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Cardiac mri

CARDIAC MRI

Diagnostic Backgrounder

NOTE: These slides are for use in educational oral presentations only. If any published figures/tables from these slides are

to be used for another purpose (e.g. in printed materials), it is the individual’s responsibility to apply for the relevant permission.Specific local use requires local approval


Outline
Outline

  • Introduction to iron overload

  • Assessing cardiac iron loading

    • echocardiography

    • cardiac MRI

  • Cardiac MRI in practice

    • preparation of the patient

    • acquisition of the image

    • analysis of the data

      • Excel spreadsheet

      • ThalassaemiaTools (CMRtools)

      • cmr42

      • FerriScan

      • MRmap

      • MATLAB

  • Summary

MRI = magnetic resonance imaging.


Introduction to iron overload

Introduction to iron overload


Introduction to iron overload1
Introduction to iron overload

  • Iron overload is common in patients who require intermittent or regular blood transfusions to treat anaemia and associated conditions

    • it may be exacerbated in some conditions by excess gastrointestinal absorption of iron

  • Iron overload can lead to considerable morbidity and mortality1

  • Excess iron is deposited in major organs, resulting in organ damage

    • the organs that are at risk of damage due to iron overload include the liver, heart, pancreas, thyroid, pituitary gland, and other endocrine organs2,3

1Ladis V, et al. Ann NY Acad Sci. 2005;1054:445-50. 2Gabutti V, Piga A. ActaHaematol. 1996;95:26-36. 3Olivieri NF. N Engl J Med. 1999;341:99-109.


Importance of analysing cardiac iron
Importance of analysing cardiac iron

  • In β-thalassaemia major, cardiac failure and arrhythmia are risk factors for mortality1

    • signs of myocardial damage due to iron overload: arrhythmia, cardiomegaly, heart failure, and pericarditis2

    • heart failure has been a major cause of death in β-thalassaemia patients in the past (50–70%)1,3

  • In MDS, the results of studies are less comprehensible

    • the reported proportion of MDS patients with cardiac iron overload is inconsistent; from high to only a small proportion of MDS patients4–7

    • cardiac iron overload occurs later than does liver iron overload4,7,8

    • however, cardiac iron overload can have serious clinical consequences in MDS patients

1Borgna-Pignatti C, et al. Haematologica. 2004;89:1187-93. 2Gabutti V, Piga A. ActaHaematol. 1996;95:26-36. 3. Modell B, et al. Lancet. 2000;355:2051-2. 4Jensen PD, et al. Blood. 2003;101:4632-9.

5Chacko J, et al. Br J Haematol. 2007;138:587-93. 6Konen E, et al. Am J Hematol. 2007;82:1013-6.

7Di Tucci AA, et al. Haematologica. 2008;93:1385-8. 8Buja LM, Roberts WC. Am J Med. 1971;51:209-21.


Importance of analysing cardiac iron cont

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Importance of analysing cardiac iron (cont.)

  • In 2010, the overall mortality rate of β-thalassaemia major patients in the UK was substantially lower than a decade ago (1.65 vs 4.3 per 1,000 patient years)1,2

    • due to improved monitoring and management of iron overload over the last decade, 77% of patients have normal cardiac T2*1

    • cardiac iron overload is no longer the leading cause of death in this population1

Baseline

Latest follow-up

Patients (%)

p < 0.001

p < 0.001

cT2* < 10 ms

cT2* ≤ 20 ms

cT2* = cardiac T2*.

1Thomas AS, et al. Blood. 2010;116:[abstract 1011]. 2Modell B, et al. Lancet. 2000;355:2051-2.


Cardiac t2 overview of correlations with other measurements
Cardiac T2*: Overview of correlations with other measurements

Transfusion duration†↑1

Ventricular dysfunction↑1-3

Arrhythmia and heart failure↑4

T2*↓

Need for cardiac medication↑1-2

APFR↓EPFR:APFR↑5

SF and LIC1-3

Weak or no correlation

†For thalassaemia, but not sickle cell.

APFR = atrial peak filling rate; EPFR = early peak filling rate; LIC = liver iron concentration; SF = serum ferritin.

