Oral Abstract Session XI – New CMR Methods Applied to Human Imaging: O69Intracellular ferritin iron is evidently in equilibrium with the cytosolic iron pool that can change rapidly with iron chelation. This study demonstrates the feasibility of quantitatively detecting short-term changes in myocardial iron produced by iron-chelating therapy using RR2 measurement.postprintThe 13th Annual Scientific Sessions of the Society for Cardiovascular Magnetic Resonance (SCMR), Phoenix, AZ., 21-24 January 2010. In Final Program of the 13th Annual Scientific Sessions of SCMR, 2010, p. 29, abstract no. O6

Au, WY

Brittenham, GM

Cheung, SC

Feng, L

Ha, SY

Jensen, J

Kim, D

Sheth, S

Wu, EX

Daniel Kim

Ed X Wu

Jens Jensen

Wing-Yan Au

Li Feng

Jerry S Cheung

Shau-Yin Ha

Sujit S Sheth

Gary M Brittenham

Springer - Publisher Connector

BioMed Central
Journal of Cardiovascular Magnetic 
Resonance
ssOpen AcceOral presentation
A breath-hold R2 mapping pulse sequence detects a 
decrease in myocardial ferritin iron after one-week of iron chelation
Daniel Kim*1, Ed X Wu2, Jens Jensen1, Wing-Yan Au2, Li Feng1, 
Jerry S Cheung2, Shau-Yin Ha2, Sujit S Sheth3 and Gary M Brittenham3
Address: 1New York University School of Medicine, New York, NY, USA, 2The University of Hong Kong, Hong Kong, Hong Kong and 3Columbia 
University College of Physicians and Surgeons, New York, NY, USA
* Corresponding author    
Introduction
In transfusional iron overload, almost all the excess iron
is sequestered intracellularly as ferritin iron, a dispersed,
soluble and rapidly mobilizable fraction, and hemosiderin
iron, an aggregated, insoluble fraction that is a long-term
reserve. The effective transverse relaxation rate (R2*) of
myocardium is predominantly influenced by hemosi-
derin iron and, even with intensive iron-chelating ther-
apy, changes only slowly over several months [1].
Intracellular ferritin iron is evidently in equilibrium with
the low molecular weight cytosolic iron pool [2] that can
decrease rapidly with iron chelation. We propose to use a
new breath-hold fast spin-echo (FSE) [3] pulse sequence
that permits calculation of RR2 [4], a "reduced transverse
relaxation rate" as a measure of myocardial ferritin iron
that is largely independent of hemosiderin iron.
Purpose
To use RR2 measurements to detect short-term changes in
myocardial ferritin iron produced by iron-chelating ther-
apy.
Methods
We imaged 10 patients with thalassemia major (New
York; mean age = 26.9 ± 10.3 years) on a 1.5 T MR scanner
(Siemens-Avanto), and another 8 patients with tha-
lassemia (Hong Kong; mean age = 29.3 ± 8.6 years) on a
3 T scanner (Phillips-Achieva). Both sets of patients were
imaged in a mid-ventricular short-axis plane of the heart
at mid-diastole, initially after discontinuing iron-chela-
tion for one week, and subsequently after resuming their
usual therapy (group 1: deferasirox; group 2: deferoxam-
ine and/or deferiprone), for one week. Three different sets
