Kidney Week

Abstract: SA-PO093

Ferumoxytol-Enhanced MR Angiography (FeMRA) vs CT Angiography (CTA) for the Assessment of Potential Kidney Transplant Recipients

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Stoumpos, Sokratis, Queen Elizabeth University Hospital, Glasgow, United Kingdom

Sokratis Stoumpos,

• Hall barrientos, Pauline, NHS, Glasgow, United Kingdom

Pauline Hall barrientos,

• Radjenovic, Aleksandra, University of Glasgow, Glasgow, United Kingdom

Aleksandra Radjenovic,

• Roditi, Giles, NHS GG & C, Glasgow, United Kingdom

Giles Roditi,

• Kingsmore, David, NHS , Glascow, United Kingdom

David Kingsmore,

• Mark, Patrick B., University of Glasgow, Glasgow, United Kingdom

Patrick B. Mark,

Background

Conventional vascular imaging techniques are problematic in chronic kidney disease (CKD) patients due to associated risks, invasiveness and imprecision. CT angiography (CTA) is routinely used to assess the vasculature of CKD patients before transplant listing. Ferumoxytol, licensed for iron-deficiency anaemia, was originally developed as an MRI contrast agent and reduces T1 properties of tissue on MRI.

Methods

Prospective comparative study of ferumoxytol-enhanced MRA (FeMRA) vs CTA for aortoiliac imaging in kidney transplant (KT) candidates. MRA using ferumoxytol 3mg/kg as intravenous contrast agent was performed in addition to CTA. We also used a specific MRI sequence called StarVIBE to detect vascular calcifications in similar way to CT using contrast-free techniques. Two independent readers assessed the FeMRA/StarVIBE and a third reader the CTA (gold standard). Interclass correlation coefficient (ICC) was performed to assess interobserver agreement. Comparisons of lumen diameter, calcification, and signal intensity at predefined vascular sections were performed. For continuous variables, mean differences (and CI) were estimated and Bland-Altman plots of interobserver variability were created. Steady-state images were analyzed using the Horos image viewer (vs3, LGPL-3.0).

Results

28 patients (mean age 68 [SD 15] yr; 58% men; 42% diabetics) undergoing CTA for pre-operative KT candidacy assessment were enrolled. There was excellent intraobserver agreement in assessment of the arterial diameter, vein diameter and calcification (ICC 0.91 [95% CI 079-0.96], 0.89 [0.79-0.94] and 0.95 [0.89-0.98], respectively). There were no significant differences in assessment of the arterial diameter and calcification between FeMRA/StarVIBE and CTA (arterial diameter 1.34 [0.42] vs 1.30 [0.44]cm; p=0.63, area of calcification 0.43 [0.35] vs 0.39 [0.29]mm²; p=0.53, respectively). However, signal intensity and qualitative lumen depiction in the venous vasculature was superior with FeMRA (p<0.001).

Conclusion

FeMRA combined with StarVIBE is comparable to CTA for assessment of lumen diameter, calcification and signal intensity in the abdominopelvic arterial vasculature of CKD patients due for KT listing with the significant advantage of improved venous depiction with no nephrotoxicity.

Funding

• Commercial Support – AMAG Pharmaceuticals