Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(01): 33-39
DOI: 10.4103/ijri.IJRI_395_18
Cardiac Radiology

Cardiac T2* magnetic resonance analysis of membranous interventricular septum in assessment of cardiac iron overload in pediatric thalassemia patients: A pilot study

Ishan Kumar
Departments of Radiodiagnosis, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Priyanka Aggarwal
Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Vineeta Gupta
Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Ashish Verma
Departments of Radiodiagnosis, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Suwen Kumar
Department of Cardiology, Queen’s Medical Center, Honolulu, Hawaii, USA
,
Ram C Shukla
Departments of Radiodiagnosis, Banaras Hindu University, Varanasi, Uttar Pradesh, India
› Author Affiliations
Subject Editor: Financial support and sponsorship Nil.
› Further Information
   Permissions and Reprints

Abstract

Background: Cardiac iron deposition in transfusion-dependent thalassemia patients is patchy in distribution. Purpose: The purpose of this study is to assess the correlation between T2* matrices of membranous interventricular septum (MIVS) and T2* values of muscular interventricular septum (IVS) on magnetic resonance imaging (MRI) and to evaluate the relationship of myocardial T2* at these two locations with MRI-estimated liver iron concentrations (LIC) and electrocardiographic (ECG) parameters. Material and Methods: MRI of heart and liver was performed in 16 consecutive pediatric patients of transfusion-dependent thalassemia major to calculate liver iron concentration and T2* time of membranous and muscular IVS. ECG parameters of these patients were charted and correlated with MRI parameters. Results: No significant correlation between T2* values of muscular IVS and MIVS was observed. Mean T2* of MIVS (9.8 ms) was significantly lower than that of muscular IVS (26.9 ms). T2* of MIVS correlated strongly with LIC where as a weak correlation was observed between T2* of IVS and LIC. Significantly higher mean QTc (corrected QT interval) value (439.86 ms) was seen in patients with T2* IVS <20 ms. Conclusion: Addition of T2* analysis of MIVS to the existing MRI protocol, consisting of muscular IVS analysis, may offer a more sensitive estimation of cardiac iron overload.