of FSE data were acquired in separate breath-holds with
different echo spacings (ESP). For details on the pulse
sequence and its parameters, please see references [3,5]. A
from 13th Annual SCMR Scientific Sessions
Phoenix, AZ, USA. 21-24 January 2010
Published: 21 January 2010
Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):O69 doi:10.1186/1532-429X-12-S1-O69
<supplement> <title> <p>Abstracts of the 13<sup>th </sup>Annual 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/O69
© 2010 Kim et al; licensee BioMed Central Ltd. 
(Left column) R2* and (right column) RR2 maps: (top row) discontinuing chelation for one week; (bottom row) esum-ing chelatio  for one weekFi ur  1
(Left column) R2* and (right column) RR2 maps: (top 
row) discontinuing chelation for one week; (bottom 
row) resuming chelation for one week.Page 1 of 2
(page number not for citation purposes)
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standard R2* mapping pulse sequence was also per-
formed.
For data analysis, the septum was segmented manually.
R2* was calculated by non-linear least square fitting of the
mono-exponential relaxation curve. The RR2 was calcu-
lated by non-linear least square fitting of the three sets of
non-monoexponential relaxation curves with different
ESPs [6].
Results
Figure 1 shows R2* and RR2 maps of a patient after one
week off and thereafter one week on iron chelation. In
both groups (Table 1), the mean RR2 was significantly
decreased on compared to off iron-chelating therapy
(group1: 22.0 ± 5.3 s-1 vs. 24.5 ± 4.9 s-1; p < 0.01; group 2:
20.0 ± 5.6 s-1 vs. 22.1 ± 5.4 s-1; p < 0.01), whereas R2* was
not different between the two states (group1: 61.1 ± 30.6
s-1 vs. 62.3 ± 27.6 s-1; group 2: 71.9 ± 43.3 s-1 vs. 74.1 ±
39.0 s-1).
Conclusion
This study demonstrates that a decrease in myocardial fer-
ritin iron can be detected after as little as one week of iron-
chelating therapy. Measurement of RR2 may provide a
new means of rapidly monitoring the effectiveness of
iron-chelating therapy.
Acknowledgements
Grant sposor: AHA 0730143N; NIH R01-HL083309, NIH R01-DK069373, 
NIH R01-EB000447-07A1, NIH R01-DK069373, NIH R01-DK066251, NIH 
R37-DK049108, NIH R01-DK049108, GRF7794/07M, HK Children Thalas-
saemia Foundation (No. 2007/02).
References
1. Anderson LJ, et al.: Br J Haematol 2004, 127:348-355.
2. De Domenico I, et al.: EMBO J 2006, 25:5396-5404.
3. Kim D, et al.: MRM 2009, 62:300-306.
4. Jensen JH, et al.: MRM 2002, 47:1131-1138.
5. Guo H, et al.: JMRI 2009, 30:394-400.
6. Tosti CL, et al.: ISMRM 2006. Abstract 1201
Table 1: R2* and RR2 values of two groups after 1 week off and thereafter 1 week on iron chelation
Group R2* (1/s) Difference in R2* (1/s) RR2 (1/s) Difference in RR2 (1/s)
Off On Off-On Off On Off-On
1 62.3 ± 27.6 61.1 ± 30.6 1.2 ± 7.8 24.5 ± 4.8 22.0 ± 5.3 2.5 ± 1.8
2 74.1 ± 39.0 71.9 ± 43.3 2.2 ± 9.9 22.1 ± 5.4 20.0 ± 5.6 2.0 ± 2.2Page 2 of 2
(page number not for citation purposes)


