Role of T1 mapping as a complementary tool to T2* for non-invasive cardiac iron overload assessment

Camilla Torlasco, Elena Cassinerio, Alberto Roghi, Andrea Faini, Marco Capecchi, Amna Abdel-Gadir, Cristina Giannattasio, Gianfranco Parati, James C Moon, Maria D Cappellini and Patrizia Pedrotti

PLOS ONE, 2018, vol. 13, issue 2, 1-10

Abstract: Background: Iron overload-related heart failure is the principal cause of death in transfusion dependent patients, including those with Thalassemia Major. Linking cardiac siderosis measured by T2* to therapy improves outcomes. T1 mapping can also measure iron; preliminary data suggests it may have higher sensitivity for iron, particularly for early overload (the conventional cut-point for no iron by T2* is 20ms, but this is believed insensitive). We compared T1 mapping to T2* in cardiac iron overload. Methods: In a prospectively large single centre study of 138 Thalassemia Major patients and 32 healthy controls, we compared T1 mapping to dark blood and bright blood T2* acquired at 1.5T. Linear regression analysis was used to assess the association of T2* and T1. A “moving window” approach was taken to understand the strength of the association at different levels of iron overload. Results: The relationship between T2* (here dark blood) and T1 is described by a log-log linear regression, which can be split in three different slopes: 1) T2* low, 30ms, weak relationship. All subjects with T2* 20ms, 38% had low T1 with most of the subjects in the T2* range 20-30ms having a low T1. Conclusions: In established cardiac iron overload, T1 and T2* are concordant. However, in the 20-30ms T2* range, T1 mapping appears to detect iron. These data support previous suggestions that T1 detects missed iron in 1 out of 3 subjects with normal T2*, and that T1 mapping is complementary to T2*. The clinical significance of a low T1 with normal T2* should be further investigated.

Date: 2018
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0192890

DOI: 10.1371/journal.pone.0192890

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