Abstract
PurposeTo assess whether black blood T2* cardiovascular magnetic resonance is superior to conventional white blood imaging of cardiac iron in patients with thalassaemia major (TM).Materials and methodsWe performed both conventional white blood and black blood T2* CMR sequences in 100 TM patients to determine intra and inter-observer variability and presence of artefacts. In 23 patients, 2 separate studies of both techniques were performed to assess interstudy reproducibility.ResultsCardiac T2* values ranged from 4.5 to 43.8 ms. The mean T2* values were not different between black blood and white blood acquisitions (20.5 vs 21.6 ms, p = 0.26). Compared with the conventional white blood diastolic acquisition, the coefficient of variance of the black blood CMR technique was superior for intra-observer reproducibility (1.47% vs 4.23%, p < 0.001), inter-observer reproducibility (2.54% vs 4.50%, p < 0.001) and inter-study reproducibility (4.07% vs 8.42%, p = 0.001). Assessment of artefacts showed a superior score for black blood vs white blood scans (4.57 vs 4.25; p < 0.001).ConclusionsBlack blood T2* CMR has superior reproducibility and reduced imaging artefacts for the assessment of cardiac iron, in comparison with the conventional white blood technique, which make it the preferred technique for clinical practice.
Highlights
Beta thalassaemia major (TM) is an inherited anaemia and without regular blood transfusions patients die during childhood
Transfusions improve health and survival, the consequent tissue iron deposition leads to organ damage in the long term. Those treated only with transfusions usually die early from cardiac failure secondary to myocardial siderosis [1,2], and long term iron chelation treatment with deferoxamine became the standard treatment of choice to control iron levels from its introduction in the late 1960s
There was no significant difference between the mean cardiac T2* values for all 100 patients for the black blood acquisition and the conventional white blood sequence with diastolic imaging (20.5 ms vs 21.6 ms; p = 0.26)
Summary
Beta thalassaemia major (TM) is an inherited anaemia and without regular blood transfusions patients die during childhood. Transfusions improve health and survival, the consequent tissue iron deposition leads to organ damage in the long term. Those treated only with transfusions usually die early from cardiac failure secondary to myocardial siderosis [1,2], and long term iron chelation treatment with deferoxamine became the standard treatment of choice to control iron levels from its introduction in the late 1960s. Long term use of deferoxamine often does not prevent the eventual accumulation of myocardial iron, left ventricular dysfunction and death from heart failure. Myocardial dysfunction is directly linked with cardiac iron burden [3], it often occurs late and can be hard to reverse once established.
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