T2 Star Research Articles

Assessment of Iron Deposition and White Matter Maturation in Infant Brains by Using Enhanced T2 Star Weighted Angiography (ESWAN): R2* versus Phase Values

Background and PurposeIron deposition and white matter (WM) maturation are very important for brain development in infants. It has been reported that the R2* and phase values originating from the gradient-echo sequence could both reflect the iron and myelination. The aim of this study was to investigate age-related changes of R2* and phase value, and compare their performances for monitoring iron deposition and WM maturation in infant brains.Methods56 infants were examined by enhanced T2 star weighted angiography (ESWAN) and diffusion tensor imaging in the 1.5T MRI system. The R2* and phase values were measured from the deep gray nuclei and WM. Fractional anisotropy (FA) values were measured only in the WM regions. Correlation analyses were performed to explore the relation among the two parameters (R2* and phase values) and postmenstrual age (PMA), previously published iron concentrations as well as FA values.ResultsWe found significantly positive correlations between the R2* values and PMA in both of the gray nuclei and WM. Moreover, R2* values had a positive correlation with the iron reference concentrations in the deep gray nuclei and the FA in the WM. However, phase values only had the positive correlation with PMA and FA in the internal capsule, and no significant correlation with PMA and iron content in the deep gray nuclei.ConclusionsCompared with the phase values, R2* may be a preferable method to estimate the iron deposition and WM maturation in infant brains.

Tissue Doppler Echocardiography in Detection of Myocardial Iron Overload Confirmed by Cardiac MRI in Patients With Beta Thalassemia Major: A Meta-Analysis

Background: Myocardial iron overload is the most serious complication seen in transfusion-dependent beta thalassemia. Congestive heart failure remains to be the leading cause of death in thalassemia major patients. It is therefore important to facilitate early detection of myocardial iron overload in affected patients to avoid inevitable complications of treatment. Cardiac magnetic resonance imaging (MRI) continues to be the gold standard in detecting myocardial iron overload as it is the most sensitive and most precise imaging procedure available. It is however expensive, time-consuming and not universally available in all institutions. These reasons preclude it from being widely utilized in our practice. Tissue Doppler echocardiography on the other hand is widely available, faster and has significantly lower costs than the latter. These characteristics make it a promising alternative diagnostic tool for detection of and screening for cardiac iron overload. This study aims to determine the correlation of tissue Doppler echo parameters compared to the current gold standard, cardiac MRI T2 star. Methods: A literature search of published English language studies was performed using PubMed, MEDLINE and the Cochrane Collaboration from 1990 to 2013. Articles included were prospective cross-sectional and case-control trials. The risk of bias assessment (PRISMA) feature of Revman 5.0 and the QUADAS criteria were used to qualify for validity of the said qualified studies. Results: Five prospective observational studies were included with a total of 276 subjects. Four tissue Doppler parameters were analyzed and compared to cardiac MRI T2* findings. Results showed that patients with some degree of iron overload, evident in CMR T2* < 20 ms, had a statistically significant decrease in left ventricular ejection fraction (LVEF) with an overall mean difference (MD) of -3.84 (-5.85, -1.83) (Z = 3.75, P = 0.0002); increased Tei index (MD 13.03 (9.77, 16.99), Z = 7.83, P < 0.00001); and shorter deceleration times (MD -27.10 (-33.50, -20.71), Z = 8.31, P < 0.00001). There was no difference in E/A ratio of normal subjects versus iron overloaded patients (MD 0.18 (0.09, 0.27)) and therefore is not a reliable parameter to gauge myocardial iron overload (Z = 3.88, P = 0.0001). Conclusion: Tissue Doppler parameters that were seen to have good correlation with cardiac MRI T2*, the current gold standard, are Tei index, deceleration time and LVEF. J Hematol. 2014;3(1):1-9 doi: http://dx.doi.org/10.14740/jh107w

Disc Degeneration Assessed by Quantitative T2* (T2 Star) Correlated With Functional Lumbar Mechanics

