Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Dec 1;11(4):CNS90.
doi: 10.2217/cns-2021-0018. Epub 2022 Nov 21.

Undesired impact of iron supplement on MRI assessment of post-treatment glioblastoma

Dahye Park  1 , Mina Lobbous  2 , Louis B Nabors  3 , James M Markert  4 , Jinsuh Kim  5
Affiliations
Case Reports

Undesired impact of iron supplement on MRI assessment of post-treatment glioblastoma

Dahye Park et al. CNS Oncol. .

Abstract

Glioblastoma (GBM) is the most common malignant adult brain and has a poor prognosis. Routine post-treatment MRI evaluations are required to assess treatment response and disease progression. We present a case of an 83-year-old female who underwent MRI assessment of post-treatment GBM after intravenous iron replacement therapy, ferumoxytol. The brain MRI revealed unintended alteration of MRI signal characteristics from the iron containing agent which confounded diagnostic interpretation and subsequently, the treatment planning. Ferumoxytol injection prior to contrast enhanced MRI must be screened in post-treatment GBM patients to accurately evaluate tumor activity.

Keywords: GBM; adverse events; brain tumor; ferumoxytol; imaging.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Brain imaging.
(A) Noncontrast axial T1 hyperintensity in the right hemisphere (arrows), (B) postcontrast T1 intensity (arrows), and (C) susceptibility weighted imaging (SWI) exhibiting iron particle uptakes in the active tumor areas (arrows) and extensive background paramagnetic effect throughout the entire brain.
Figure 2.
Figure 2.. Brain images and ROI curve.
(A) Dynamic susceptibility contrast (DSC) perfusion MR image of right temporal tumor (arrows) with ROI mask (red circle) at the baseline. (B) Relative cerebral blood volume (rCBV) map of tumor region (arrows). (C) ROI signal-intensity curve across the acquisition time (A: intravascular peak and B: capillary pooling phase). ROI: Region of interest.
Figure 3.
Figure 3.. Noncontrast brain CT exhibiting mildly increased attenuation value (35 Hounsfield unit) at the area of tumor core.
See this image and copyright information in PMC

References

    1. Davis ME. Glioblastoma: overview of disease and treatment. Clin. J. Oncol. Nurs. 20(Suppl. 5), S2–S8 (2016). - PMC - PubMed
    1. Clarke JL, Chang S. Pseudoprogression and pseudoresponse: challenges in brain tumor imaging. Curr. Neurol. Neurosci. Rep. 9(3), 241–246 (2009). - PubMed
    1. Hygino Da Cruz LC Jr, Rodriguez I, Domingues RC, Gasparetto EL, Sorensen AG. Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma. Am. J. Neuroradiol. 32(11), 1978–1985 (2011). - PMC - PubMed

    2. •• Reviews pseudoprogression and pseudoresponse.

    1. Cha J, Kim ST, Kim HJ et al. Differentiation of tumor progression from pseudoprogression in patients with posttreatment glioblastoma using multiparametric histogram analysis. Am. J. Neuroradiol. 35(7), 1309–1317 (2014). - PMC - PubMed

    2. •• Discusses the usefulness of multiparametric histogram analysis of post-treatment glioblastoma in predicting true tumor progression.

    1. Suh CH, Kim HS, Jung SC, Choi CG, Kim SJ. Multiparametric MRI as a potential surrogate endpoint for decision-making in early treatment response following concurrent chemoradiotherapy in patients with newly diagnosed glioblastoma: a systematic review and meta-analysis. Eur. Radiol. 28(6), 2628–2638 (2018). - PubMed

Publication types