1Wood JC, et al. Blood. 2004;103:1934-6. 2Anderson LJ, et al. Eur Heart J. 2001;22:2171-9. 3Tanner MA, et al. J CardiovascMagnReson. 2006;8:543-7. 4Kirk P, et al. Circulation. 2009;120:1961-8.

5Westwood MA, et al. J MagnReson Imaging. 2005;22:229-33.


Cardiac t2 relationship with lvef
Cardiac T2*: Relationship with LVEF measurements

Normal T2* range

90

80

Normal LVEF range

70

60

Cardiac T2* value of 37 ms in a normal heart

50

LVEF (%)

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Cardiac T2* value of 4 ms in a significantly iron-overloaded heart

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Cardiac T2* (ms)

Myocardial T2* values < 20 ms are associated with a progressive and significant decline in LVEF

LVEF = left-ventricular ejection fraction.

Anderson LJ, et al. Eur Heart J. 2001;22:2171-9.


Cardiac t2 relationship with cardiac failure and arrhythmia

0.30 measurements

0.25

0.20

0.15

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Cardiac T2*: Relationship with cardiac failure and arrhythmia

Cardiac failure

Arrhythmia

0.6

< 6 ms

0.5

< 10 ms

0.4

6–8 ms

Proportion of patients with arrhythmia

Proportion of patients developing cardiac failure

0.3

0.2

8–10 ms

10–20 ms

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> 20 ms

> 10 ms

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Follow-up time (days)

Follow-up time (days)

T2* < 10 ms: relative risk 159 (p < 0.001)T2* < 6 ms: relative risk 268 (p < 0.001)

T2* < 20 ms: relative risk 4.6 (p < 0.001)T2* < 6 ms: relative risk 8.65 (p < 0.001)

Low myocardial T2* predicts a high risk of developing cardiac failure and arrhythmia

Kirk P, et al. Circulation. 2009;120:1961-8.


Assessing cardiac iron overload

Assessing measurements cardiac iron overload


Assessing cardiac iron loading agenda
Assessing cardiac iron loading: Agenda measurements

  • Echocardiography

  • Cardiac MRI

    • advantages and disadvantages of cardiac MRI

    • MRI: a non-invasive diagnostic tool

    • T2* is the standard method for analysing cardiac iron


Echocardiography

Echocardiography measurements


Assessing cardiac iron loading e chocardiography
Assessing cardiac iron loading measurements : Echocardiography

EF = ejection fraction.

1Leonardi B, et al. JACC Cardiovasc Imaging. 2008;1:572-8. 2Hoffbrand AV. Eur Heart J. 2001;22:2140-1.


Cardiac mri1

Cardiac MRI measurements


Mri a non invasive diagnostic tool
MRI: A non-invasive diagnostic tool measurements

Protons

  • Indirectly measures levels of iron in the heart

  • MRI measures longitudinal (T1) and transverse (T2) relaxation times of the protons

    • iron deposition disrupts the homogeneous magnetic field and shortens T1 and T2 times in a concentration-dependent manner

Magnetic field

RF/spin echo/gradient echo

Iron

Echo signal → T1, T2

Signal processing

RF = radio-frequency.

1Wood JC, Ghugre N. Hemoglobin. 2008;32:85-96. 2Wood JC, et al. Circulation. 2005;112:535-43.

3Wang ZJ, et al. Radiology. 2005;234:749-55. 4Ghugre NR, et al. MagnReson Med. 2006;56:681-6.


Mri a non invasive diagnostic tool cont
MRI: A non-invasive diagnostic tool (cont.) measurements

Protons

  • If a spin-echo sequence is used, the relaxation time is T2

  • If a gradient-echo sequence is used, it is T2*

  • Cardiac MRI methods

    • gradient-echo T2* MRI: most used in clinical practice

    • spin-echo T2 MRI: less useful (motion artefacts common due to characteristics of the heart)

Magnetic field

Most used in clinical practice:

Gradient echo

Spin echo

Image acquired at different TEs

Image acquired at different TEs

Excel or software

Excel or software

T2* [ms}

T2* [ms}

R2* [Hz]=1,000/T2*

R2* [Hz]=1,000/T2*

TE = echo time.

