Download Simultaneos evaluation of iron overload in heart, liver and pancreas

Simultaneos evaluation of iron overload in heart, liver and
pancreas by means of T2* sequence.
Poster No.:
C-1746
Congress:
ECR 2015
Type:
Scientific Exhibit
Authors:
R. Malago, A. Pezzato, G. Sala, M. Tezza, R. Pozzi-Mucelli;
Verona/IT
Keywords:
Cardiac, Abdomen, Pancreas, MR, Diagnostic procedure, Imaging
sequences, Treatment effects, Hematologic diseases, Metabolic
disorders
DOI:
10.1594/ecr2015/C-1746
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Page 1 of 14
Aims and objectives
Hemochromatosis has been studied using MRI quantification of iron deposition in the
liver area, however recently it has been possible to stratify these patients also through
study of iron overload in pancreatic and cardiac tissue by sequences such as T2*.
The aims of this study were to correlate the iron overload in heart, liver and pancreas
and to correlate it with iron-chelating therapy.
Methods and materials
We prospectively evaluated 41 consecutive patients (21#, ages 6-62yr) for quantification
of cardiac, hepatic and pancreatic iron overload, between October 2013 and September
2014. Fig. 1 on page 2
We evaluated cardiac and pancreatic iron deposition by T2* sequence (TE 10msec,
range of 2.6-16.7, 2msec of increase). Fig. 2 on page 3 Fig. 3 on page 4 Fig. 4
on page 5 To quantify liver overload we used T2* and the Rennes' method by DP/
T1/T2 sequences with increasing echo times. Fig. 5 on page 6 Fig. 6 on page 7
We calculated the concordance between districts and we correlated the data with ferritin
values and compared the results of the previous MRI.
Images for this section:
Page 2 of 14
Fig. 1: Patient population: Patients directed to this examination were mainly for
thalassemia (57%) e sickle cell anemia (29%), which count around 90% of overrall
patients
Page 3 of 14
Fig. 2: Intra miocardic iron deposists lead to tipical changes in magnetic properties fairly
evident in cardiac magnetic resonance imaging. In specific sequences the iron present in
the cardiac tissue leads to a signal decreas which can be quantified as a t2* parameter.
Page 4 of 14
Fig. 3: The T2* sequence is made up of 10 images on 2 chamber short axis plane with
increasing Echo Time. For each image signal intensity is related to ET in order to obtain
the T2* value in terms of ms.
Page 5 of 14
Fig. 4: For each image in the T2* sequence we traced a ROI (Region of Interest) of
about 2 square Cm, for the calculation of T2*. The ROI is positioned at the miocardial
interventricular septum which is the most representative location of overrall miocardial
iron overload. Thereafter the workstation gives the results in terms of colorimetric map.
Page 6 of 14
Fig. 5: In order to quantify the hepatic and pancreatic iron overload we used the same
T2* sequence used for cardiac imaging.
Page 7 of 14
Fig. 6: Moreover to quantify the liver iron overload we used the Gandon method from
the Rennes University which consists of DP, T1, T2 seqiences with different T2 times
9ms,14ms, 21ms (TE 4-30 ms) and 2 pulse angle (20°-90°) For each sequence we used
the same slice containing the righr liver lobe, the paravertebral muscles and the pancreas.
For each region we drawed a ROI for signal intensity registration : 3 ROI at the right liver
lobe, 2 ROI at the paravertebral muscles.
Page 8 of 14
Results
Cardiac T2* analysis shows 36 cases without overload and 2/41 with severe overload.
Liver analysis by Rennes method shows 7 mild, 13 moderate and 11 severe overload,
whereas with T2* results were 3, 13 and 12 respectively. In 31/37 cases we found
concordance between the two techniques, in 6/37 underestimation by T2*. Pancreas
analysis reported respectively 19 negative, 3 mild, 1 moderate and 9/32 severe overload.
Fig. 7 on page 9 Fig. 8 on page 10
We reported a correlation between the pancreatic and hepatic overload in 14/32 cases,
and between liver and heart in 13/40 cases. Fig. 9 on page 10
In comparison with previous data: cardiac overload was stable in 12/14 of cases; in the
liver there was worsening of disease in 6/14 cases. Fig. 10 on page 11
Images for this section:
Fig. 7
Page 9 of 14
Fig. 8
Page 10 of 14
Fig. 9: Results: Concordance between diffferents districts, correlation with other previous
CMR exams, Correlation T2* with Ferritine
Page 11 of 14
Fig. 10: Results: Concordance between diffferents districts, correlation with other
previous CMR exams, Correlation T2* with Ferritine
Page 12 of 14
Conclusion
These data show that T2* sequence is accurate to simultaneously quantify the iron
overload in heart, liver and pancreas and to follow up of the effectiveness of iron chelation
therapy.
Personal information
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