MRI of cardiac iron overload

Chu, Winnie C.W.; Au, Wing Y.; Lam, William W. Y.

doi:10.1002/jmri.23628

Cited by 36 publications

(21 citation statements)

References 70 publications

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“…Hepatic fibrosis and cirrhosis may occur, but onset may be delayed compared to that observed in cases of increased intestinal absorption of iron. Cardiac toxicity is the greatest clinical concern in transfusional overload, and death often occurs from cardiomyopathy or cardiac arrhythmias .…”

Section: Mechanisms Of Iron Overloadmentioning

confidence: 99%

Quantification of liver iron with MRI: State of the art and remaining challenges

Hernando

Levin

Sirlin

et al. 2014

Magnetic Resonance Imaging

237

259

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Liver iron overload is the histological hallmark of hereditary hemochromatosis and transfusional hemosiderosis, and can also occur in chronic hepatopathies. Iron overload can result in liver damage, with the eventual development of cirrhosis, liver failure and hepatocellular carcinoma. Assessment of liver iron levels is necessary for detection and quantitative staging of iron overload, and monitoring of iron-reducing treatments. This article discusses the need for non-invasive assessment of liver iron, and reviews qualitative and quantitative methods with a particular emphasis on MRI. Specific MRI methods for liver iron quantification include signal intensity ratio as well as R2 and R2* relaxometry techniques. Methods that are in clinical use, as well as their limitations, are described. Remaining challenges, unsolved problems, and emerging techniques to provide improved characterization of liver iron deposition are discussed.

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Section: Mechanisms Of Iron Overloadmentioning

confidence: 99%

Quantification of liver iron with MRI: State of the art and remaining challenges

Hernando

Levin

Sirlin

et al. 2014

Magnetic Resonance Imaging

237

259

View full text Add to dashboard Cite

show abstract

“…This morbidity and mortality is preventable provided adequate chelation therapy is instituted and maintained over time (i.e., tissue iron is kept within the target range, or if it excessive, lowered to the target range by use of an effective chelation strategy which the patient is willing and able to use). Three chelators are FDA approved in the US: deferoxamine (DFO), deferasirox (DFX), and deferiprone (DFP), (approval years 1968, 2005, and 2011, respectively) . The era of widely available oral chelators began only in 2006, with the commercial launch of DFX.…”

Section: Introductionmentioning

confidence: 99%

MRI guided iron assessment and oral chelator use improve iron status in thalassemia major patients

et al. 2014

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Oral iron chelators and magnetic resonance imaging (MRI) assessment of heart and liver iron burden have become widely available since the mid 2000s, allowing for improved patient compliance with chelation and noninvasive monitoring of iron levels for titration of therapy. We evaluated the impact of these changes in our center for patients with thalassemia major and transfusional iron overload. This single center, retrospective observational study covered the period from 2005 through 2012. Liver iron content (LIC) was estimated both by a T2* method and by R2 (Ferriscan®) technique. Cardiac iron was assessed as cT2*. Forty-two patients (55% male) with transfused thalassemia and at least two MRIs were included (median age at first MRI, 17.5 y). Over a mean follow-up period of 5.2 ± 1.9 y, 190 MRIs were performed (median 4.5 per patient). Comparing baseline to last MRI, 63% of patients remained within target ranges for cT2* and LIC, and 13% improved from high values to the target range. Both the median LIC and cT2* (cR2* = 1000/cT2*) status improved over time: LIC 7.3 to 4.5 mg/g dry weight, P = 0.0004; cR2* 33.4 to 28.3 Hz, P = 0.01. Individual responses varied widely. Two patients died of heart failure during the study period. Annual MRI iron assessments and availability of oral chelators both facilitate changes in chelation dose and strategies to optimize care.

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“…An advantage of the proposed method over previous two‐point Dixon techniques for whole heart imaging is the possibility to obtain R 2 * maps in addition to the water and fat images. While the diagnostic utility of the fat image in the context of cardiac imaging is still debated , T 2 * (=1/R 2 *) is a well‐known and widely accepted biomarker of cardiac iron overload whose importance has been extensively reported in the literature . One of the major challenges inherent to cardiac T 2 * mapping is the wide spectrum of T 2 * values to be resolved.…”

Section: Discussionmentioning

confidence: 99%

Whole‐heart chemical shift encoded water–fat MRI

Taviani

Hernando

François

et al. 2013

Magnetic Resonance in Med

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Purpose To develop and evaluate a free-breathing chemical-shift-encoded (CSE) spoiled gradient-recalled echo (SPGR) technique for whole-heart water–fat imaging at 3 Tesla (T). Methods We developed a three-dimensional (3D) multi-echo SPGR pulse sequence with electrocardiographic gating and navigator echoes and evaluated its performance at 3T in healthy volunteers (N = 6) and patients (N = 20). CSE-SPGR, 3D SPGR, and 3D balanced-SSFP with chemical fat saturation were compared in six healthy subjects with images evaluated for overall image quality, level of residual artifacts, and quality of fat suppression. A similar scoring system was used for the patient datasets. Results Images of diagnostic quality were acquired in all but one subject. CSE-SPGR performed similarly to SPGR with fat saturation, although it provided a more uniform fat suppression over the whole field of view. Balanced-SSFP performed worse than SPGR-based methods. In patients, CSE-SPGR produced excellent fat suppression near metal. Overall image quality was either good (7/20) or excellent (12/20) in all but one patient. There were significant artifacts in 5/20 clinical cases. Conclusion CSE-SPGR is a promising technique for whole-heart water–fat imaging during free-breathing. The robust fat suppression in the water-only image could improve assessment of complex morphology at 3T and in the presence of off-resonance, with additional information contained in the fat-only image.

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MRI of cardiac iron overload

Cited by 36 publications

References 70 publications

Quantification of liver iron with MRI: State of the art and remaining challenges

Quantification of liver iron with MRI: State of the art and remaining challenges

MRI guided iron assessment and oral chelator use improve iron status in thalassemia major patients

Whole‐heart chemical shift encoded water–fat MRI

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