Adapted from Wood JC, Ghugre N. Hemoglobin. 2008;32:85-96.


Assessing cardiac iron loading c ardiac mri
Assessing cardiac iron loading measurements : Cardiac MRI


Faq cardiac mri
FAQ: Cardiac MRI measurements

What are sequences?

Sequences are a set of radio-frequency and gradient pulses (slight tilts in the magnetization curves of the scanner) generated repeatedly during the scan, which produce echoes with varied amplitudes and shapes that will define the MR image

What is gradient echo?

A gradient-echo sequence is obtained after 2 gradient impulses are applied to the body, resulting in a signal echo that is read by the coils. In these sequences, the spins are not refocused and, therefore, are subject to local inhomogeneities, with a more rapid decay curve. For gradient-echo pulse sequences, the T2* relaxation times (which reflect these inhomogeneities) on the signal are more significant

1Image from Ridgway JP. J CardiovascMagnReson. 2010;12:71.


Gradient relaxometry t2 r2 is the method for analysing cardiac iron levels
Gradient relaxometry (T2*, R2*) is the method for analysing cardiac iron levels

1Guo H, et al. J MagnReson Imaging. 2009;30:394-400. 2Anderson LJ, et al. Eur Heart J. 2001;22:2171-9. 3Wood JC, Noetzli L. Ann N Y Acad Sci. 2010;1202:173-9.4Wood JC, Ghugre N. Hemoglobin. 2008;32:85-96. 5Westwood M, et al. J MagnReson Imaging. 2003;18:33-9.

6Hoffbrand AV. Eur Heart J. 2001;22:2140-1. 7He T, et al. MagnReson Med. 2008;60:1082-9.


Gradient relaxometry t2 r2 can conveniently measure cardiac and liver iron

14 cardiac iron levels

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10

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0

0

100

200

300

400

Gradient relaxometry (T2*, R2*) can conveniently measure cardiac and liver iron

Liver MRI

Cardiac MRI

30

Hankins, et al.

25

20

Wood, et al.

15

HIC (mg Fe/g of dry weight liver)

[Fe] (mg/g dry wt)

10

Anderson, et al.

R2 = 0.82540

5

0

0

200

400

600

800

1000

Cardiac R2* (Hz)

Liver R2* (Hz)

Cardiac and liver iron can be assessed together conveniently by gradient echo during the a single MRI measurement.

HIC = hepatic iron concentration

Carpenter JP, et al. J CardiovascMagnReson. 2009;11 Suppl 1:P224.

Hankins et al Blood. 2009;113:4853-4855.


Cardiac t2 mri is usually measured in the septum of the heart
Cardiac T2* MRI is usually measured in the septum of the heart

Heart with normal iron levels

T2* = 22.8 ms or R2* = 43.9 Hz

Heart with severe iron overload

T2* = 5.2 ms or R2* = 192 Hz

Images courtesy of Dr J. de Lara Fernandes.


What is r2
What is R2*? heart

Conversion from T2* to R2* is a simple mathematical calculation: R2* = 1,000/T2*

These values are only applicable to 1.5 T scanners1

1Anderson LJ, et al. Eur Heart J. 2001;22:2171-9. 2Kirk P, et al. Circulation. 2009;120:1961-8.


Why should the data be presented as r2 and not t2

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Why should the data be presented as R2* and not T2*?

  • Seven whole hearts from patients with transfusion-dependent anaemias were assessed by histology and cardiac MRI

[Fe] (mg/g dry wt)

[Fe] (mg/g dry wt)

R2 = 0.949

R2 = 0.82540

Cardiac T2* (ms)

Cardiac R2* (Hz)

R2* has a linear relationship with tissue iron concentration, which simplifies the interpretation of data and allows comparison of changes over time

Carpenter JP, et al. J CardiovascMagnReson. 2009;11 Suppl 1:P224.


Why should the data be presented as r2 and not t2 cont

100 heart

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Why should the data be presented as R2* and not T2*? (cont.)

The relationship between cardiac T2*/R2* and LVEF

Hockey stick effect?

Or a more gradual relationship?