Experimental correlation study design to quantify features of disc health, including signal intensity and distinction between the annulus fibrosus and nucleus pulposus, with T2* magnetic resonance imaging (MRI) and correlate with the functional mechanics in corresponding motion segments. Establish the relationship between disc health assessed by quantitative T2* MRI and functional lumbar mechanics. Degeneration leads to altered biochemistry in the disc, affecting the mechanical competence. Clinical routine MRI sequences are not adequate in detecting early changes in degeneration and fails to correlate with pain or improve patient stratification. Quantitative T2* relaxation time mapping probes biochemical features and may offer more sensitivity in assessing disc degeneration. Cadaveric lumbar spines were imaged using quantitative T2* mapping, as well as conventional T2-weighted MRI sequences. Discs were graded by the Pfirrmann scale, and features of disc health, including signal intensity (T2* intensity area) and distinction between the annulus fibrosus and nucleus pulposus (transition zone slope), were quantified by T2*. Each motion segment was subjected to pure moment bending to determine range of motion (ROM), neutral zone (NZ), and bending stiffness. T2* intensity area and transition zone slope were significantly correlated with flexion ROM (P = 0.015; P = 0.002), ratio of NZ/ROM (P = 0.010; P = 0.028), and stiffness (P = 0.044; P = 0.026), as well as lateral bending NZ/ROM (P = 0.005; P = 0.010) and stiffness (P = 0.022; P = 0.029). T2* intensity area was also correlated with lateral bending ROM (P = 0.023). Pfirrmann grade was only correlated with lateral bending NZ/ROM (P = 0.001) and stiffness (P = 0.007). T2* mapping is a sensitive quantitative method capable of detecting changes associated with disc degeneration. Features of disc health quantified with T2* predicted altered functional mechanics of the lumbar spine better than traditional Pfirrmann grading. This new methodology and analysis technique may enhance the assessment of degeneration and enable greater patient stratification for therapeutic strategies. N/A.

Quantitative assessment of iron deposition in the midbrain using 3D-enhanced T2 star weighted angiography (ESWAN): A preliminary cross-sectional study of 20 Parkinson’s disease patients

Conventional magnetic resonance imaging (MRI) assesses neurodegenerative structural changes in the cerebral anatomy of Parkinson's disease (PD) patients but cannot detect non-structural abnormalities; however, enhanced T2 star weighted angiography (ESWAN) can precisely indicate PD-related substantia nigra (SN) iron deposition. The differences in ESWAN-based parameters between different PD stages were assessed using midbrain iron deposits of 20 PD patients aged 64.3±12.7 (41–85) years grouped by Hoehn and Yahr staging into minimal (stages ≤2.5) or moderate to severe (stages ≥3.0) motor impairment groups and 14 healthy control subjects. Conventional MRI and ESWAN measurements of mean phase value (MPV) and midbrain dimensions (width and diameter) revealed similar anatomical characteristics; however, ESWAN revealed the presence of smaller MPVs and SN pars compacta (SNc) (P<0.01) and a negative correlation between reduction extent and motor impairment (P<0.01). SNc width to midbrain diameter was reduced in moderate to severe impairment patients versus control and minimal impairment patients (both P<0.01). A positive correlation was found between MPV and width or SNc width to midbrain diameter ratio (P<0.01 and P<0.05, respectively). Minimal impairment group mean MPV and substantia nigra pars reticulata (SNr) width evidenced no significant reduction, unlike significant reductions in the moderate to severe impairment group (P<0.01). No significant changes were observed in MPV or width in the RN region (P>0.05). ESWAN allows for early and accurate iron deposition determination in PD patients, particularly useful as a supplement to conventional MRI in early-stage PD patients.

Assessment of brain maturation in the preterm infants using diffusion tensor imaging (DTI) and enhanced T2 star weighted angiography (ESWAN)

PurposeTo assess the brain maturation of preterm infants using diffusion tensor imaging (DTI) and enhanced T2 star weighted angiography (ESWAN). Materials and methodsConventional magnetic resonance imaging (MRI), DTI and ESWAN were performed in 60 preterm infants and 21 term controls. 60 preterm infants were subgrouped to two groups according to the age at imaging: before and at term-equivalent age (TEA). Fractional anisotropy (FA), apparent diffusion coefficient (ADC) map from DTI, T2* and R2* maps from ESWAN were post-processed at an off-line workstation. The values of FA, ADC, T2* and R2* from the posterior limb of internal capsule (PLIC), frontal white matter (FWM), occipital white matter (OWM) and lentiform nuclei (LN) were determined. These parameters were compared between preterm and term infants. Correlations of DTI and ESWAN parameters with the gestational age, postmenstrual age and postnatal age were analyzed. ResultsADCs of FWM, OWM and LN, and T2* values of the PLIC and LN were higher in the preterm infants at TEA compared with the term controls.The correlations were existed between the postmenstrual age and the values of FA, ADC, T2*, R2* from the PLIC, values of ADC, T2*, R2* from the LN, T2* value from the OWM. The correlations were also found between the postnatal age and the values of FA, ADC, T2* from the PLIC, and T2* value from the LN. ConclusionThe maturity of preterm brain around TEA was different from that of term controls and appeared to be independent of the prematurity at birth. T2* was one of valuable indices to evaluate brain maturation in preterm infants.

