Phagocytosis of ferumoxytol (FMX) by tumor-associated macrophages (TAMs) results in intracellular compartmentation, which has opposing effects on longitudinal (R1) and transverse (R2*) relaxivity of FMX. Pixelwise mismatch between apparent ferumoxytol concentration (FMXc) computed from post-FMX R1 and R2* maps can be exploited to identify pixels with high concentrations of phagocytosed (compartmentalized) FMX. Here we show mismatch on MRI, acquired 24 h post-FMX, measured in terms of compartmentation index (CI) greater than 1 and hypothesized to be indicative of FMX intracellular compartmentation, was predictive of the response of breast cancer brain metastases to liposomal irinotecan (nal-IRI) at the individual tumor level.
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