Fig. 2

Axial pre- (a) and post-gadolinium (b) fat-suppressed T1 gradient recalled echo (GRE) images (1.7/4.3) show no appreciable change in the signal intensity of the blood pool or abdominal organs (liver, spleen) after gadolinium injection (b) due to the pre-existing T1 shortening effects of ferumoxytol, which masks the T1 shortening effects of gadolinium. This interaction renders the post-gadolinium images non-diagnostic. Note enhancement of gastroesophageal varices on both pre- and post-contrast images (white arrows). Axial T1 in-phase GRE image (2.3/4.3) performed prior to gadolinium injection (c) also depicts T1 shortening effects in the liver and spleen (which masks expected profound hypointensity based on T2 signal) and blood pool. Note the marked hypointensity of the bone marrow (M) in (c) due to marrow uptake of ferumoxytol when compared to the baseline axial T1 GRE (d) image performed 15 months earlier, which demonstrates normal marrow (M) signal intensity