurovascular involvement and tumour thrombi. Therefore,FMX-MRI is a possiblealternative to Gd-MRIfor tumour staging in paediatric/adolescent sarcoma patients.KEY POINTS: Ferumoxytol can be used as an alterative to gadolinium chelates for MRI staging ofpaediatric sarcomas. Ferumoxytol-enhanced MRI provides equal assessment of tumour size and other diagnostic parameters compared to gadolinium chelate-enhanced MRI. Ferumoxytol-enhanced MRI provides improved delineation of sarcomas from bone marrow, liver and vessels compared to gadolinium chelate-enhanced MRI.

View details for DOI 10.1007/s00330-019-06569-y

View details for PubMedID 31844962