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LVEF (%)

LVEF (%)

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Heart T2* (ms)

R2* (s–1)

R2* allows demonstration of cardiac risk in a more gradual way

Anderson LJ, et al. Eur Heart J. 2001;22:2171-9.


Why should the data be presented as r2 and not t2 cont1
Why should the data be presented as R2* and not T2*? (cont.) heart

Standard errors on a single measurement are approximately constant with R2*, but are non-uniform with T2*

Transform to R2*

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T2* first measurement (ms)

R2* first measurement (s–1)

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T2* second measurement (ms)

R2* second measurement (s–1)

R2* has a constant standard error that makes assessment of the significance of changes easier

Westwood M, et al. J MagnReson Imaging. 2003;18:33-9.


Cardiac t2 mri in practice

Cardiac T2* heart MRI in practice


Mri scanners
MRI scanners heart

  • Manufacturers

    • Siemens Healthcare (Erlangen, Germany; www.siemensmedical.com)

    • GE Healthcare (Milwaukee, WI, USA; www.gemedicalsystems.com)

    • Philips Healthcare (Best, the Netherlands; www.medical.philips.com)

  • Magnetic field

    • T2* varies with magnetic field strength1

    • need 1.5 T for cutoff levels of 20 ms (iron overload) and 10 ms (severe iron overload)1,2

  • Cardiac package

    • needs to be acquired separately from the manufacturers. The cost is about USD 40,000. However, in most centres, this is available since MRI is frequently used in non-iron-related cardiovascular imaging

    • includes all necessary for acquisition of the image

    • sequences are included in Siemens and Philips Healthcare cardiac packages, but for GE Healthcare they need to be acquired separately (note: variations may exist between countries)

1Anderson LJ, et al. Eur Heart J. 2001;22:2171-9. 2Kirk P, et al. Circulation. 2009;120:1961-8.


Cardiac t2 mri in practice the process
Cardiac T2* MRI in practice: The process heart

3. Analysis ofMRI data(time depends on experience*)

2. Acquisition of the MRI image

(approx. 5-20 min)

1. Patientpreparation(5 min)

T2*, R2*

*Time to manually calculate T2*/R2* values in an Excel spreadsheet depends on the experience of the physician.


Cardiac t2 mri in practice the process cont
Cardiac T2* MRI in practice: The process (cont.) heart

  • Preparation of the patient

  • Acquisition of the image

  • Analysis of the data (post-processing)

    • Excel spreadsheet

    • ThalassaemiaTools, CMRtools

    • cmr42

    • FerriScan

    • MRmap

    • MATLAB


Preparation of the patient

Preparation heart of the patient


Preparation of the patient1
Preparation of the patient heart

  • Standard precautions need to be taken

  • There is no need for peripheral vein access since no contrast agent is required

  • Special care

    • remove all infusion/medication pumps (e.g. with insulin,pain-relieving drugs)

    • stop continuous i.v. application of ICT during the measurement

    • ECG signal should be positioned according to scanner specifications

ECG = electrocardiography.


Cardiac t2 mri in practice the process cont1
Cardiac T2* MRI in practice: The process (cont.) heart

  • Preparation of the patient

  • Acquisition of the image

  • Analysis of the data (post-processing)

    • Excel spreadsheet

    • ThalassaemiaTools, CMRtools

    • cmr42

    • FerriScan

    • MRmap

    • MATLAB


Acquisition of the image

Acquisition heart of the image


Acquisition of the image mri pulse sequences
Acquisition of the image: MRI pulse sequences heart

  • Pulse sequences

    • are a preselected set of defined radio-frequency and gradient pulses

    • are computer programs that control all hardware aspects of the scan

    • determine the order, spacing, and type of radio-frequency pulses that produce magnetic resonance images according to changes in the gradients of the magnetic field

  • Several different pulse sequences exist1

    • a gradient-echo sequence generates T2*

1Wood JC, Ghugre N. Hemoglobin. 2008;32:85-96.


The most common commercially available t2 acquisition techniques
The most common commercially available T2* acquisition techniques

The various techniques give clinically comparable results.2-3, 5

1Anderson LJ, et al. Eur Heart J. 2001;22:2171-9. 2Westwood M, et al. J Magn Reson Imaging. 2003;18:33-9. 3He T, et al. J Magn Reson Imaging. 2007;25:1205-9. 4He T, et al. Magn Reson Med. 2008;60:1082-9. 5Pepe A, et al. J Magn Reson Imaging. 2006;23:662-8.