Abstract TP164: Significance of the Thrombus Component as a Predictor for Malignant Middle Cerebral Artery Infarction

Background and Purpose— Malignant middle cerebral artery (MCA) infarction is one of the most devastating forms of ischemic stroke, and identification of predictors of a malignant course of the MCA or internal carotid artery (ICA) infarction is exceedingly important. Here, we investigated whether thrombus component defined with MR imaging could predict malignant changes in the acute stage of the cerebral infarction. Methods— We retrospectively analyzed 468 consecutive patients with cerebral infarction in our institute from 2007 to 2011. In all the patients, initial MR imaging including T2 star (T2*), diffusion weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR) and MR angiography were performed and susceptibility vessel sign (SVS) on T2* was evaluated in relation to the brain swelling on CT 24 hours after the initial imaging. Correlation of the thrombus component between MRI and CT was also evaluated. Results— One hundred and twelve patients showed MCA main trunk or carotid T occlusion. Among them, 38 patients were t-PA failed or did not undergo endovascular treatment. Twenty eight patients had ICA occlusion and 10 patients had MCA main trunk occlusion. SVS was apparent in 17 (45%) patients, and there was no significant difference between SVS positive and SVS negative group in age (75.6 vs. 72.3 years old), time to arrival (84.4 vs. 106.9 min) and NIH stroke scale (19.5 vs. 18.7). On the other hand, DWI area was significantly larger in SVS positive group (189.3 vs. 107.6 ml). DWI area was also significantly correlated with brain swelling 24 hour later regardless of SVS. Most SVS positive patients showed MCA dense sign on CT performed 24 hours later (85.7% vs. 29.4%). Conclusions— Susceptibility vessel sign on MRI, which suggests RBC rich thrombus, indicates early maturation of the infarct in the MCA area, but could not predict following malignant change.

Abstract 2427: Significance of Susceptibility Vessel Sign on T2 Star Weighted-images to Predict Clinical Outcome following Emergency Endovascular Treatment in Patients with Probable Acute Embolic Basilar Artery Occlusion

Purpose The purpose of our retrospective study is to investigate whether or not susceptibility vessel sign of the basilar artery (SVS-BA) on T2*-weighted gradient echo images at 1.5T can predict clinical outcome after emergency endovascular treatment (EET) in patients where MRA suggests the embolic acute BA occlusion. Materials and Methods Included for retrospective analysis were patients as follows, (1) study period was from November 2005 to December 2010, (2) who were admitted to our institution within 8 hours from stroke onset, (3) who underwent emergency MR imaging including DWI, T2*WI, MRA at 1.5T and symptomatic and embolic acute BAO was diagnosed by MRA, (4) whose NIHSS score on admission was 10 or more, and (5) who underwent EET. Excluded were patients (1) in whom DWIs showed extensive high signal intensity area in pons or cerebelli, (2) who had contraindications for EET. They were divided into two groups according to presence (group P) or absence (group A) of SVS-BA on T2*WI. The relationships between the presence of BA-SVS and patients’ baseline characteristics on admission (age, gender), onset to admission time (OTA time), onset to treatment time (OTT time), NIHSS on admission (NIHadm), NIHSS on the 7th day (NIH7th), modified Rankin Scale at 3 months (3M-mRS) and estimated lengths of BAO on emergency MRA (eMRA) were investigated. Estimated lengths of BAO were graded according to eMRA as follows: grade 4, no occlusion; grade 3, occluded distal AICA; grade 2, occluded distal union; grade 1: not visualized. TIMI grades 2 and 3 were defined as successful recanalization. Results During the study periods, 17 patients were included for analysis. Successful recanalization was achieved in 11 patients (65%). In P (n=8) and A (n=9) groups, there were no significant differences statistically in age (mean; 73.6±15.2 and 68.1±14.0 years), man (%) (88 and 89), OTA time (median; 0.8 and 1.7 hrs), OTT time (median; 4.2 and 3.5 hrs), and NIHadm (median; 27 and 16). There were significant differences between two groups in BAO grade (median; 1.5 and 3), successful recanalization rate (%) (38 and 89), NIH7th (median; 35 and 8), 3M-mRS (median; 5.5 and 3) (p&lt;0.05), respectively. Conclusion Clinical outcome following emergency endovascular treatment for probable acute embolic basilar artery occlusion was better in patients without SVS-BA on T2*WI than with SVS-BA. The SVS-BA on T2*WI seems to be a significant predictor for achieving less recanalization immediately after EET.