A breath-hold R2 mapping pulse sequence detects a decrease in myocardial ferritin iron after one-week of iron chelation

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Title A breath-hold R2 mapping pulse sequence detects a decrease inmyocardial ferritin iron after one-week of iron chelationAuthor(s) Kim, D; Jensen, J; Cheung, SC; Feng, L; Ha, SY; Au, WY; Sheth,S; Brittenham, GM; Wu, EXCitationThe 13th Annual Scientific Sessions of the Society forCardiovascular Magnetic Resonance (SCMR), Phoenix, AZ., 21-24 January 2010. In Final Program of the 13th Annual ScientificSessions of SCMR, 2010, p. 29, abstract no. O69Issued Date 2010URL http://hdl.handle.net/10722/129704Rights Creative Commons: Attribution 3.0 Hong Kong LicenseSaturday, January 23, 2010 www.scmr.org2911:53 AM O66 Visualization of carotid plaquecalcification - a novel approach usingsusceptibility weighted MR imagingQi Yang, MD, PhD, Xuanwu HospitalSWI phase image offers a radiation free approach to detect calcificationsof the carotid artery and has the potential to separate the hemorrhage andcalcification of carotid plaque within one scan.12:05 PM O67 Assessing the hemodynamicresponse to exercise - a novel MR approachJennifer A. Steeden, MEng, UCL Department of MedicalPhysics & BioengineeringA novel high temporal resolution, real-time MR flow sequence has beendeveloped. Flow quantification has been carried out at rest and at twoexercise levels, and combined with simultaneous blood pressuremeasurements to measure the hemodynamic response to exercise.12:17 PM O68 Lipid modifying therapy and aorticwall thickness regression by magneticresonance imaging (MRI): the plaquefollow up study by the National Instituteof Aging (NIA)Gustavo K. Godoy, MD, Johns Hopkins UniversityMRI is a precise non invasive tool to measure aortic plaque regression inresponse to lipid lowering therapy. Two groups of treatment, onereceiving simvastatin and niacin and simvastatin alone were followed byMRI over a period of 18 months.11:00 AM - 12:30 PM Paradise Valley RoomOral Abstract Session XI – New CMRMethods Applied to Human ImagingModerators: Sebastian Kozerke, PhD, Institute forBiomedical Engineering UniversityHildo J. Lamb, MD, PhD, Leiden UniversityMedical Center11:05 AM O69 A breath-hold R2 mapping pulsesequence detects a decrease in myocardialferritin iron after one-week of iron chelationDaniel Kim, PhD, New York University Schoolof MedicineIntracellular ferritin iron is evidently in equilibrium with the cytosoliciron pool that can change rapidly with iron chelation. This studydemonstrates the feasibility of quantitatively detecting short-termchanges in myocardial iron produced by iron-chelating therapy usingRR2 measurement.11:17 AM O70 Validation of the shortened modifiedlook locker inversion recovery (Sh-MOLLI)sequence for cardiac gated T1 mappingStefan K. Piechnik, MScEE, PhD, University of OxfordFor T1-mapping of the human myocardium, we propose the Sh-MOLLIsequence using very short recovery epochs and conditional nonlinearfitting. Robust quantitative single-breath-hold T1 maps can be obtainedin less than 10 heart beats with high spatial resolution.11:29 AM O71 Highly-accelerated first-pass cardiacperfusion MRI using compressed sensingand parallel imagingRicardo Otazo, New York University School of MedicineCompressed sensing and parallel imaging are combined into a single jointreconstruction technique for highly accelerated first-pass cardiacperfusion MRI. We demonstrate feasibility of whole-heart coverage perheartbeat with high spatial (<2mm) and temporal (60ms/slice) resolution.11:41 AM O72 Clinical CMR at 3.0 Tesla usingparallel RF transmission withpatient-adaptive B1 shimming: initialexperienceAndreas Mueller, MD, University of BonnA novel multi-source RF-transmission system with patient-adaptiveRF-shimming at 3.0 Tesla improves image homogeneity and contrast ofBlack-Blood and SSFP-sequences. The B1-shimming and consecutivereduction of local SAR-peaks results in shorter allowable TR/TE values,reducing off-resonance artifacts in SSFP-sequences.11:53 AM O73 Navigator guided high-resolutionsingle-shot black-blood (BB) TSE imagesusing zoom and sensitivity encoding (sense)on a 32 channel RF systemRaja Muthupillai, PhD, St. Luke’s Episcopal Hospitaland Texas Heart InstituteWe demonstrate that by using a judicious combination of reduced FOVimaging (ZOOM), SENSE, and half-scan, it is feasible to obtainhigh-resolution single-shot (SSH) BB TSE images with minimal imageblurring.12:05 PM O74 Highly accelerated high spatialresolution myocardial perfusion imagingRobert Manka, MD, German Heart Institute BerlinEvaluation of the severity of coronary artery disease is of great importancefor therapy. Highly accelerated CMR perfusion imaging offers excellentdiagnostic performance in the evaluation of patients with known orsuspected coronary artery disease.12:17 PM O75 Non invasive quantification ofcoronary endothelial function using 3T MRIPierre-Julien Moro, MD, Centre de RésonanceMagnétique Biologique et MédicaleEndothelial dysfunction (ED) is a key element in the development ofcardiovascular diseases. We propose here a non invasive method to detectED combining cold pressor test with measurement of myocardial bloodflow at the venous coronary sinus site.11:00 AM – 12:30 PM Cave Creek RoomCases with the ExpertsPanel of Experts:Andrew Arai, MD, NHLBI-NIH -Artifacts in Cardiac MRIChristopher M. Kramer, MD, University of VirginiaHealth System - Adult Congenital Heart DiseaseScientific Sessions AgendaLegend: Gen = General, Cgen = Congenital, BSci = Basic Science *At the conclusion of this presentation, the attendee should be better able to:SATURDAYPROGRAMBSciCgen

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A breath-hold R2 mapping pulse sequence detects a decrease in myocardial ferritin iron after one-week of iron chelation

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