Cardiac T2* measurements in patients with iron overload: a comparison of imaging parameters and analysis techniques

Measurement of cardiac T2 has emerged as an important tool to noninvasively quantify cardiac iron concentration in order to detect preclinical evidence of toxic levels and titrate chelation therapy. However, there exists variation among practitioners in cardiac T2 measurement methods. This study examines the impact of different imaging parameters and data analysis techniques on the calculated cardiac R2 (1/T2) in patients at risk for cardiac siderosis. The study group consisted of 36 patients with thalassemia syndromes who had undergone clinical magnetic resonance imaging assessment of cardiac siderosis using a standardized protocol and who were selected to yield a broad range of cardiac R2 values. Cardiac R2 measurements were performed on a 1.5-T scanner using an electrocardiogram-gated, segmented, multiecho gradient echo sequence obtained in a single breath-hold. R2 was calculated from the signal intensity versus echo time data in the ventricular septum on a single midventricular short-axis slice. There was good agreement between R2 measured with a blood suppression prepulse (black blood technique) and without (mean difference 6.0 ± 10.7 Hz). The black blood technique had superior within-study reproducibility (R2 mean difference 1.6 ± 8.6 Hz versus 2.7 ± 14.6 Hz) and better interobserver agreement (R2 mean difference 3.4 ± 8.2 Hz versus 8.3 ± 16.5 Hz). With the same minimum echo time, the use of small (1.0 ms) versus large (2.2 ms) echo spacing had minimal impact on cardiac R2 (mean difference 0.3 ± 8.7 Hz). The application of a region-of-interest-based versus a pixel-based data analysis also had little effect on cardiac R2 calculation (mean difference 8.4 ± 6.9 Hz). With black blood images, fitting the signal curve to a monoexponential decay or to a monoexponential decay with a constant offset yielded similar R2 values (mean difference 3.4 ± 8.1 Hz). In conclusion, the addition of a blood suppression prepulse for cardiac R2 measurement yields similar R2 values and improves reproducibility and interobserver agreement. The findings regarding other variations may be helpful in establishing a broadly accepted imaging and analysis technique for cardiac R2 calculation.