Potential for differentiation of pseudoprogression from true tumor progression with dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging using ferumoxytol vs. gadoteridol: a pilot study

Int J Radiat Oncol Biol Phys. 2011 Feb 1;79(2):514-23. doi: 10.1016/j.ijrobp.2009.10.072. Epub 2010 Apr 13.


Purpose: We evaluated dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging (DSC-MRI) using gadoteridol in comparison to the iron oxide nanoparticle blood pool agent, ferumoxytol, in patients with glioblastoma multiforme (GBM) who received standard radiochemotherapy (RCT).

Methods and materials: Fourteen patients with GBM received standard RCT and underwent 19 MRI sessions that included DSC-MRI acquisitions with gadoteridol on Day 1 and ferumoxytol on Day 2. Relative cerebral blood volume (rCBV) values were calculated from DSC data obtained from each contrast agent. T1-weighted acquisition post-gadoteridol administration was used to identify enhancing regions.

Results: In seven MRI sessions of clinically presumptive active tumor, gadoteridol-DSC showed low rCBV in three and high rCBV in four, whereas ferumoxytol-DSC showed high rCBV in all seven sessions (p = 0.002). After RCT, seven MRI sessions showed increased gadoteridol contrast enhancement on T1-weighted scans coupled with low rCBV without significant differences between contrast agents (p = 0.9). Based on post-gadoteridol T1-weighted scans, DSC-MRI, and clinical presentation, four patterns of response to RCT were observed: regression, pseudoprogression, true progression, and mixed response.

Conclusion: We conclude that DSC-MRI with a blood pool agent such as ferumoxytol may provide a better monitor of tumor rCBV than DSC-MRI with gadoteridol. Lesions demonstrating increased enhancement on T1-weighted MRI coupled with low ferumoxytol rCBV are likely exhibiting pseudoprogression, whereas high rCBV with ferumoxytol is a better marker than gadoteridol for determining active tumor. These interesting pilot observations suggest that ferumoxytol may differentiate tumor progression from pseudoprogression and warrant further investigation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Blood Volume
  • Blood-Brain Barrier
  • Brain Neoplasms / blood supply
  • Brain Neoplasms / drug therapy
  • Brain Neoplasms / pathology*
  • Brain Neoplasms / radiotherapy
  • Contrast Media*
  • Disease Progression*
  • Female
  • Ferrosoferric Oxide
  • Gadolinium
  • Glioblastoma / blood supply
  • Glioblastoma / drug therapy
  • Glioblastoma / pathology*
  • Glioblastoma / radiotherapy
  • Heterocyclic Compounds*
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Magnetite Nanoparticles*
  • Male
  • Middle Aged
  • Organometallic Compounds*
  • Pilot Projects
  • Young Adult


  • Contrast Media
  • Heterocyclic Compounds
  • Magnetite Nanoparticles
  • Organometallic Compounds
  • gadoteridol
  • Gadolinium
  • Ferrosoferric Oxide