Acquisition of the image tes

Shortest TE = 2 ms techniques

Shortest TE = 1 ms

500

Shortest TE = 4 ms

450

Shortest TE = 5.5 ms

True

400

350

Mean R2*: ramp, dualtone, & uniform (Hz)

300

250

200

150

100

50

0

100

200

300

400

500

0

True R2* (Hz)

Acquisition of the image: TEs

  • Images are taken at a minimum of 5 different TEs, normally 8‒121

  • The choice of minimum TE determines the smallest measurable T21

    • ideally, min TE  2 ms, max TE 17‒20 ms

  • Different T2* acquisition techniques according to TE

    • multiple breath-hold: acquire an image for each TE in separate breath-holds2

    • single breath-hold multi-echo acquisition: acquire images for all TE during 1 breath-hold3

  • Mean R2* compared with true value in the case of synthetic images for different minimum TEs, but same echo duration (18 ms)4

    1Wood JC, Noetzli L. Ann N Y AcadSci. 2010;1202:173-9. 2Anderson LJ, et al. Eur Heart J. 2001;22:2171-9. 3Westwood M, et al. J MagnReson Imaging. 2003;18:33-9. 4Ghugre NR, et al. J MagnReson Imaging. 2006;23:9-16.


    How does the mri data output looks like
    How does the MRI data output looks like? techniques

    MRI data output

    Data visualization

    During a single breath hold the pulse sequence run several times at increasing echo time (TE), generating data points corresponding to decreased signal intensity1

    1Wood JC, Ghugre N. Hemoglobin. 2008;32:85-96.


    Faq acquisition technique
    FAQ: Acquisition technique techniques

    Which is recommended: single or multiple breath-hold technique?

    Comparison of the 2 methods, single and multiple breath-hold, showed no significant skewing between T2* values in all patients with -thalassaemia major, regardless of their T2* value (see Bland-Altman plots)1

    However, in cardiac MRI the most recommended technique is single breath-hold, because it allows quick acquisition of the information. This is especially important to avoid movement artefacts (heart beating, breathing) and assure the good quality of the MRI image

    Patients with T2* < 20 ms1

    Patients with T2*  20 ms 1

    1Westwood M, et al. J MagnReson Imaging. 2003;18:33-9.


    Acquisition of the image1
    Acquisition of the image techniques

    • Single breath-hold multi-echo acquisition

      • take a short-axis slice of the ventricle (halfway between the base and the apex): orange line

      • image acquisition should occur immediately after the R wave

      • do not alter any settings that could alter TE (e.g. FOV)

    Image courtesy of Dr J. de Lara Fernandes.


    Cardiac t2 mri in practice the process cont2
    Cardiac T2* MRI in practice: The process (cont.) techniques

    • Preparation of the patient

    • Acquisition of the image

    • Analysis of the data (post-processing)

      • Excel spreadsheet

      • ThalassaemiaTools, CMRtools

      • cmr42

      • FerriScan

      • MRmap

      • MATLAB


    Analysis of the data post processing

    Analysis techniquesof the data (post-processing)


    How t2 is calculated from the mri output
    How T2* is calculated from the MRI output? techniques

    Data visualization

    Curve Fitting

    T2*

    Noise level

    T2* calculation is fitting a curve on the data points and calculating at what echo time no signal is left from iron (only noise)1

    1Wood JC, Ghugre N. Hemoglobin. 2008;32:85-96.


    Analysis of the data
    Analysis of the data techniques

    • The data can be analysed manually or using post-processing software


    Analysis of the data cont
    Analysis of the data (cont.) techniques

    FDA = Food and Drug Administration.

    1www.cmrtools.com/cmrweb/ThalassaemiaToolsIntroduction.htm. Accessed Dec 2010. 2Pennell DJ. JACC Cardiovasc Imaging. 2008;1:579-81.3www.circlecvi.com. Accessed Dec 2010.


