T2* map at cardiac MRI reveals incidental hepatic and cardiac iron overload

Jan M Brendel; Alina Kratzenstein; Josephine Berger; Florian Hagen; Konstantin Nikolaou; Meinrad Gawaz; Simon Greulich; Patrick Krumm

doi:10.1016/j.diii.2023.07.005

T2* map at cardiac MRI reveals incidental hepatic and cardiac iron overload

Diagn Interv Imaging. 2023 Aug 5:S2211-5684(23)00153-5. doi: 10.1016/j.diii.2023.07.005. Online ahead of print.

Authors

Jan M Brendel¹, Alina Kratzenstein¹, Josephine Berger¹, Florian Hagen¹, Konstantin Nikolaou¹, Meinrad Gawaz², Simon Greulich³, Patrick Krumm¹

Affiliations

¹ Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany.
² Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany.
³ Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany. Electronic address: simon.greulich@med.uni-tuebingen.de.

PMID: 37550171
DOI: 10.1016/j.diii.2023.07.005

Abstract

Purpose: The purpose of this study was to assess the diagnostic capabilities of cardiac magnetic resonance (CMR) T2* mapping in detecting incidental hepatic and cardiac iron overload.

Materials and methods: Patients with various clinical indications for CMR examination were consecutively included at a single center from January 2019 to April 2023. All patients underwent T2* mapping at 1.5 T in a single mid-ventricular short-axis as part of a comprehensive routine CMR protocol. T2* measurements were performed of the heart (using a region-of-interest in the interventricular septum) and the liver, categorized according to the severity of iron overload. The degree of cardiac iron overload was categorized as mild (15 ms < T2* < 20 ms), moderate (10 ms < T2* < 15 ms) and severe (T2* < 10 ms). The degree of hepatic iron overload was categorized as mild (4 ms < T2* < 8 ms), moderate (2 ms < T2* < 4 ms), severe (T2* < 2 ms). Image quality and inter-reader agreement were assessed using intraclass correlation coefficient (ICC).

Results: CMR examinations from 614 patients (374 men, 240 women) with a mean age of 50 ± 18 (standard deviation) years were fully evaluable. A total of 24/614 patients (3.9%) demonstrated incidental hepatic iron overload; of these, 22/614 patients (3.6%) had mild hepatic iron overload, and 2/614 patients (0.3%) had moderate hepatic iron overload. Seven out of 614 patients (1.1%) had incidental cardiac iron overload; of these, 5/614 patients (0.8%) had mild iron overload, 1/614 patients (0.2%) had moderate iron overload, and 1/614 patients (0.2%) had severe iron overload. Good to excellent inter-reader agreement was observed for the assessment of T2* values (ICC, 0.90 for heart [95% confidence interval: 0.88-0.91]; ICC, 0.91 for liver [95% confidence interval: 0.89-0.92]).

Conclusion: Analysis of standard CMR T2* maps detects incidental cardiac and hepatic iron overload in 1.1% and 3.9% of patients, respectively, which may have implications for further patient management. Therefore, despite an overall low number of incidental abnormal findings, T2* imaging may be included in a standardized comprehensive CMR protocol.

Keywords: Cardiac magnetic resonance imaging; Hemochromatosis; Hemosiderosis; Iron overload; T2* mapping.