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October 22, 2019; 93 (17) Resident & Fellow Section

Teaching NeuroImages: Diffuse cerebrovascular susceptibility artifact following ferumoxytol infusion

Philip Gastrell, Joseph Carrera, Prem Batchala, Andrew Southerland
First published October 21, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008367
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A 79-year-old woman presented with dysarthria, aphasia, and right hemiparesis. MRI of the brain demonstrated a small acute infarct in the left temporoparietal convexity (figure 1) and a marked decrease in susceptibility signal of the cerebral vasculature (figure 2). Due to her religious beliefs (Jehovah's Witness), the patient’s anemia is treated with ferumoxytol infusions rather than red blood cell transfusion. She received an infusion 1 day prior to her scan. Susceptibility artifact of cerebral vasculature following IV iron therapy has been described.1 Ferumoxytol has gained interest as an MRI contrast agent in patients with decreased renal function.2

Figure 1
Figure 1 Diffusion-weighted imaging sequence of brain MRI demonstrates left temporoparietal hyperintensity (white arrow) consistent with acute infarction
Figure 2
Figure 2 Susceptibility-weighted imaging of brain MRI demonstrates markedly diminished susceptibility signal throughout the cerebrovasculature

Author contributions

P. Gastrell: drafting/revising the manuscript, study concept or design, accepts responsibility for conduct of research and final approval. J. Carrera: drafting/revising the manuscript, study concept or design, accepts responsibility for conduct of research and final approval. P. Batchala: drafting/revising the manuscript, data acquisition, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and final approval. A. Southerland: drafting/revising the manuscript, data acquisition, study concept or design, accepts responsibility for conduct of research and final approval.

Study funding

No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Teaching slides links.lww.com/WNL/A981

References

  1. 1.↵
    1. Hoque K,
    2. Myers C,
    3. Law M,
    4. Kim P
    . MRI brain findings of intravenous iron therapy. Neurographics 2017;7:61–63.
    OpenUrl
  2. 2.↵
    1. Bashir MR,
    2. Bhatti L,
    3. Marin D,
    4. Nelson RC
    . Emerging applications for ferumoxytol as a contrast agent in MRI. J Magn Reson Imaging 2014;41:884–898.
    OpenUrlCrossRefPubMed

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