    Analysis of the data cont1
    Analysis of the data (cont.) techniques

    1www.resonancehealth.com/resonance/ferriscan. Accessed Dec 2010. 2www.cmr-berlin.org/forschung/ mrmapengl/index.html. Accessed Dec 2010. 3Wood JC, Noetzli L. Ann N Y Acad Sci. 2010;1202:173-9.


    Faq mistakes in analysing the data
    FAQ: Mistakes in analysing the data techniques

    What are the most common mistakes in analysing the data that could lead to a wrong interpretation of the T2* value?

    • Interpreting the data from cardiac MRI is usually quite straightforward; problems may arise when analysing data from patients with severe cardiac iron overload. In this case, the signal from heavily iron-loaded muscle will decay quickly and a single exponential decay curve does not fit the data well.1

    • Models exist that can help to solve this issue (see next slide):

    • the offset model (Prof Wood and colleagues)

    • truncation of the data (Prof Pennell and colleagues)

    • Both models should give comparable results; the differences should not be clinically relevant

    Signal decay curve from a patient with T2* ≈ 5 ms, showing that the data do not fit well2

    1Wood JC, Noetzli L. Ann N Y Acad Sci. 2010;1202:173-9. 2Ghugre NR, et al. J MagnReson Imaging. 2006;23:9-16.


    Faq mistakes in analysing the data cont
    FAQ: Mistakes in analysing the data (cont.) techniques

    What is truncation?

    After the selection of the ROI, the signal decay can be fitted using different models. In the truncation model, the late points in the curve that form a plateau are subjectively discarded; the objective is to have a curve with an R2 > 0.995. A new single exponential curve is made by fitting the remaining signals.1

    Generally, a truncation model should be used with the bright-blood technique to obtain more reproducible and more accurate T2* measurements1

    What is an offset model?

    The offset model consists of a single exponential with a constant offset. Using only the exponential model can underestimate the real T2* values (at quick signal loss at short TE, there is a plateau), while inclusion of the offset model into the fitting equation can improve this.2

    Generally, the offset model is recommended to be used with the black-blood technique

    1He T, et al. MagnReson Med. 2008;60:1082-9. 2Ghugre NR, et al. J MagnReson Imaging. 2006;23:9-16.


    Faq how to start measuring cardiac iron loading
    FAQ: How to start measuring cardiac techniquesiron loading?

    How to start measuring cardiac iron loading in a hospital? What steps need to be taken?

    • To start assessing cardiac iron loading by MRI, these steps can be followed:

    • Check MRI machine requirements

      • 1.5 T

      • calibrated

    • Buy cardiac package from the manufacturer. It must include all that is necessary for acquisition of the data (the sequences are included with Siemens and Philips Healthcare cardiac packages, but for GE Healthcare they need to be acquired separately)

    • Optional: buy software for analysing the data (if not, Excel spreadsheet can be used)

    • Highly recommended: training of personnel for acquisition of cardiac MR images (e.g. functional analyses)

    • Highly recommended: training of personnel on how to analyse the data with the chosen software


    Implementation of liver and cardiac mri
    Implementation of liver and cardiac MRI techniques

    1.5T MRI Scanner

    US$1.000.000

    Yes

    ½ day training

    Liver

    Analysis

    Experienced radiologist

    No

    1 day training

    Post-processing analysis

    US$40.000 or US$4.000/y

    or in-house or outsource

    US$50.000

    Cardiac acquisition package

    1-2 day training

    Yes

    Heart

    Analysis

    Routine cardiac MR exams

    4 day training

    No

    Slide presented at Global Iron Summit 2011 - With the permission of Juliano de Lara Fernandes


    Summary

    Summary techniques


    Summary1
    Summary techniques

    • Iron overload is common in patients who require intermittent or regular blood transfusions to treat anaemia and associated conditions

    • Analysing cardiac iron levels is important

      • in β-thalassaemia major, cardiac failure and arrhythmia are risk factors for mortality

      • in MDS, cardiac iron overload can have serious clinical consequences

      • due to improved monitoring and management of iron overload over the last decade, 77% of patients have normal cardiac T2*1

    • MRI: the method to rapidly and effectively assess cardiac iron loading

      • T2* allows specific assessment of cardiac iron levels. The use of this convenient, non-invasive procedure has had a significant impact on outcomes in patients with cardiac iron overload1

      • R2* is a simple calculation from T2* and has a linear relationship with cardiac iron concentration

    1Thomas AS, et al. Blood. 2010;116:[abstract 1011]. 2Modell B, et al. J CardiovascMagnReson. 2008;10:42-9.


