Cardiac magnetic resonance T2* mapping and its clinical utilization in myocardial iron metabolism_West China Medical Journal

Authors：

XU Huayan ¹ ,  GUO Yingkun ¹ , YANG Zhigang ²

1. Department of Radiology, West China Second University Hospital / Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

GUO Yingkun, Email: gykpanda@163.com

Keywords：

Cardiac magnetic resonance; T2* mapping; Myocardial iron metabolism

DOI：

10.7507/1002-0179.201902069

Video：

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Cardiac magnetic resonance T2* mapping technique is a gradient echoes relaxation recovery sequence, being used to measure the iron metabolism abnormality clinically, such as myocardial iron of hemorrhage in acute myocardial infarction reperfusion injury, transfusion-dependent anemia, hemochromatosis and so on, which is supposed to be the main quantitative evaluation method for myocardial iron overload or deficiency with critical clinical value. This paper summarizes the technical and post-processing points of cardiac magnetic resonance T2* mapping and its clinical applications in diseases related to abnormal myocardial iron metabolism.

Citation： XU Huayan, GUO Yingkun, YANG Zhigang. Cardiac magnetic resonance T2* mapping and its clinical utilization in myocardial iron metabolism. West China Medical Journal, 2019, 34(4): 437-442. doi: 10.7507/1002-0179.201902069 Copy

