Parenteral ferumoxytol interaction with magnetic resonance imaging: a case report, review of the literature and advisory warning

BACKGROUND: Ferumoxytol is a safe and effective parenteral therapy used for the treatment of iron deficiency anaemia that has recently been approved for use in North America and in Europe. METHODS: Ferumoxytol consists of a superparamagnetic iron oxide (SPIO) core, which causes T1, T2 and T2* shortening effects, and a carbohydrate shell, which results in a prolonged intravascular half life. RESULTS: These properties are under-reported and not well recognised. They can interfere with MRI interpretation, potentially masking enhancement and rendering examinations non-diagnostic or simulating pathologic disease states. Both radiologists and non-radiologist physicians must consider the potential interaction of ferumoxytol with MRI when interpreting and prescribing MRI examinations in their patients. MAIN MESSAGES: • Ferumoxytol has recently been approved for the treatment of iron deficiency anaemia. • Ferumoxytol is a small iron oxide particle with prolonged intravascular half life and T1, T2 and T2* shortening effects. • Administration of ferumoxytol can mask enhancement, rendering MRI studies potentially non-diagnostic. • Ferumoxytol can mimic diseases such as haemosiderosis, haemochromatosis and superficial siderosis. • Ferumoxytol interactions with MRI must be recognised by radiologists and non-radiologist physicians.