Analysis of iron deposition in the brain lesions of patients with multiple sclerosis by three dimensional enhanced T2-star weighted angiography

Objective To explore the values of 3D enhanced T2-star weighted angiography (ESWAN) in detecting iron deposition of the brain in patients with multiple sclerosis ( MS).Methods Conventional MRI and 3D ESWAN were performed in 22 patients with released-remitting MS(RR-MS) and in 22 age- and gender-matched normal controls.Both the magnitude images and phase images were available after post processing of the original ESWAN data post processing.The expanded disability status scale (EDSS) scores of the patients were from 0 to 8.5,and the course of disease were between 0.5 year and 15 years.The manifestation of MS lesions was evaluated on conventional MR images and ESWAN images by two experienced radiologists with blind methods.The phase values were measured for MS lesions between the semioval center and periventricular white matter and the corresponding regions in the normal control group were measured as well The Wilcoxon rank test was used to compare the differences of phase values between MS patients and normal controls,and the Spearman rank correlation analysis were used to analyze the correlations among the phase values of MS lesions,EDSS scores and course of disease of MS patients.Results ( 1 ) MS lesions were observed on magnitude images and phase images,respectively and together.Two hundred and thirteen(32.8％ )lesions were detected on both the magnitude images and phase images,164 (25.2％)lesions were detected on the magnitude images only,and 273 (42.0％) lesions were detected on the phase images only.A total of 650 lesions were observed on the ESWAN,which showed more 42 lesions than conventional images(608).Among 486(273 + 213 )lesions observed on the phase images,205 (31.5％) lesions were homogeneously hypointense,45 (6.9％ ) lesions showed hypointense ring,and 236 (36.4％ ) lesions were inhomogeneously hypointense.(2) “ Penetrating veins” were showed in 424 (65.2％ ) periventricular lesions.The “penetrating veins” showed dilated and prolonged in 198 (30.5％ ) acute lesions,thin and short in 208 (32.9％ ) chronic lesions.However,the “penetrating veins” of 12 ( 1.8％ ) chronic lesions in 5 stable MS patients were expanded and prolonged slightly.( 3 ) The average phase value of the lesions ( - 0.05 ± 0.08) in patients with RR-MS was significantly lower than that of corresponding to regions (0.06 ± 0.05 ) in the normal control group( Z = 22.30,P ＜ 0.01 ).(4) The phase values of MS lesions were significantly correlated to the EDSS and course of disease of patients with RR-MS (r = -0.98,0.99 respectively,P ＜ 0.01 ).Conclusion ESWAN can be helpful in the evaluation and quantification of abnormal iron deposition in MS lesions,which provides important values for the pathogenesis and pathological study for MS patients. Key words: Multiple sclerosis; Magnetic resonance imaging; Iron

T2 star relaxation times for assessment of articular cartilage at 3 T: a feasibility study

T2 mapping techniques use the relaxation constant as an indirect marker of cartilage structure, and the relaxation constant has also been shown to be a sensitive parameter for cartilage evaluation. As a possible additional robust biomarker, T2* relaxation time is a potential, clinically feasible parameter for the biochemical evaluation of articular cartilage. The knees of 15 healthy volunteers and 15 patients after microfracture therapy (MFX) were evaluated with a multi-echo spin-echo T2 mapping technique and a multi-echo gradient-echo T2* mapping sequence at 3.0 Tesla MRI. Inline maps, using a log-linear least squares fitting method, were assessed with respect to the zonal dependency of T2 and T2* relaxation for the deep and superficial regions of healthy articular cartilage and cartilage repair tissue. There was a statistically significant correlation between T2 and T2* values. Both parameters demonstrated similar spatial dependency, with longer values measured toward the articular surface for healthy articular cartilage. No spatial variation was observed for cartilage repair tissue after MFX. Within this feasibility study, both T2 and T2* relaxation parameters demonstrated a similar response in the assessment of articular cartilage and cartilage repair tissue. The potential advantages of T2*-mapping of cartilage include faster imaging times and the opportunity for 3D acquisitions, thereby providing greater spatial resolution and complete coverage of the articular surface.

