Multicenter validation of the magnetic resonance T2* technique for quantification of pancreatic iron

Meloni, Antonella; Marchi, Daniele De; Pistoia, Laura; Grassedonio, Emanuele; Peritore, Giuseppe; Preziosi, P; Restaino, Gennaro; Righi, Riccardo; Riva, Ada; Renne, Stefania; Schicchi, Nicolò; Vallone, Antonino; Peluso, Angelo; Gerardi, Calogera; Positano, Vincenzo; Pepe, Alessia

doi:10.1007/s00330-018-5783-6

Cited by 37 publications

(28 citation statements)

References 25 publications

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“…The aim of the E-MIOT project was to explore prospectively at 18 and 36 months the link of pancreatic iron quantified by MRI with glucose metabolism and with cardiac complications in a large cohort of TM patients. E-MIOT is an Italian network constituted by 11 MRI sites and 66 thalassemia centers, where MRI exams are performed using homogeneous, standardized, and validated procedures for the heart, the liver, and the pancreas (14)(15)(16). All centers are linked by a shared database where all clinical, laboratory, and instrumental data are collected.…”

Section: Study Populationmentioning

confidence: 99%

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The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications in Thalassemia Major: A Large, Multicenter Observational Study

et al. 2020

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We systematically explored the link of pancreatic iron with glucose metabolism and with cardiac complications in a cohort of 1,079 patients with thalassemia major (TM) enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. RESEARCH DESIGN AND METHODSMRI was used to quantify iron overload (T2* technique) and cardiac function (cine images) and to detect macroscopic myocardial fibrosis (late gadolinium enhancement technique). Glucose metabolism was assessed by the oral glucose tolerance test (OGTT). RESULTSPatients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with impaired fasting glucose, impaired glucose tolerance, and diabetes. A pancreas T2* <13.07 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for disturbances of glucose metabolism and for cardiac iron. Patients with myocardial fibrosis showed significantly lower pancreas T2* values. Patients with cardiac complications had significantly lower pancreas T2* values. No patient with arrhythmias/heart failure had a normal global pancreas T2*. CONCLUSIONSPancreatic iron is a powerful predictor not only for glucose metabolism but also for cardiac iron and complications, supporting the close link between pancreatic iron and heart disease and the need to intensify iron chelation therapy to prevent both alterations of glucose metabolism and cardiac iron accumulation.Thalassemia major (TM) is a hereditary anemia characterized by ineffective erythropoiesis and hemolysis, requiring regular red blood cell transfusions to sustain life. A major drawback of this treatment is iron overload, which can cause organ dysfunction (1). The introduction of chelation therapy has improved the survival of TM patients, but cardiac complications remain the main cause of mortality, while endocrinopathies are the most frequent morbidities. Diabetes is the third-most-common endocrine complication (2). In a large cohort of well-treated and well-chelated TM patients, the

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Section: Study Populationmentioning

confidence: 99%

“…A T2* measurement .20 ms was taken as a "conservative" normal value (20,25). The reproducibilityofthemethodologyhadbeen previously assessed for all organs (14)(15)(16).…”

Section: Mri Protocolmentioning

confidence: 99%

The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications in Thalassemia Major: A Large, Multicenter Observational Study

et al. 2020

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“…We considered 146 β-TM patients (87 females, 38.7 ± 11.1 years), consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassaemia (E-MIOT) project, an Italian network constituted by 66 thalassaemia centres and 11 validated CMR sites [ 8 , 24 , 25 ] sharing clinical data.…”

Section: Methodsmentioning

confidence: 99%

Myocardial iron overload by cardiovascular magnetic resonance native segmental T1 mapping: a sensitive approach that correlates with cardiac complications

