Improvement of image quality and diagnostic accuracy of novel ferumoxytol-enhanced magnetic resonance coronary angiography: compared to non-contrast enhanced imaging

Purpose To assess whether ferumoxytol-enhanced magnetic resonance coronary angiography (CMRA) improves image quality and diagnostic performance compared to non-contrast CMRA, using invasive coronary angiography (ICA) as the reference standard. Methods This is a retrospective analysis of a prospective trial ( ClinicalTrials.gov , NCT 05032937). Non-contrast and ferumoxytol-enhanced CMRA were performed on a 3.0 T scanner, with ICA as the gold standard. Two cardiovascular radiologists, blinded to ICA results, independently assessed image quality and diagnostic performance across proximal, middle, and distal coronary artery segments. Contrast-to-noise ratios (CNR) relative to myocardium (CNRmyo) and pericardial fat (CNRfat) were calculated. Sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy were evaluated at the per‑patient, per-vessel, and per‑segment levels. Results Twenty-nine patients (median age, 64 years, 58.6 % male) were included into final analysis. Ferumoxytol-enhanced CMRA significantly improved CNRmyo and CNRfat across all artery segments. At the per‑patient level, compared with non‑contrast CMRA, ferumoxytol‑enhanced CMRA increased sensitivity from 52.2 % (95 % CI: 30.6 %–73.2 %) to 100 % (95 % CI: 85.2 %–100 %) (p < 0.001), while specificity remained 100 % (95 % CI: 54.1 %–100 %). At the per-segment level (225/261 assessable segments), ferumoxytol‑enhanced CMRA outperformed non‑contrast CMRA, with sensitivity improving from 32.4 % to 88.2 % (p < 0.001), NPV from 89.1 % to 97.9 % (p < 0.001), and accuracy from 88.4 % to 96.9 % (p < 0.001). The diagnostic performance was most pronounced in the middle coronary segments, where sensitivity, PPV, NPV, and accuracy increased from 20.0 %, 50.0 %, 82.6 %, and 80.0 % to 80.0 %, 80.0 %, 95.0 %, and 92.0 %, respectively. Conclusions Ferumoxytol-enhanced CMRA significantly improved image quality and diagnostic accuracy compared with non‑contrast CMRA, particularly in the middle coronary segments. These findings suggest that ferumoxytol may serve as a viable gadolinium‑free alternative for noninvasive detection of coronary artery disease.