Susceptibility-weighted angiography (SWAN) of cerebral veins and arteries compared to TOF-MRA

High resolution, non-contrast imaging of both cerebral veins and arteries by use of gradient echo T2 star weighted angiography (SWAN) is a new method for susceptibility-weighted imaging with short acquisition times. We assessed the potential of this sequence for the depiction of both cerebral veins and arteries. 15 healthy volunteers were included in the study. MRI was performed on a 3T MR scanner using the following sequences: (1) a 3D multi-echo gradient echo T2 star weighted angiography (SWAN), (2) an arterial 3D TOF MR angiography and (3) a venous 2D TOF. With regard to the SWAN sequence, both MinIP and MIP images were reconstructed and systematically compared to MIP reconstructions of the artTOF and the venTOF. To suggest possible clinical implications of our findings, we additionally included two illustrative cases. With regard to the visualization of the cerebral veins, the MinIP reconstructions of the SWAN sequence were considerably superior compared to the venTOF. Concerning the depiction of the main segments of the big cerebral arteries the value of the MIP reconstructions of the SWAN was comparable to that of the artTOF with limitations in the homogenity and in the depiction of smaller arteries. SWAN allows for high-resolution visualization of both cerebral veins and arteries in one sequence without application of contrast agent and with significantly shortened scan time compared to the combined scan time of TOF-MRA and TOF-MRV. By use of either MinIP or MIP reconstructions, the arteries can be distinguished from the veins.

Early electrocardiographic evaluation of atrial fibrillation risk in beta-thalassemia major patients

Although previous studies have documented a variety of electrocardiogram abnormalities in beta-thalassemia major (β-TM), little is known about P-wave dispersion (PD), an independent risk factor for development of atrial fibrillation. The aim of our study was to evaluate PD in β-TM patients with conserved systolic and diastolic functions. The study involved 40 β-TM patients (age 37.5±10.2; 33M) and 40 healthy subjects used as controls, matched for age and gender. PD was carefully measured using a 12-lead electrocardiogram. Cardiac iron levels were measured by cardiac magnetic resonance T2 star (CMR T2*) imaging. Comparing to the healthy control group, β-TM group presented increased values of the PD (40.1±12.9 vs. 24±7ms; P<0.004) and decreased CMR T2* imaging (29±15 vs. 55±13ms; P=0.03). We found a significant correlation between PD and CMR T2* values. Our study showed a significant increase of PD in β-TM patients with conserved systolic and diastolic cardiac functions. Our results indicate that PD is correlated to myocardial iron deposit, as assessed by CMR T2* imaging.

Quantification of myocardial iron deposition by two-dimensional speckle tracking in patients with β-thalassaemia major and Blackfan–Diamond anaemia

BackgroundCardiac disease related to transfusional iron overload is the leading cause of death in patients with β-thalassaemia major. Early myocardial iron deposition predates decreased left ventricular dysfunction and currently is...

Biochemical T2* MR quantification of ankle arthrosis in pes cavovarus

Pes cavovarus affects the ankle biomechanics and may lead to ankle arthrosis. Quantitative T2 STAR (T2*) magnetic resonance (MR) mapping allows high resolution of thin cartilage layers and quantitative grading of cartilage degeneration. Detection of ankle arthrosis using T2* mapping in cavovarus feet was evaluated. Eleven cavovarus patients with symptomatic ankle arthrosis (13 feet, mean age 55.6 years, group 1), 10 cavovarus patients with no or asymptomatic, mild ankle arthrosis (12 feet, mean age 41.8 years, group 2), and 11 controls without foot deformity (18 feet, mean age 29.8 years, group 3) had quantitative T2* MR mapping. Additional assessment included plain radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) score (groups 1 and 2 only). Mean global T2* relaxation time was significantly different between groups 1 and 2 (p = 0.001) and groups 1 and 3 (p = 0.017), but there was no significance for decreased global T2* values in group 2 compared to group 3 (p = 0.345). Compared to the medial compartment T2* values of the lateral compartment were significantly (p = 0.025) higher within group 1. T2* values in the medial ankle joint compartment of group 2 were significantly lower than those of group 1 (p = 0.019). Ankle arthrosis on plain radiographs and the AOFAS score correlated significantly with T2* values in the medial compartment of group 1 (p = 0.04 and 0.039, respectively). Biochemical, quantitative T2* MR mapping is likely effective to evaluate ankle arthrosis in cavovarus feet but further studies are required.