    Glossary of terms

    GLOSSARY techniquesOF TERMS


    Glossary
    GLOSSARY techniques

    • AML = acute myeloid leukemia

    • APFR = Atrialp peak filling rate

    • BA = basilar artery

    • ß-TM = Beta Thalassemia Major

    • ß-TI = Beta ThalassemiaIntermedia

    • BM = bone marrow

    • BTM = bone marrow transplantation

    • BW = bandwidth

    • CFU = colony-forming unit

    • CMML = chronic myelomonocytic leukemia

    • CT2 = cardiac T2*.

    • DAPI = 4',6-diamidino-2-phenylindole


    Glossary1
    GLOSSARY techniques

    • DFS = = disease-free survival.

    • DysE = dyserythropoiesis

    • ECG = electrocardiography

    • EDV = end-diastolic velocity

    • EF = ejection fraction

    • EPFR = early peak filling rate

    • FatSat = fat saturation

    • FAQ = frequently asked questions

    • FDA = Food and Drug Administration

    • FISH = fluorescence in situ hybridization.

    • FOV = field of view

    • GBP = Currency, pound sterling (£)


    Glossary2
    GLOSSARY techniques

    • Hb = hemoglobin

    • HbE= hemoglobin E

    • HbF = fetalhemoglobin

    • HbS = sickle cell hemoglobin.

    • HbSS = sickle cell anemia.

    • HIC = hepatic iron concentration

    • HU = hydroxyurea

    • ICA = internal carotid artery.

    • ICT = iron chelation therapy

    • IDL = interface description language

    • IPSS = International Prognostic Scoring System

    • iso = isochromosome


    Glossary3
    GLOSSARY techniques

    • LIC = liver iron concentration

    • LVEF = left-ventricular ejection fraction

    • MCA = middle cerebral artery

    • MDS = Myelodysplastic syndromes

    • MDS-U = myelodysplastic syndrome, unclassified

    • MRA = magnetic resonance angiography

    • MRI = magnetic resonance imaging

    • MV = mean velocity.

    • N = neutropenia

    • NEX = number of excitations

    • NIH = National Institute of Health

    • OS = overall survival


    Glossary4
    GLOSSARY techniques

    • pB = peripheral blood

    • PI = pulsatility index

    • PSV = peak systolic Velocity

    • RA =refractory anemia

    • RAEB = refractory anemia with excess blasts

    • RAEB -T = refractory anemia with excess blasts in transformation

    • RARS = refractory anemia with ringed sideroblasts

    • RBC = red blood cells

    • RF = radio-frequency

    • RCMD = refractory cytopenia with multilineage dysplasia

    • RCMD-RS = refractory cytopenia with multilineage dysplasia with ringed sideroblasts

    • RCUD = refractory cytopenia with unilineage dysplasia


    Glossary5
    GLOSSARY techniques

    • RN = refractory neutropenia

    • ROI = region of interest

    • RT = refractory thrombocytopenia

    • SCD = sickle cell disease

    • SD = standard deviation

    • SI = signal intensity

    • SIR = signal intensity ratio

    • SF = serum ferritin

    • SNP-a = single-nucleotide polymorphism

    • SQUID = superconducting quantum interface device.

    • STOP = = Stroke Prevention Trial in Sickle Cell Anemia

    • STOP II = Optimizing Primary Stroke Prevention in Sickle Cell Anemia


    Glossary6
    GLOSSARY techniques

    • T = thrombocytopenia

    • TAMMV = time-averaged mean of the maximum velocity.

    • TCCS = transcranialcolour-coded sonography

    • TCD = transcranialdopplerultrasonography

    • TCDI = duplex (imaging TCD)

    • TE = echo time

    • TR = repetition time

    • WHO = World Health Organization

    • WPSS = WHO classification-based Prognostic Scoring System


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