Magnetic resonance imaging during management of patients with transfusion-dependent thalassemia: a single-center experience
Cardiac and hepatic magnetic resonance imaging evaluation during treatment can tailor physicians’ chelation therapy titrations.
The aim of the study was to assess the relationship of cardiac and hepatic T2* values with chelation therapy in patients with transfusion-dependent thalassemia (TDT).
A total of 106 patients with TDT who were followed up in Istanbul Medical Faculty Thalassemia Center were evaluated for the study. Forty-eight (45%) patients with TDT had more than one consecutive MRI examination. The patients were divided into three subgroups according to the cardiac T2* values as the high-risk group (T2* MRI < 10 ms), medium-risk group (T2* MRI 10-20 ms), and the low-risk group (T2* MRI > 20 ms).
The majority of patients used DFX (deferasirox) (79%) and deferiprone (DFP) (17%). Approximately 80% of patients according to cardiac T2* value and 40% of patients according to hepatic T2* value were initially in the low-risk group. Patients with follow-up MRI examinations exhibited significant improvement in liver iron concentration, which correlated with an increase in hepatic T2* values. The decrease of liver iron concentration was prominent in the DFX group (p < 0.01). The serum ferritin level was significantly correlated with liver iron concentrations (rs = 0.65, p < 0.001), hepatic T2* value (rs = − 0.62, p < 0.001), but not with cardiac T2* value (rs = − 0.20, p = 0.07).
Cardiovascular and hepatic MRI is a useful follow-up tool during the assessment of risk groups and chelation therapy of patients with TDT. Consecutive MRI tests showed good monitoring of cardiac and liver iron overload.
KeywordsThalassemia Cardiovascular magnetic resonance Hepatic magnetic resonance Chelation therapy
Magnetic resonance imaging
Liver iron concentration
We gratefully thank Mr. David Chapman for kindly providing language revision.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
This study was approved by the Institutional Review Board (Istanbul University, Istanbul Medical Faculty Clinical Research Ethics Committee).
- 1.Viprakasit V, Origa R (2014) Genetic basis, pathophysiology and diagnosis. In: Cappellini MD, Cohen A, Porter J, Taher A, Viprakasit V (eds). Guidelines for the management of transfusion-dependent thalassemia (TDT), 3rd edn. Nicosia:Thalassaemia International Federation (TIF) Publication, No. 20, pp 14–26Google Scholar
- 9.Wood JC (2011) Impact of iron assessment by MRI. Hematol Am Soc Hematol Educ Program 2011:443–450Google Scholar
- 18.Pepe A, Meloni A, Rossi G et al (2013) Cardiac and hepatic iron and ejection fraction in thalassemia major: multicentre prospective comparison of combined deferiprone and deferoxamine therapy against deferiprone or deferoxamine monotherapy. J Cardiovasc Magn Reson 15:1CrossRefPubMedPubMedCentralGoogle Scholar