A Simple Way to Improve Anatomical Mapping of Functional Brain Imaging

Advances in functional neuroimaging studies have led to the need for improved anatomical precision to face with more and more specific challenges. Nevertheless, functional magnetic resonance imaging (MRI) (fMRI) suffers from geometrical distortions, which limit the matching between functional and anatomical data necessary to interpret fMRI results. The "FieldMap" method is the most widely used technique to correct for geometrical distortions but in some cases cannot be applied or provides unsatisfactory results. The objective of this study is thus to provide a very simple alternative method for distortion correction and to demonstrate its efficiency. This correction relies on the nonlinear registration of echo-planar imaging (EPI) acquisitions onto their corresponding undistorted non-EPI T2 Star volume, and was tested on two independent groups of subjects undertaking the same paradigm but scanned with distinct EPI sequences. This procedure was found to considerably decrease the mismatch between functional and anatomical data in both groups, as revealed through several quantitative and qualitative measures on both EPI volumes and activation maps. This study describes a simple, rapid, and easily implementable method to significantly improve neuroanatomical accuracy of fMRI results localization, which may be relevant for future neuroimaging studies.

Impact of Myocardial Iron Loading On Right Ventricular Function.

Abstract 2012Poster Board I-1034 Background:Cardiovascular magnetic resonance (CMR) is being increasingly used worldwide for monitoring chelation therapy in transfusion-dependent β-thalassemia patients. The assessment of cardiac iron loading using myocardial T2 star (T2*) is a reliable, quick and non-invasive method which can be combined with highly accurate and reproducible cardiac volume and function measurements. It has previously been noted that myocardial siderosis (T2*<20ms) is associated with progressive impairment in left ventricular (LV) function but little is known about the relation of T2* measurements to right ventricular (RV) function in these patients. This study assesses the impact of myocardial iron loading on the right ventricle. Methods:A retrospective analysis was performed of 323 consecutive β-thalassemia patients referred for their first CMR scan from 21 UK hematology centers. Only patients on a single chelating agent (deferoxamine) were included. All had received chelation from the mid-to-late 1970s or from an early age if born since then. Patients were excluded if there was significant cardiac, vascular or lung pathology (such as aortic stenosis, pulmonary artery stenosis, tetralogy of Fallot or pulmonary hypertension). All scans were performed using a 1.5T Sonata (Siemens Medical Systems, Germany). A single breath-hold multi-echo sequence with 8 different echo times (TE = 2.54-17.9ms) was used to measure T2* from a full-thickness region of interest in the septum of a mid-ventricular short axis slice. Myocardial T2* was calculated from the exponential signal intensity decay curve using a truncation method to account for background noise. RV and LV volumes and ejection fraction (EF) were calculated from a series of short axis ventricular slices (7mm thickness with 3mm gap). Results:In patients with normal T2* (>20ms), RV EF was within normal limits in 98% of cases (RV EF [mean ±SD] = 65.0 ±6.1%). In patients with myocardial siderosis (T2*<20ms), there was a progressive and significant fall in RV EF (r=0.43, p<0.001) and an increase in RV end-systolic volume index (r= -0.33, p<0.001). LV EF was within the normal range in 99% of patients with T2*>20ms (LV EF = 69.5 ±5.2%). Once again, where T2* fell below 20ms, there was a progressive decline in LV EF (r=0.40, p<0.001). 82.6% of the patients with low T2* and impaired RV ejection fraction also had an impaired LV EF and linear regression analysis showed a significant relation between RV and LV EF (r=0.69, p<0.001). Conclusions:There is a strong association between increasing myocardial iron loading and RV dysfunction which mirrors the decrease in LV ejection fraction seen with worsening myocardial siderosis. RV impairment may be a significant contributor to the syndrome of heart failure associated with severe myocardial siderosis. [Display omitted] Disclosures:Carpenter:Swedish Orphan: Honoraria; Apotex: Honoraria. Porter:Novartis: Consultancy, Research Funding. He:Novartis: Consultancy. Smith:Novartis: Consultancy. Pennell:Siemens: Consultancy; Novartis: Consultancy; Apotex: Honoraria; Cardiovascular Imaging Solutions, London: Equity Ownership.

