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CMR for myocardial iron overload quantification: calibration curve from the MIOT Network

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

R2* cardiac magnetic resonance (CMR) allows the non-invasive measurement of myocardial iron. We calibrated cardiac R2* values against myocardial tissue–measured iron concentration by using a segmental approach and we assessed the iron distribution.

Methods

Five hearts of thalassemia patients were donated after death/transplantation to the CoreLab of the Myocardial Iron Overload in Thalassemia Network. A multislice multiecho R2* approach was adopted. After CMR, used as guidance, the heart was cut in three short-axis slices and each slice was cut into different equiangular segments according to AHA segmentation and differentiated into endocardial and epicardial layers. Tissue iron concentration was measured by atomic absorption spectrometer technique.

Results

Fifty-five samples were used since only for two hearts all the 16 samples were analyzed. Mean iron concentration was 4.71 ± 4.67 mg/g dw. Segmental iron levels ranged from 0.24 to 13.78 mg/g dw. The coefficient of variability of iron for myocardial segments ranged from 8.08 to 24.54% (mean 13.49 ± 6.93%). Iron concentration was significantly higher in the epicardial than in the endocardial layer (5.99 ± 6.01 vs 4.84 ± 4.87 mg/g dw; p = 0.042). Four different circumferential regions (anterior, septal, inferior, and lateral) were defined. A circumferential heterogeneity was noted, with more iron in the anterior region, followed by the inferior region. The direct nonlinear fitting of R2* and [Fe] data led to the calibration curve: [Fe] = 0.0022 ∙ (R2*-ROI)1.462 (R-square = 0.956).

Conclusions

Our data further validate R2* CMR using a segmental approach as a sensitive and early technique for quantifying iron distribution in the current clinical practice.

Key Points

• Calibration in humans for cardiovascular magnetic resonance R2* against myocardial iron concentration was provided.

• A circumferential heterogeneity in cardiac iron distribution was detected: more iron was observed in the anterior region, followed by the inferior region. This finding corroborates the use of a segmental T2* CMR approach in the clinical practice to detect a heterogeneous iron distribution.

• The comparison between the cardiac T2* values obtained with the region-based and the pixel-wise approaches showed a significant correlation and no significant difference but, in presence of significant iron load, the region-based approach resulted in significantly higher T2* values.

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Abbreviations

ANOVA:

Analysis of variance

CMR:

Cardiovascular magnetic resonance

CoV:

Coefficient of variation

EMB:

Endomyocardial biopsy

LV:

Left ventricle

MIO:

Myocardial iron overload

MIOT:

Myocardial Iron Overload in Thalassemia

MRI:

Magnetic resonance imaging

PW:

Pixel-wise

RB:

Region-based

ROI:

Region of interest

SD:

Standard deviation

TE:

Echo times

TM:

Thalassemia major

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Funding

The MIOT project receives “no-profit support” from industrial sponsorships (Chiesi Farmaceutici S.p.A. and ApoPharma Inc.).

Author information

Authors and Affiliations

  1. MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, 56124, Pisa, Italy

    Antonella Meloni, Vincenzo Positano, Laura Pistoia, Daniele De Marchi & Alessia Pepe

  2. Ematologia II con Talassemia, Ospedale “V. Cervello”, Palermo, Italy

    Aurelio Maggio & Filippo Leto

  3. Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy

    Annalisa Angelini, Cristina Basso & Martina Perazzolo Marra

  4. Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padua, Italy

    Maria Caterina Putti

  5. Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli studi di Palermo, Palermo, Italy

    Emiliano Maresi

  6. Department of Histopathology, Pisa University Hospital, Pisa, Italy

    Angela Pucci

Authors
  1. Antonella Meloni
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  2. Aurelio Maggio
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  8. Angela Pucci
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  9. Cristina Basso
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  10. Martina Perazzolo Marra
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  11. Laura Pistoia
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  12. Daniele De Marchi
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  13. Alessia Pepe
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Corresponding author

Correspondence to Alessia Pepe.

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Guarantor

The scientific guarantor of this publication is Alessia Pepe.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from the parents of all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• Prospective

• Observational

• Multicenter study

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Meloni, A., Maggio, A., Positano, V. et al. CMR for myocardial iron overload quantification: calibration curve from the MIOT Network. Eur Radiol 30, 3217–3225 (2020). https://doi.org/10.1007/s00330-020-06668-1

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  • DOI: https://doi.org/10.1007/s00330-020-06668-1

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