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Journal of Cardiovascular Magnetic Resonance

Open AccessPoster presentationThe optimisation of cardiac iron overload assessment by systolic imagingGillian Smith*, John Paul Carpenter, Taigang He and Dudley Pennell

Address: Royal Brompton Hospital, London, UK

* Corresponding author

IntroductionWithout regular blood transfusions most patients withThalassaemia major (TM) die during infancy. This how-ever leads to tissue iron overload, in the heart potentiallycausing heart failure and subsequent death unless chela-tion therapy is instigated. The introduction of cardiovas-cular magnetic resonance (CMR) has been associated witha reduction in death rates from iron overload cardiomy-opathy. Imaging allows identification of patients at risk ofheart failure and regular follow-up aids the optimizationof therapeutic regimes.

A bright blood gradient echo sequence with no delay afterthe R wave trigger has been validated for the assessment ofcardiac iron levels. A full thickness septal ROI is selectedfor analysis, rate of signal intensity decay with increasingecho time is proportional to iron loading. Good imagequality is usually obtained but there may be bloodmotion artifact, contrast between the myocardial andblood pool low and the septum thin in children andyoung adults. A black blood double inversion recovery(DIR) sequence has been developed with improved con-trast and reduced blood signal contamination andimproved reproducibility. The scan duration thus breath-hold is however considerably longer and it has only beenpossible to transfer this protocol to other Siemens scan-ners to date. At end systole myocardial thickness is maxi-mal while blood volume is minimal which may improveimage quality.

PurposeTo evaluate whether acquiring myocardial images duringsystole improves cardiac T2* evaluation in patients withiron overload.

Methods22 consecutive TM patients were scanned using a 1.5 T Sie-mens Sonata scanner with a 6 channel phased array car-diac coil and ECG gating. A mid ventricular short axis slicewas selected and imaged with no delay after the R wavetrigger and at end systole, the trigger delay calculated fromthe corresponding cine image. The same slice was thenimaged using the black blood preparation. A mono-expo-nential decay curve was derived for all acquisitions usingThalassaemia tools (CMRtools, Cardiovascular ImagingSolutions, London, UK) and expressed as T2*.

ResultsThe mean T2* was 11.3 ms (± 3.57) for black blood imag-ing, 12.3 (± 3.62) diastolic and 11.3 (± 3.57) for systolicbright blood imaging. There was no statistically signifi-cant difference between any groups.

ConclusionThis study suggests that imaging during systole can be uti-lized if septal visualization is inadequate in diastole andthe DIR sequence breath-hold is too long. It may also bepreferential in highly iron overloaded patients where theright ventricular septal boundary may be oured.

from 13th Annual SCMR Scientific SessionsPhoenix, 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

<supplement> <title> <p>Abstracts of the 13^thAnnual SCMR Scientific Sessions - 2010</p> </title> <note>Meeting abstracts - A single PDF containing all abstracts in this Supplement is available <a href="http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-full.pdf">here</a>.</note> <url>http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-info</url> </supplement>

This abstract is available from: http://jcmr-online.com/content/12/S1/P291

© 2010 Smith et al; licensee BioMed Central Ltd.