1.	Anderson LJ. Assessment of iron overload with T2* magnetic resonance imaging. Prog Cardiovasc Dis, 2011, 54(3): 287-294.
2.	Roghi A, Poggiali E, Pedrotti P, et al. Myocardial and hepatic iron overload assessment by region-based and pixel-wise T2* mapping analysis: technical pitfalls and clinical warnings. J Comput Assist Tomogr, 2015, 39(1): 128-133.
3.	Roy C, Slimani A, Meester CD, et al. Age and sex corrected normal reference values of T1, T2, T2* and ECV in healthy subjects at 3T CMR. J Cardiovasc Magn Reson, 2017, 19(1): 72.
4.	Greulich S, Arai AE, Sechtem U, et al. Recent advances in cardiac magnetic resonance. F1000Res, 2016, 5: 2253.
5.	Lota AS, Gatehouse PD, Mohiaddin RH. T2 mapping and T2^* imaging in heart failure. Heart Fail Rev, 2017, 22(4): 431-440.
6.	阳文景, 廖建云, 温建芸, 等. MRI定量肝脏及心脏铁过载对地中海贫血全相合造血干细胞移植的影响. 中国组织工程研究, 2017, 21(33): 5293-5298.
7.	Ouederni M, Ben KM, Mellouli F, et al. Myocardial and liver iron overload, assessed using T2* magnetic resonance imaging with an excel spreadsheet for post processing in Tunisian thalassemia major patients. Ann Hematol, 2017, 96(1): 133-139.
8.	张倩, 侯波, 王璐, 等. 磁共振成像技术在铁过载诊断及随访中的应用. 中华血液学杂志, 2015, 36(4): 302-306.
9.	Wu B, Li W, Avram AV, et al. Fast and tissue-optimized mapping of magnetic susceptibility and T2* with multi-echo and multi-shot spirals. Neuroimage, 2012, 59(1): 297-305.
10.	Wahidiyat PA, Liauw F, Sekarsari D, et al. Evaluation of cardiac and hepatic iron overload in thalassemia major patients with T2* magnetic resonance imaging. Hematology, 2017, 22(8): 1-7.
11.	Buia LM, Roberts WC. Iron in the heart. Etiology and clinical significance. Am J Med, 1971, 51(2): 209-221.
12.	杨婧, 崔炜. 急性心肌梗死患者心肌出血的研究进展. 中华心血管病杂志, 2016, 44(7): 635-638.
13.	Till H, Katharina P, Min-chi K, et al. Myocardial T2* mapping with ultrahigh field magnetic resonance: physics and frontier applications. Front in Phys, 2017, 5: 22.
14.	Jin N, da Silveira JS, Jolly MP, et al. Free-breathing myocardial T2* mapping using GRE-EPI and automatic non-rigid motion correction. J Cardiovasc Magn Reson, 2015, 17(1): 113.
15.	Dekkers IA, Lamb HJ. Clinical application and technical considerations of T1&T2(*) mapping in cardiac, liver, and renal imaging. Br J Radiol, 2018, 91: 1092.
16.	Mokhtar GM, Ibrahim WE, Elbarbary NS, et al. Pancreatic functions in adolescents with beta thalassemia major could predict cardiac and hepatic iron loading: relation to T2-star (T2*) magnetic resonance imaging. J Investig Med, 2016, 64(3): 771-781.
17.	李大创, 黄海波, 尹晓林, 等. 地中海贫血患者肝脏 T2*、血清铁蛋白预测心肌铁过载价值研究. 磁共振成像, 2016, 12(12): 909-914.
18.	Kritsaneepaiboon S, Ina N, Chotsampancharoen T, et al. The relationship between myocardial and hepatic T2 and T2* at 1.5T and 3T MRI in normal and iron-overloaded patients. Acta Radiol, 2018, 59(3): 355-362.
19.	Westwood MA, Wonke B, Maceira AM, et al. Left ventricular diastolic function compared with T2* cardiovascular magnetic resonance for early detection of myocardial iron overload in thalassemia major. J Magn Reson Imaging, 2010, 22(2): 229-233.
20.	张晓琦, 赵明峰, 尹建忠, 等. 输血依赖性疾病多脏器铁沉积 MRI 量化分析. 中国医学影像技术, 2016, 32(3): 407-410.
21.	Kirk P, Roughton M, Porter JB, et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation, 2009, 120(20): 1961-1968.
22.	暴苗, 赵艳红, 周晋. 铁过载在输血依赖性血液系统疾病的概述及进展. 临床血液学杂志, 2018, 225(3): 71-75.
