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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(01): 54-59
DOI: 10.1055/s-0043-1772467
Original Article

Diagnostic Value of T1 Mapping in Detecting Iron Overload in Indian Patients with Thalassemia Major: A Comparison with T2* Mapping

Surya Pratap Singh
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
,
Priya Jagia 
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
,
Vineeta Ojha 
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
,
Tulika Seth
2   Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
,
Nitish Naik
3   Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
,
Kartik P. Ganga 
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
,
Sanjeev Kumar
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Purpose T2* is the gold standard for iron quantification in liver as well as myocardium. In this study, we evaluated the diagnostic accuracy of myocardial T1 mapping for the assessment of myocardial iron overload (MIO) as compared to the T2* mapping in patients with thalassemia major (TM).

Methods Consecutive TM patients attending the thalassemia clinic were prospectively enrolled. Magnetic resonance imaging was performed on a 1.5 T scanner (Siemens Healthineers, Germany) using a gradient echo T2* as well as a T1 mapping (MOLLI) sequence done at a mid-ventricular short-axis single 8 mm slice of the left ventricle. Values were analyzed by manually drawing a region of interest in the mid-septum. T2*less than 20ms was used as the cutoff for significant MIO.

Results One-hundred three patients (58 males, mean age: 17 ± 7.8 years, mean ferritin: 2009.5 µg/L) underwent cardiovascular magnetic resonance. Median T2* of myocardium was 33.45ms. Nineteen patients (18.4%) had T2*less than 20ms. T1 value was low (<850ms) in all the patients with T2* less than 20 ms. Receiver operating characteristic curve analysis revealed the best cutoff of native T1 mapping value as 850 ms which had high specificity (95.2%), sensitivity (94.2%) and negative predictive value (98.8%) for T2* less than 20ms. There was excellent agreement between T1 and T2* for diagnosis of MIO (Kappa—0.848, p <0.001). We did not find any patient who had normal T1 mapping values but had MIO on T2*.

Conclusion T1 and T2* correlate well and normal T1 values may rule out presence of MIO. T1 mapping can act as additional imaging marker for MIO and may be helpful in centers with nonavailability or limited experience of T2*.

Keywords

T1 mapping - thalassemia - T2* mapping - iron overload

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.


Ethical Statement

Research involved human participants The work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans.


Ethical Approval

The study was performed according to the Code of Ethics (Declaration of Helsinki).


Informed Consent

Informed consent was obtained from all the participants.


Author Contributions

S.P.S., P.J., and V.O. wrote the manuscript and did statistical analysis. T.S., N.N., K.P.G., and M.V. helped with clinical care of the patients and conceived the study design and critically revised the manuscript for important intellectual content and final approval of the version to be submitted. S.K. helped with the images and revised the manuscript. All authors read and approved the final manuscript.




Publication History

Article published online:
04 September 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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