Magnetic resonance imaging assessment of cardiac and liver iron load in transfusion dependent patients

Magnetic resonance imaging (MRI) is an emerging tool to assess organ-specific iron load in patients with transfusion dependent anemia. We performed MRI T2 star (T2*) assessment in 44 transfusion dependent patients to study the prevalence of cardiac and liver iron overload and the relationship of T2* measurement with various clinical and biochemical parameters. Mean age of the study subjects was 19.9 years (range 8.8-32.3) and the mean cardiac T2* was 23.4 +/- 13.8 msec. Fifty percent of the subjects had abnormal cardiac T2* (below 20 msec). Cardiac T2* was not found to have any correlation with serum ferritin or liver T2*. Liver T2* value was abnormal in 79% of the subjects and it correlated inversely with both current and 12 months average serum ferritin (r = -0.44, P = 0.003; r = -0.46, P = 0.002). Clinical parameters including age, duration of transfusion, age starting iron chelation therapy, and ratio between transfusion volume and desferrioxamine dosage were not correlated with cardiac and liver T2*. We conclude that iron overload in heart and liver is common in our transfusion dependent patients. Liver T2* has inverse correlation with serum ferritin. Cardiac T2* does not have any correlation with the various clinical and biochemical parameters.

On the use of conventional and tissue Doppler echocardiography in patients with β-Thalassemia major and myocardial iron-overload: Preliminary data by a single centre study

Abstract β-Thalassemia Major (βTM) is a hereditary chronic haemolytic anaemia that requires multiple blood transfusions all along lifetime. Late complication of this treatment is tissue iron overload (IO), mostly located on the reticulo-endothelial system, joints, liver, endocrine glands and the heart. In some patients, IO is responsible for heart failure. Echocardiography allows recognizing preclinical left ventricular dysfunction, which can be related to myocardial IO. Over the last few years, cardiac magnetic resonance imaging has become the gold standard for making diagnosis of myocardial IO, by a specific index of myocardial relaxation time, called T2 star (T2⁎). We enrolled 14 βTM patients, mean aged 37.7±10.4 years, with no signs of heart failure, on treatment with iron chelating agents, in whom we sought to investigate whether conventional and/or tissue Doppler velocity echocardiography could discriminate low T2⁎ value patients. Important findings from this preliminary study likely indicate a low prevalence of myocardial IO (approximately 14%) in regularly treated βTM patients. Tissue Doppler velocity imaging was not able to discriminate these latter patients. On the contrary, isovolumetric relaxation time 2, and both atrial chambers dilatation were associated with T2⁎ value

Impact of Whole-Body Magnetic Resonance Imaging on Staging in Patients with Newly Diagnosed Plasma Cell Disease.

INTRODUCTION: MRI has a high sensitivity in determining changes in bone marrow induced by metastatic disease or primary neoplasms of the bone marrow. Whole-Body Magnetic Resonance Imaging (WB-MRI) is a novel imaging technique that displays nearly the complete skeletal system in one exam. We investigated the differences between conventional skeletal survey and WB-MRI and their impact on staging of patients with newly diagnosed plasma cell disease.METHOD AND MATERIALS: In 41 consecutive patients with newly diagnosed MGUS (n=5), Multiple Myeloma (n=34) or AL-Amyloidosis (n=2) conventional radiographs and WB-MRI (coronar T1 tse and T2 tirm sequences and sagittal T2 star sequences, 1,5 T MRI with parallel imaging, Siemens Avanto®) were performed. Radiographs and scans were evaluated for diffuse and focal bone marrow involvement in consent by two experienced radiologists blinded for patient name and study time. Staging was performed including clinical data according to the Salmon/Durie classification system and the Durie/Salmon PLUS classification system with inclusion of WB-MRI.RESULTS: In 24 (59%) patients there were no lesions in conventional radiography or MRI. In 17 (41 %) patients results of MRI and conventional radiography were discrepant. 4 (10%) patients had lesions only in MRI, 3 (7%) only in conventional radiography and 10 (24%) in both techniques but in different localization. In 16 (38%) patients with radiological signs of osteopenia there was no diffuse infiltration in MRI or vice versa. We systematically analysed the consequences of WB-MRI on staging of patients based on the newly proposed staging system Durie/Salmon PLUS. Replacing conventional radiographs by WB-MRI resulted in reclassification of 12 patients. 3 patients were reclassified from MGUS or stage I into stage II or III. 9 patients were downstaged from stage III or II into stage I or MGUS.CONCLUSION: WB-MRI is a valuable technique for the initial work-up of patients with Multiple Myeloma. In comparison with conventional skeletal survey there are often differing results with impact on clinical staging and influence on therapy decision. WB-MRI can give additional information in patients with unclear staging situation before onset of therapy. Further evaluation of WB-MRI within prospective studies is warranted in particular with respect to prognostic impact regarding overall prognosis as well as regarding local complications. Until then WB-MRI should be used complementary to conventional radiography or CT-techniques that provide accurate imaging of the bone.