23.	Wood JC, Carson S, Nelson MD, et al. Myocardial iron loading in transfusion-dependent thalassemia and sickle cell disease. Blood, 2004, 103(5): 1934-1936.
24.	Pepe A, Meloni A, Rossi G, et al. Prediction of cardiac complications for thalassemia major in the widespread cardiac magnetic resonance era: a prospective multi-centre study by a multi-parametric approach. Eur Heart J Cardiovasc Imaging, 2018, 19(3): 299-309.
25.	Mavrogeni SI, Markussis V, Kaklamanis L, et al. A comparison of magnetic resonance imaging and cardiac biopsy in the evaluation of heart iron overload in patients with beta-thalassemia major. Eur J Haematol, 2005, 75(3): 241-247.
26.	Casale M, Meloni A, Filosa A, et al. Multiparametric cardiac magnetic resonance survey in children with thalassemia major a multicenter study. Circ Cardiovasc Imaging, 2015, 8(8): e003230.
27.	Meloni A, Positano V, Ruffo GB, et al. Improvement of heart iron with preserved patterns of iron store by CMR-guided chelation therapy. Eur Heart J Cardiovasc Imaging, 2015, 16(3): 325-334.
28.	Powell LW, Seckington RC, Haemochromatosis DY. Haemochromatosis. Lancet, 2016, 388(10045): 706-716.
29.	刘华平, 李文政, 李海兰, 等. 磁共振成像技术在肝脏铁过载的应用进展. 磁共振成像, 2017, 8(6): 475-480.
30.	Brissot P, Pietrangelo A, Adams PC, et al. Haemochromatosis. Nat Rev Dis Primers, 2018, 8(6): 18016.
31.	Zaman A, Higgins DM, Motwani M, et al. Robust myocardial T2 and T2* mapping at 3T using image-based shimming. J Magn Reson Imaging, 2015, 41(4): 1013-1020.
32.	Robbers LFHJ, Nijveldt R, Beek AM, et al. The influence of microvascular injury on native T1 and T2* relaxation values after acute myocardial infarction: implications for non-contrast-enhanced infarct assessment. Eur Radiol, 2018, 28(2): 824-832.
33.	O’Regan DP, Shi WZ, Ariff B, et al. Remodeling after acute myocardial infarction: mapping ventricular dilatation using three dimensional CMR image registration. J Cardiovasc Magn Reson, 2012, 14(1): 41.
34.	Ghugre NR, Pop M, Thomas R, et al. Hemorrhage promotes inflammation and myocardial damage following acute myocardial infarction: insights from a novel preclinical model and cardiovascular magnetic resonance. J Cardiovasc Magn Reson, 2017, 19(1): 50.
35.	Bulluck H, Rosmini S, Abdel-Gadir AA, et al. Residual myocardial iron following intramyocardial hemorrhage during the convalescent phase of reperfused ST-segment-elevation myocardial infarction and adverse left ventricular remodeling. Circ Cardiovasc Imaging, 2016, 9(10): e004940.
36.	Carrick D, Haig C, Ahmed N, et al. Myocardial hemorrhage after acute reperfused ST-segment-elevation myocardial infarction: relation to microvascular obstruction and prognostic significance. Circ Cardiovasc Imaging, 2016, 9: e004148.
37.	Betgem RP, De Waard GA, Nijveldt R, et al. Intramyocardial haemorrhage after acute myocardial infarction. Nat Rev Cardiol, 2015, 12(3): 156-167.
38.	Nagao M, Matsuo Y, Kamitani T, et al. Quantification of myocardial iron deficiency in non-ischemic heart failure by cardiac T2* magnetic resonance imaging. Am J Cardiol, 2014, 113(6): 1024-1030.
39.	Xu HY, Yang ZG, Li R, et al. Myocardial iron deficiency in hemodialysis-dependent end-stage renal disease patients undergoing oral iron therapy. J Am Coll Cardiol, 2017, 70(19): 2455-2456.

