The optimisation of cardiac iron overload assessment by systolic imaging
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BioMed Central
Open Access
Poster presentation
The optimisation of cardiac iron overload assessment by systolic imaging Gillian Smith*, John Paul Carpenter, Taigang He and Dudley Pennell Address: Royal Brompton Hospital, London, UK * Corresponding author
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010 Published: 21 January 2010 Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):P291
doi:10.1186/1532-429X-12-S1-P291
Abstracts of the 13th Annual SCMR Scientific Sessions - 2010
Meeting abstracts - A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-infoThis abstract is available from: http://jcmr-online.com/content/12/S1/P291 © 2010 Smith et al; licensee BioMed Central Ltd.
Introduction
Purpose
Without regular blood transfusions most patients with Thalassaemia major (TM) die during infancy. This however leads to tissue iron overload, in the heart potentially causing heart failure and subsequent death unless chelation therapy is instigated. The introduction of cardiovascular magnetic resonance (CMR) has been associated with a reduction in death rates from iron overload cardiomyopathy. Imaging allows identification of patients at risk of heart failure and regular follow-up aids the optimization of therapeutic regimes.
To evaluate whether acquiring myocardial images during systole improves cardiac T2* evaluation in patients with iron overload.
A bright blood gradient echo sequence with no delay after the R wave trigger has been validated for the assessment of cardiac iron levels. A full thickness septal ROI is selected for analysis, rate of signal intensity decay with increasing echo time is proportional to iron loading. Good image quality is usually obtained but there may be blood motion artifact, contrast between the myocardial and blood pool low and the septum thin in children and young adults. A black blood double inversion recovery (DIR) sequence has been developed with improved contrast and reduced blood signal contamination and improved reproducibility. The scan duration thus breathhold is however considerably longer and it has only been possible to transfer this protocol to other Siemens scanners to date. At end systole myocardial thickness is maximal while blood volume is minimal which may improve image quality.
Methods 22 consecutive TM patients were scanned using a 1.5 T Siemens Sonata scanner with a 6 channel phased array cardiac coil and ECG gating. A mid ventricular short axis slice was selected and imaged with no delay after the R wave trigger and at end systole, the trigger delay calculated from the corresponding cine image. The same slice was then imaged using the black blood preparation. A mono-exponential decay curve was derived for all acquisitions using Thalassaemia tools (CMRtools, Cardiovascular Imaging Solutions, London, UK) and expressed as T2*.
Results The mean T2* was 11.3 ms (± 3.57) for black blood imaging, 12.3 (± 3.62) diastolic and 11.3 (
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