Early Morphologic and Spectroscopic Magnetic Resonance in Severe Traumatic Brain Injuries Can Detect “Invisible Brain Stem Damage” and Predict “Vegetative States”

A precise evaluation of the brain damage in the first days of severe traumatic brain injured (TBI) patients is still uncertain despite numerous available cerebral evaluation methods and imaging. In 5-10% of severe TBI patients, clinicians remain concerned with prolonged coma and long-term marked cognitive impairment unexplained by normal morphological T2 star, flair, and diffusion magnetic resonance imaging (MRI). For this reason, we prospectively assessed the potential value of magnetic resonance spectroscopy (MRS) of the brain stem to evaluate the functionality of the consciousness areas. Forty consecutive patients with severe TBI were included. Single voxel proton MRS of the brain stem and morphological MRI of the whole brain were performed at day 17.5 +/- 6.4. Disability Rating Scale and Glasgow Outcome Scale (GOS) were evaluated at 18 months posttrauma. MRS appeared to be a reliable tool in the exploration of brainstem metabolism in TBI. Three different spectra were observed (normal, cholinergic reaction, or neuronal damage) allowing an evaluation of functional damage. MRS disturbances were not correlated with anatomical MRI lesions suggesting that the two techniques are strongly complementarity. In two GOS 2 vegetative patients with normal morphological MRI, MRS detected severe functional damage of the brainstem (NAA/Cr < 1.50) that was described as "invisible brain stem damage." MRI and MRS taken separately could not distinguish patients GOS 3 (n = 7) from GOS 1-2 (n = 11) and GOS 4-5 (n = 20). However, a principal component analysis of combined MRI and MRS data enabled a clear-cut separation between GOS 1-2, GOS 3, and GOS 4-5 patients with no overlap between groups. This study showed that combined MRI and MRS provide a reliable evaluation of patients presenting in deep coma, specially when there are insufficient MRI lesions of the consciousness pathways to explain their status. In the first few days post-trauma metabolic (brainstem spectroscopy) and morphological (T2 star and Flair) MRI studies can predict the long-term neurological outcome, especially the persistent vegetative states and minimally conscious state.

Magnetic Ressonance Imaging (MRI) in the Evaluation of Iron Overload in Patients with Beta Thalassaemia. The Brazilian National Program Preliminary Results.

Magnetic Ressonance Imaging (MRI) using T2 star (T2*) tecnique appears to be a very useful method for monitoring iron overload and iron chelation therapy in thalassaemia. In Brazil, we have around 400 thalassaemic major patients all over the country. They were treated with hipertransfusion protocols and desferroxamine and/or deferiprone chelation. We developed a cooperative program with the Brazilian Thalassaemic Patients Association (ABRASTA) in order to developT2* tecnique in Brazil to submit brazilian patients to an annual iron overload monitoring process with MRI.. We performed the magnetic ressonance T2* using GE equipment (GE, Milwaukee USA), with validation to chemical estimation of iron in patients undergoing liver biopsy. Until now, 60 patients were scanned, median age=23,2 (12–54); gender: 18 male (30%) and 42 female (70%). The median ferritin levels were 2030 ng/ml (Q1=1466; Q3=3296). As other authors described before, there was a curvilinear inverse correlation between iron concentration by biopsy, liver T2*(r=0,92) and also there were a correlation with ferritin levels. We also correlated myocardial iron measured by T2* with ventricular function.. As miocardial iron increased, there was a progressive decline in ejection fraction and no significant correlation was found between miocardial T2* and the ferritin levels.Liver iron content can be predicted by ferritin levels. On the other hand, cardiac disfunction is the most important cause of mortality among thalassaemic patients. Since Miocardio iron content cannot be predicted from serum ferritin or liver iron, and ventricular function can only detect those with advance disease, intensification and combination of chelation therapy, guided by T2* MRI tecnique should reduce mortality from the reversible cardiomyopathy among thalassaemic patients.