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Protocol optimization for cardiac and liver iron content assessment using MRI: What sequence should I use?

Christian A Barrera1, Hansel J Otero1, Helge D Hartung2

  • 1Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA.

Clinical Imaging
|March 20, 2019
PubMed
Abstract

Insights

Optimizing MRI protocols for pediatric iron overload assessment is crucial. A single breath-hold sequence can efficiently measure iron in both the liver and heart, reducing scan time and improving patient care.

Area of Science:

  • Pediatric Radiology
  • Magnetic Resonance Imaging
  • Medical Physics

Background:

  • Iron overload is a significant concern in children, necessitating accurate monitoring.
  • Accurate estimation of iron concentration in the liver and heart is vital for managing conditions like thalassemia and sickle cell disease.
  • Current MRI protocols may be lengthy and involve redundant sequences.

Purpose of the Study:

  • To identify the optimal MRI protocol and sequences for assessing liver and cardiac iron concentration in pediatric patients.
  • To streamline MRI protocols for iron estimation in children, reducing examination time.

Main Methods:

  • Evaluation of pediatric patients (≤18 years) undergoing cardiac and liver MRI for iron estimation.
  • Measurement of liver T2, liver T2*, and cardiac T2* values.
  • Correlation analysis and Bland-Altman plots to compare different MRI sequences and organ measurements.

Main Results:

  • Strong correlations were observed between liver T2 and T2* values (r=0.96) and between liver T2* measurements from dedicated liver and cardiac MRIs (r=0.96).
  • Cardiac T2* values also showed a strong correlation (r=0.81).
  • Liver and cardiac iron estimations demonstrated high agreement between dedicated and integrated MRI sequences.

Conclusions:

  • MRI protocols for pediatric liver and cardiac iron assessment can be simplified.
  • A single breath-hold Gradient Recalled Echo (GRE) sequence is sufficient for evaluating iron concentration in both the liver and heart in most pediatric cases.
  • Simplification of MRI protocols can reduce scan time and eliminate redundant data acquisition.
Keywords:
ChildrenHeartLiverMRIProtocolT2T2 star

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