Keywords

Cardiac - heart - magnetic resonance imaging - pediatrics - thalassemia


Publication History

Article published online:
23 July 2021

© 2019. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Taghizadeh Sarvestani R, Moradveisi B, Kompany F, Ghaderi E. Correlation between heart and liver iron levels measured by MRI T2* and serum ferritin in patients with β-thalassemia major. Int J Pediatr 2016; 4: 1559-67
    Google Scholar
  • 2 Vichinsky EP. Changing patterns of thalassemia worldwide. Ann N Y Acad Sci 2005; 1054: 18-24
    CrossrefPubMedGoogle Scholar
  • 3 Wood JC, Origa R, Agus A, Matta G, Coates TD, Galanello R. Onset of Cardiac iron loading in pediatric patients with thalassemia major. Haematologica 2008; 93: 917-20
    CrossrefPubMedGoogle Scholar
  • 4 Zurlo MG, De Stefano P, Borgna-Pignatti C, Di Palma A, Piga A, Melevendi C. et al. Survival and causes of death in thalassaemia major. Lancet 1989; 2: 27-30
    CrossrefPubMedGoogle Scholar
  • 5 Chouliaras G, Berdoukas V, Ladis V, Kattamis A, Chatziliami A, Fragodimitri C. et al. Impact of magnetic resonance imaging on cardiac mortality in thalassaemia major. J Magn Reson Imaging 2011; 34: 565-9
    CrossrefPubMedGoogle Scholar
  • 6 Hekmatnia A, Radmard AR, Rahmani AA, Adibi A, Khademi H. Magnetic resonance imaging signal reduction may precede volume loss in the pituitary gland of transfusion-dependent beta- thalassemic patients. Acta Radiol 2010; 51: 71-7
    CrossrefPubMedGoogle Scholar
  • 7 Tanner MA, Galanello R, Dessi C, Westwood MA, Smith GC, Nair SV. et al. Myocardial iron loading in patients with thalassemia major on deferoxamine chelation. J Cardiovasc Magn Reson 2006; 8: 543-7
    CrossrefPubMedGoogle Scholar
  • 8 Aessopos A, Fragodimitri C, Karabatsos F, Hatziliami A, Yousef J, Giakoumis A. et al. Cardiac magnetic resonance imaging R2* assessments and analysis of historical parameters in patients with transfusion-dependent thalassemia. Haematologica 2007; 92: 131-2
    CrossrefPubMedGoogle Scholar
  • 9 Gandon Y, Olivié D, Guyader D, Aubé C, Oberti F, Sebille V. et al. Non-invasive assessment of hepatic iron stores by MRI. Lancet 2004; 363: 357-62
    CrossrefPubMedGoogle Scholar
  • 10 Gandon Y. On-line liver iron quantification. Available from: https://imagemed.univ-rennes1.fr/en/mrquantif/online_quantif.php. [Last accessed on 2017 Mar 25]
    Google Scholar
  • 11 Fahmy HS, Khater NH, El-Shahat HM, Madani AA, El Hadidy SS. Reassessing the value of MRI T2* in evaluation of hepatic and myocardial iron concentration: An institutional study. Egypt J Radiol Nucl Med 2015; 46: 1085-90
    CrossrefGoogle Scholar
  • 12 Voskaridou E. Magnetic resonance imaging in the evaluation of iron overload in patients with beta thalassemia and sickle cell disease. Br J Haematol 2004; 126: 736-42
    CrossrefPubMedGoogle Scholar
  • 13 Fischer R, Longo F, Nielsen P, Engelhardt R, Hider RC, Piga A. Monitoring long term efficacy of iron chelation therapy by deferiprone and deferoxamine in patients with beta-thalassemia major application SQUID biomagnetic liver susceptometry. Br J Haematol 2003; 121: 938-48
    CrossrefPubMedGoogle Scholar
  • 14 Modell B, Khan M, Darlison M, Westwood MA, Ingram D, Pennell DJ. Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2008; 10: 42
    CrossrefPubMedGoogle Scholar
  • 15 Wood JC. Impact of iron assessment by MRI. Hematology Am Soc Hematol Educ Program 2011; 443-50
    CrossrefPubMedGoogle Scholar
  • 16 Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH. et al. Cardiovascular T2 star (T2*) magnetic resonance for early diagnosis of myocardial iron overload. Eur Heart J 22: 2171-9
    CrossrefPubMedGoogle Scholar
  • 17 Westwood M, Anderson LJ, Firmin DN, Gatehouse PD, Charrier CC, Wonke B. et al. A single breath-hold multiecho T2* cardiovascular magnetic resonance technique for diagnosis of myocardial overload. J Magn Reson Imaging 2003; 18: 33-9
    CrossrefPubMedGoogle Scholar
  • 18 Buja LM, Roberts WC. Iron in the heart: Etiology and clinical significance. Am J Med 1971; 51: 209-21
    CrossrefPubMedGoogle Scholar
  • 19 Kirk P, Roughton M, Porter JB, Walker JM, Tanner MA, Patel J. et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation 2009; 120: 1961-8
    CrossrefPubMedGoogle Scholar
  • 20 Pepe A, Meloni A, Rossi G, Cuccia L, D’Ascola GD, Santodirocco M. et al. Cardiac and hepatic iron and ejection fraction in thalassemia major: Multicentre prospective comparison of combined deferiprone and deferoxamine therapy against deferiprone or deferoxamine monotherapy. J Cardiovasc Magn Reson 2013; 15: 1
    CrossrefPubMedGoogle Scholar
  • 21 Christoforidis A, Haritandi A, Tsitouridis I, Tsatra I, Tsantali H, Karyda S. et al. Correlative study of iron accumulation in liver, myocardium and pituitary assessed with MRI in young thalassemic patients. J Pediatr Hematol Oncol 2006; 28: 311-5
    CrossrefPubMedGoogle Scholar
  • 22 Eghbali AMD. Association between serum ferritin level, cardiac and hepatic T2-star MRI in patients with major B- thalassemia. Iranian J Pediatr Hematolo Oncol 2014; 4: 17-21
    Google Scholar
  • 23 Mandal S, Sodhi KS, Bansal D, Sinha A, Bhatia A, Trehan A. et al. MRI for quantification of liver and cardiac iron in thalassemia major patients: Pilot study in Indian population. Indian J Pediatr 2017; 84: 276-82
    CrossrefPubMedGoogle Scholar
  • 24 Tziomalos K, Perifanis V. Liver iron content determination by magnetic resonance imaging. World J Gastroenterol 2010; 16: 1587-97
    CrossrefPubMedGoogle Scholar
  • 25 Noetzli LJ, Carson SM, Nord AS, Coates TD, Wood JC. Longitudinal analysis of heart and liver iron in thalassemia major. Blood 2008; 112: 2973-8
    CrossrefPubMedGoogle Scholar
  • 26 Olivieri NF, Nathan DG, MacMillan JH, Wayne AS, Liu PP, McGee A. et al. Survival in medically treated patients with homozygous β-thalassemia. N Eng J Med 1994; 331: 574-8
    CrossrefPubMedGoogle Scholar
  • 27 Murphy CJ, Oudit GY. Iron-overload cardiomyopathy: Pathophysiology, diagnosis, and treatment. J Cardiac Failure 2010; 11: 888-900
    CrossrefPubMedGoogle Scholar
  • 28 Kayrak M, Acar K, Gul EE, Ozbek O, Abdulhalikov T, Sonmez O. et al. The association between myocardial iron load and ventricular repolarization parameters in asymptomatic beta-thalassemia patients. Adv Hematol 2012; 2012: 1705-10
    CrossrefPubMedGoogle Scholar
  • 29 Magri D, Sciomer S, Fedele F, Gualdi G, Casciani E, Pugliese P. et al. Increased QT variability in young asymptomatic patients with β-thalassemia major. Eur J Haematol 2007; 79: 322-9
    CrossrefPubMedGoogle Scholar
  • 30 Detterich J, Noetzli L, Dorey F, Bar-Cohen Y, Harmatz P, Coates T. et al. Electrocardiographic consequences of cardiac iron overload in thalassemia major. Am J Hematol 2012; 87: 139-44
    CrossrefPubMedGoogle Scholar
  • 31 Scheiber-Mojdehkar B, Zimmermann I, Dresow B, Goldenberg H. Differential response of non- transferrin bound iron uptake in rat liver cells on long-term and short-term treatment with iron. J Hepatol 1999; 31: 61-70
    CrossrefPubMedGoogle Scholar