Alessia Pepe

Angela Ciancio

Antonella Meloni

Brunella Favilli

Cristina Salvatori

Eliana Cracolici

Gennaro Restaino

Maria Chiara Dell'Amico

Maria Filomena Santarelli

Massimo Lombardi

Pasquale Pepe

Petra Keilberg

Stefano Pulini

Vincenzo Positano

Journal of Cardiovascular Magnetic Resonance

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BioMed Central
Journal of Cardiovascular Magnetic 
Resonance
ssOpen AccePoster presentation
Preferential patterns of myocardial iron deposit by multislice 
multiecho T2* CMR in thalassemia major patients
Vincenzo Positano*1, Antonella Meloni1, Alessia Pepe1, Pasquale Pepe1, 
Maria Chiara Dell'Amico1, Brunella Favilli1, Cristina Salvatori1, 
Petra Keilberg1, Gennaro Restaino2, Eliana Cracolici3, Stefano Pulini4, 
Angela Ciancio5, Maria Filomena Santarelli1 and Massimo Lombardi1
Address: 1G Monasterio Foundation and Institute of Clinical Physiology, CNR, Pisa, Italy, 2Università Cattolica del Sacro Cuore, Campobasso, 
Italy, 3Policlinico "Paolo Giaccone", Palermo, Italy, 4Osped. Civile "Spirito Santo", Pescara, Italy and 5Ospedale "Madonna delle Grazie", Matera, 
Italy
* Corresponding author    
Introduction
T2* multislice multiecho cardiac magnetic resonance
(CMR) technique has permitted quantification of myocar-
dial iron burden by a segmental approach. Little is known
in the literature about patterns of iron store in hemochro-
matosis.
Purpose
Our study aimed to investigate myocardial iron overload
in thalassemia major (TM) patients by segmental T2*
CMR technique, in order to determine if there were pref-
erential patterns of iron deposit.
Methods
Five hundred and nineteen TM patients underwent CMR.
Three short-axis views (basal, medium, and apical) of the
left ventricle were acquired and analyzed using custom-
written, previously validated software. The myocardium
was automatically segmented into a 16-segment standard-
ized LV model and the T2* value on each segment was cal-
culated, as well as the global T2* value. Four different
main circumferential regions (anterior, septal, inferior
and lateral) were defined by averaging the corresponding
segmental T2* values.
Results
Two-hundred and twenty-nine patients showed global
T2* value < 26 ms, corresponding to significant global
heart iron overload. The analysis was focused on this
patient population, subsequently divided into two
groups: severe iron overload (N = 83, global T2* < 10 ms)
and mild-moderate iron overload (N = 146, global T2*
between 10 and 26 ms). For each group, segments were
sorted by mean T2* value. Segment order was signifi-
cantly preserved between the two groups (r = 0.91, P <
0.0001). Significant circumferential variability was found
in patients with overall heart iron overload (figure 1A) as
well as in both groups (P < 0.0001). The mean T2* value
over the anterior region was significantly lower than the
mean T2* values over the other regions and the mean T2*
over the inferior region was significantly lower than the
T2* values over the septal and lateral regions (figure 1B).
This pattern was preserved within each single slice (figure
1C). We found a significantly higher T2* value in the
basal slice vs the medium and apical slices in patients with
severe iron overload.
Conclusion
A preferential pattern of iron store in anterior and inferior
regions appears to be present in TM patients with severe
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):P276 doi:10.1186/1532-429X-12-S1-P276
<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/P276
© 2010 Positano et al; licensee BioMed Central Ltd. Page 1 of 2
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and mild-moderate iron overload. The preserved pattern
between the groups prevents attributing this datum to
additive susceptibility artefacts, which are negligible in
heavily iron-loaded patients. A segmental T2* CMR
approach could identify early iron deposit, useful for tai-
loring chelation therapy and preventing myocardial dys-
function in the clinical setting.
Iron overload patterns: circumferential (A), longitudinal (B), slice-by-slice (C)Figure 1
Iron overload patterns: circumferential (A), longitudinal (B), slice-by-slice (C).Page 2 of 2
(page number not for citation purposes)


Preferential patterns of myocardial iron deposit by multislice multiecho T2* CMR in thalassemia major patients

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Preferential patterns of myocardial iron deposit by multislice multiecho T2* CMR in thalassemia major patients

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