Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload

Anderson, LJ; Holden, S; Davis, Bernard A.; Prescott, Emma; Charrier, C; Bunce, Nicholas; Firmin, David N.; Wonke, B; Porter, John B.; Walker, John M.; Pennell, Dudley J.

doi:10.1053/euhj.2001.2822

Cited by 1,489 publications

(1,681 citation statements)

References 36 publications

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“…The variations for these segments ranged from 12.6% to 17.5%. In fact, segments VII and VIII are the preferred locations in the single ROI analysis, due to the presence of a large area without blood vessels (10). The divergence between single ROI T2* values and mean hepatic T2* values was lower in patients with an abnormal single ROI T2* value.…”

Section: Discussionmentioning

confidence: 93%

“…For the heart, a multislice approach was set up (6,7) to detect the heterogeneous myocardial iron distribution shown by histological studies (8,9). For the liver, a single transverse slice is traditionally acquired in clinical practice and the T2* measurement is performed in a region of interest (ROI) of the parenchyma (7,10,11). The use of the conventional single ROI technique has been partially due the fact that the early development of the T2* sequence in single echo multi-breathhold required approximately nine 10-s breathholds to acquire a single slice.…”

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confidence: 99%

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Single region of interest versus multislice T2* MRI approach for the quantification of hepatic iron overload

Meloni

Luciani

Positano

et al. 2011

Magnetic Resonance Imaging

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Purpose: To evaluate the effectiveness of the single ROI approach for the detection of hepatic iron burden in thalassemia major (TM) patients in respect to a whole liver measurement. Materials and Methods:Five transverse hepatic slices were acquired by a T2* gradient-echo sequence in 101 TM patients and 20 healthy subjects. The T2* value was calculated in a single region of interest (ROI) defined in the medium-hepatic slice. Moreover, the T2* value was extracted on each of the eight ROIs defined in the functionally independent segments. The mean hepatic T2* value was calculated.Results: For patients, the mean T2* values over segments VII and VIII were significantly lower. This pattern was substantially preserved in the two groups identified considering the T2* normal cutoff. All segmental T2* values were correlated with the single ROI T2* value. After the application of a correction map based on T2* fluctuations in the healthy subjects, no significant differences were found in the segmental T2* values.Conclusion: Hepatic T2* variations are low and due to artifacts and measurement variability. The single ROI approach can be adopted in the clinical arena, taking care to avoid the susceptibility artifacts, occurring mainly in segments VII and VIII.

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

Single region of interest versus multislice T2* MRI approach for the quantification of hepatic iron overload

Meloni

Luciani

Positano

et al. 2011

Magnetic Resonance Imaging

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“…Nevertheless, no study so far has evaluated the short‐term effect of intravenous iron therapy on myocardial iron content and its correlation with simultaneous changes in left ventricular (LV) function. Cardiac magnetic resonance (CMR) T2* sequence has emerged as a reliable non‐invasive technique for assessing myocardial iron overload 7, 8. Recently, this technique has also shown a potential utility for evaluating myocardial iron deficiency 9, 10…”

Section: Introductionmentioning

confidence: 99%

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

et al. 2016

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AimsIn patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency, treatment with intravenous iron has shown a clinical improvement regardless of anaemic status. Cardiac magnetic resonance (CMR) T2* sequence has shown a potential utility for evaluating myocardial iron deficiency. We aimed to evaluate whether T2* sequence significantly changes after ferric carboximaltose (FCM) administration, and if such changes correlate with changes in left ventricle ejection fraction (LVEF).Methods and resultsIn this pilot study, we included eight patients with chronic symptomatic (New York Heart Association II–III) HFrEF and iron deficiency. A CMR, including T2* analysis, was performed before and at a median of 43 days (interquartile range = 35–48) after intravenous FCM administration. Pearson or Spearman correlation coefficient (r) was used for bivariate contrast as appropriate. A partial correlation analysis was performed between ΔLVEF and ΔT2* while controlling for anaemia status at baseline. Anaemia was present in half of patients. After FCM administration, T2* decreased from a median of 39.5 (35.9–48) to 32 ms (32–34.5), P = 0.012. Simultaneously, a borderline increase in median of LVEF [40% (36–44.5) to 48.5% (38.5–53), P = 0.091] was registered. In a bivariate correlational analysis, ΔT2* was highly correlated with ΔLVEF (r = −0.747, P = 0.033). After controlling for anaemia at baseline, the association between ΔT2* and ΔLVEF persisted [r(partial): −0.865, R 2(partial): 0.748, P = 0.012]. A median regression analysis backed‐up these findings.ConclusionsIn a small sample of patients with HFrEF and iron deficiency, myocardial iron repletion assessed by CMR was associated to left ventricular remodelling. Further studies are warranted.

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“…Optimal values are >20 msec, and severe impairment is considered when <10 msec because the rate of heart failure has been shown to increase dramatically below this value. In this case, the T2 was 4.5 msec and therefore represents severe iron overload of the myocardium 9, 10, 11.…”

Section: Discussionmentioning

confidence: 91%

Acute cardiac decompensation in a patient with beta‐thalassemia and diabetes mellitus following cessation of chelation therapy

Lioudaki

Whyte

2016

Clinical Case Reports

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Key Clinical MessagePatients with higher liver iron stores are likely to have a worse cardiac outcome following noncompliance with chelation. Cardiovascular magnetic resonance identifies myocardial siderosis allowing optimization of iron chelation regimes. Diabetes puts thalassemic patients at increased risk of myocardial fibrosis. Dual chelation therapy with deferoxamine and deferiprone offers improved cardiac outcomes.

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Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload

Cited by 1,489 publications

References 36 publications

Single region of interest versus multislice T2* MRI approach for the quantification of hepatic iron overload

Single region of interest versus multislice T2* MRI approach for the quantification of hepatic iron overload

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

Acute cardiac decompensation in a patient with beta‐thalassemia and diabetes mellitus following cessation of chelation therapy

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