Meloni

Mondaini

Positano

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background We compared cardiovascular magnetic resonance segmental native T1 against T2* values for the detection of myocardial iron overload (MIO) in thalassaemia major and we evaluated the clinical correlates of native T1 measurements. Methods We considered 146 patients (87 females, 38.7 ± 11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassaemia Network. T1 and T2* values were obtained in the 16 left ventricular (LV) segments. LV function parameters were quantified by cine images. Post-contrast late gadolinium enhancement (LGE) and T1 images were acquired. Results 64.1% of segments had normal T2* and T1 values while 10.1% had pathologic T2* and T1 values. In 526 (23.0%) segments, there was a pathologic T1 and a normal T2* value while 65 (2.8%) segments had a pathologic T2* value but a normal T1 and an extracellular volume (ECV) ≥ 25% was detected in 16 of 19 segments where ECV was quantified. Global native T1 was independent from gender or LV function but decreased with increasing age. Patients with replacement myocardial fibrosis had significantly lower native global T1. Patients with cardiac complications had significantly lower native global T1. Conclusions The combined use of both segmental native T1 and T2* values could improve the sensitivity for detecting MIO. Native T1 is associated with cardiac complications in thalassaemia major.

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“…We considered 221 β-TI patients (53.2% females, mean age: 42.95 ± 13.74 years, age range: 9–77 years), consecutively enrolled in the Extension–Myocardial Iron Overload in Thalassemia (E-MIOT) project between October 2015 and March 2020. E-MIOT is an Italian network constituted by 66 thalassemia centers and 11 MRI sites where MRI exams are performed using homogeneous, standardized, and validated procedures for the heart, the liver, and the pancreas [ 19 , 20 , 21 ]. All centers use a web-based central system for collection of clinical, laboratory, and instrumental data, implementing the applicable requirements from General Data Protection Regulation (European Union 2016/679) and Directive on security of network and information systems (European Union 2016/1148).…”

Section: Methodsmentioning

confidence: 99%

“…The global heart T2* value was obtained by averaging all segmental T2* values. The reproducibility of the methodology had been previously assessed for all organs [ 21 , 32 ].…”

Section: Methodsmentioning

confidence: 99%

The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study

Meloni

Pistoia

Gamberini³

et al. 2021

JCM

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In thalassemia major, pancreatic iron was demonstrated as a powerful predictor not only for the alterations of glucose metabolism but also for cardiac iron, fibrosis, and complications, supporting a profound link between pancreatic iron and heart disease. We determined for the first time the prevalence of pancreatic iron overload (IO) in thalassemia intermedia (TI) and systematically explored the link between pancreas T2* values and glucose metabolism and cardiac outcomes. We considered 221 beta-TI patients (53.2% females, 42.95 ± 13.74 years) consecutively enrolled in the Extension–Myocardial Iron Overload in Thalassemia project. Magnetic Resonance Imaging was used to quantify IO (T2* technique) and biventricular function and to detect replacement myocardial fibrosis. The glucose metabolism was assessed by the oral glucose tolerance test (OGTT). Pancreatic IO was more frequent in regularly transfused (N = 145) than in nontransfused patients (67.6% vs. 31.6%; p < 0.0001). In the regular transfused group, splenectomy and hepatitis C virus infection were both associated with high pancreatic siderosis. Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with altered OGTT. A pancreas T2* < 17.9 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for cardiac iron. Pancreas T2* values were not associated to biventricular function, replacement myocardial fibrosis, or cardiac complications. Our findings suggest that in the presence of pancreatic IO, it would be prudent to initiate or intensify iron chelation therapy to prospectively prevent both disturbances of glucose metabolism and cardiac iron accumulation.

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Multicenter validation of the magnetic resonance T2* technique for quantification of pancreatic iron

Cited by 37 publications

References 25 publications

The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications in Thalassemia Major: A Large, Multicenter Observational Study

The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications in Thalassemia Major: A Large, Multicenter Observational Study

Myocardial iron overload by cardiovascular magnetic resonance native segmental T1 mapping: a sensitive approach that correlates with cardiac complications

The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study

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