1. Anderson LJ. Assessment of iron overload with T2* magnetic resonance imaging. Prog Cardiovasc Dis, 2011, 54(3): 287-294.
2. Roghi A, Poggiali E, Pedrotti P, et al. Myocardial and hepatic iron overload assessment by region-based and pixel-wise T2* mapping analysis: technical pitfalls and clinical warnings. J Comput Assist Tomogr, 2015, 39(1): 128-133.
3. Roy C, Slimani A, Meester CD, et al. Age and sex corrected normal reference values of T1, T2, T2* and ECV in healthy subjects at 3T CMR. J Cardiovasc Magn Reson, 2017, 19(1): 72.
4. Greulich S, Arai AE, Sechtem U, et al. Recent advances in cardiac magnetic resonance. F1000Res, 2016, 5: 2253.
5. Lota AS, Gatehouse PD, Mohiaddin RH. T2 mapping and T2^* imaging in heart failure. Heart Fail Rev, 2017, 22(4): 431-440.
6. 阳文景, 廖建云, 温建芸, 等. MRI定量肝脏及心脏铁过载对地中海贫血全相合造血干细胞移植的影响. 中国组织工程研究, 2017, 21(33): 5293-5298.
7. Ouederni M, Ben KM, Mellouli F, et al. Myocardial and liver iron overload, assessed using T2* magnetic resonance imaging with an excel spreadsheet for post processing in Tunisian thalassemia major patients. Ann Hematol, 2017, 96(1): 133-139.
8. 张倩, 侯波, 王璐, 等. 磁共振成像技术在铁过载诊断及随访中的应用. 中华血液学杂志, 2015, 36(4): 302-306.
9. Wu B, Li W, Avram AV, et al. Fast and tissue-optimized mapping of magnetic susceptibility and T2* with multi-echo and multi-shot spirals. Neuroimage, 2012, 59(1): 297-305.
10. Wahidiyat PA, Liauw F, Sekarsari D, et al. Evaluation of cardiac and hepatic iron overload in thalassemia major patients with T2* magnetic resonance imaging. Hematology, 2017, 22(8): 1-7.
11. Buia LM, Roberts WC. Iron in the heart. Etiology and clinical significance. Am J Med, 1971, 51(2): 209-221.
12. 杨婧, 崔炜. 急性心肌梗死患者心肌出血的研究进展. 中华心血管病杂志, 2016, 44(7): 635-638.
13. Till H, Katharina P, Min-chi K, et al. Myocardial T2* mapping with ultrahigh field magnetic resonance: physics and frontier applications. Front in Phys, 2017, 5: 22.
14. Jin N, da Silveira JS, Jolly MP, et al. Free-breathing myocardial T2* mapping using GRE-EPI and automatic non-rigid motion correction. J Cardiovasc Magn Reson, 2015, 17(1): 113.
15. Dekkers IA, Lamb HJ. Clinical application and technical considerations of T1&T2(*) mapping in cardiac, liver, and renal imaging. Br J Radiol, 2018, 91: 1092.
16. Mokhtar GM, Ibrahim WE, Elbarbary NS, et al. Pancreatic functions in adolescents with beta thalassemia major could predict cardiac and hepatic iron loading: relation to T2-star (T2*) magnetic resonance imaging. J Investig Med, 2016, 64(3): 771-781.
17. 李大创, 黄海波, 尹晓林, 等. 地中海贫血患者肝脏 T2*、血清铁蛋白预测心肌铁过载价值研究. 磁共振成像, 2016, 12(12): 909-914.
18. Kritsaneepaiboon S, Ina N, Chotsampancharoen T, et al. The relationship between myocardial and hepatic T2 and T2* at 1.5T and 3T MRI in normal and iron-overloaded patients. Acta Radiol, 2018, 59(3): 355-362.
19. Westwood MA, Wonke B, Maceira AM, et al. Left ventricular diastolic function compared with T2* cardiovascular magnetic resonance for early detection of myocardial iron overload in thalassemia major. J Magn Reson Imaging, 2010, 22(2): 229-233.
20. 张晓琦, 赵明峰, 尹建忠, 等. 输血依赖性疾病多脏器铁沉积 MRI 量化分析. 中国医学影像技术, 2016, 32(3): 407-410.
21. Kirk P, Roughton M, Porter JB, et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation, 2009, 120(20): 1961-1968.
22. 暴苗, 赵艳红, 周晋. 铁过载在输血依赖性血液系统疾病的概述及进展. 临床血液学杂志, 2018, 225(3): 71-75.
23. Wood JC, Carson S, Nelson MD, et al. Myocardial iron loading in transfusion-dependent thalassemia and sickle cell disease. Blood, 2004, 103(5): 1934-1936.
24. Pepe A, Meloni A, Rossi G, et al. Prediction of cardiac complications for thalassemia major in the widespread cardiac magnetic resonance era: a prospective multi-centre study by a multi-parametric approach. Eur Heart J Cardiovasc Imaging, 2018, 19(3): 299-309.
25. Mavrogeni SI, Markussis V, Kaklamanis L, et al. A comparison of magnetic resonance imaging and cardiac biopsy in the evaluation of heart iron overload in patients with beta-thalassemia major. Eur J Haematol, 2005, 75(3): 241-247.
26. Casale M, Meloni A, Filosa A, et al. Multiparametric cardiac magnetic resonance survey in children with thalassemia major a multicenter study. Circ Cardiovasc Imaging, 2015, 8(8): e003230.
27. Meloni A, Positano V, Ruffo GB, et al. Improvement of heart iron with preserved patterns of iron store by CMR-guided chelation therapy. Eur Heart J Cardiovasc Imaging, 2015, 16(3): 325-334.
28. Powell LW, Seckington RC, Haemochromatosis DY. Haemochromatosis. Lancet, 2016, 388(10045): 706-716.
29. 刘华平, 李文政, 李海兰, 等. 磁共振成像技术在肝脏铁过载的应用进展. 磁共振成像, 2017, 8(6): 475-480.
30. Brissot P, Pietrangelo A, Adams PC, et al. Haemochromatosis. Nat Rev Dis Primers, 2018, 8(6): 18016.
31. Zaman A, Higgins DM, Motwani M, et al. Robust myocardial T2 and T2* mapping at 3T using image-based shimming. J Magn Reson Imaging, 2015, 41(4): 1013-1020.
32. Robbers LFHJ, Nijveldt R, Beek AM, et al. The influence of microvascular injury on native T1 and T2* relaxation values after acute myocardial infarction: implications for non-contrast-enhanced infarct assessment. Eur Radiol, 2018, 28(2): 824-832.
33. O’Regan DP, Shi WZ, Ariff B, et al. Remodeling after acute myocardial infarction: mapping ventricular dilatation using three dimensional CMR image registration. J Cardiovasc Magn Reson, 2012, 14(1): 41.
34. Ghugre NR, Pop M, Thomas R, et al. Hemorrhage promotes inflammation and myocardial damage following acute myocardial infarction: insights from a novel preclinical model and cardiovascular magnetic resonance. J Cardiovasc Magn Reson, 2017, 19(1): 50.
35. Bulluck H, Rosmini S, Abdel-Gadir AA, et al. Residual myocardial iron following intramyocardial hemorrhage during the convalescent phase of reperfused ST-segment-elevation myocardial infarction and adverse left ventricular remodeling. Circ Cardiovasc Imaging, 2016, 9(10): e004940.
36. Carrick D, Haig C, Ahmed N, et al. Myocardial hemorrhage after acute reperfused ST-segment-elevation myocardial infarction: relation to microvascular obstruction and prognostic significance. Circ Cardiovasc Imaging, 2016, 9: e004148.
37. Betgem RP, De Waard GA, Nijveldt R, et al. Intramyocardial haemorrhage after acute myocardial infarction. Nat Rev Cardiol, 2015, 12(3): 156-167.
38. Nagao M, Matsuo Y, Kamitani T, et al. Quantification of myocardial iron deficiency in non-ischemic heart failure by cardiac T2* magnetic resonance imaging. Am J Cardiol, 2014, 113(6): 1024-1030.
39. Xu HY, Yang ZG, Li R, et al. Myocardial iron deficiency in hemodialysis-dependent end-stage renal disease patients undergoing oral iron therapy. J Am Coll Cardiol, 2017, 70(19): 2455-2456.

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