Use of fat suppression in R2 relaxometry with MRI for the quantification of tissue iron overload in beta-thalassemic patients.

PURPOSE: To assess the performance and results of R(2) relaxometry using a fat-suppressed (FS) multiecho sequence and compare these to conventional R(2) relaxometry in estimating tissue iron overload. MATERIALS AND METHODS: Relaxation rate values (R(2)=1/T2) of the liver, spleen, pancreas and vertebral bone marrow (VBM) were estimated in 21 patients with ß-thalassemia major, using a respiratory-triggered 16-echo Carr-Purcell-Meiboom-Gill (CPMG) spin-echo sequence before (R(2)) and after (R(2) FS) the application of chemically selective fat suppression. RESULTS: Hepatic and splenic R(2) FS values correlated with respective R(2) values (r=0.98 and r=0.96, P<.001), whereas correlations between R(2) FS and R(2) values for pancreas and VBM were not statistically significant. Bland-Altman plots show disagreement between R(2) and R(2) FS values, particularly for pancreas and VBM. Hepatic, pancreatic and VBM R(2) FS values correlated with serum ferritin (r=0.88, P<.001; r=0.51, P<.003; and r=0.75, P<.002, respectively). Hepatic R(2) FS values correlated with splenic R(2) FS (r=0.77, P<.03), pancreatic R(2) FS (r=0.61, P<.006) and VBM R(2) FS values (r=0.70, P<.001), whereas pancreatic R(2) FS values correlated also with VMB R(2) FS values. On the contrary, among the R(2) values of the above tissues, obtained without fat suppression, only hepatic R(2) values correlated with serum ferritin, whereas no correlation was documented between hepatic and pancreatic or VBM R(2) values. The application of fat suppression did not improve breathing or flow artifacts. CONCLUSION: Application of fat suppression in the standard CPMG sequence improved the capability of MRI in noninvasive quantification of iron, particularly in lipid-rich tissues, such as vertebral bone marrow (VBM) and pancreas.

Assessment of iron distribution between liver, spleen, pancreas, bone marrow, and myocardium by means of R2 relaxometry with MRI in patients with beta-thalassemia major.

PURPOSE: To investigate the correlation between the degree of hepatic, splenic, pancreatic, vertebral bone marrow (VBM), and myocardial siderosis, as expressed by relaxation rate (R2 = 1/T2) values, in patients with thalassemia. MATERIALS AND METHODS: R2 relaxation rate values of liver, spleen, VBM, pancreas, and myocardium were estimated in 68 consecutive transfusion-dependent patients with beta-thalassemia major and 10 healthy controls using a respiratory triggered 16-echo Carr-Purcell-Meiboom-Gill (CPMG) spin echo sequence. RESULTS: Hepatic R2 values were significantly increased in all 68 patients; VBM, pancreatic, and myocardial R2 values were increased in 67/68, 35/47, and 47/61 patients, whereas five patients showed decreased pancreatic R2 attributed to fatty degeneration. Of the 39 nonsplenectomized patients, splenic R2 values were decreased in 30 and normal in nine patients. Hepatic R2 values correlated with splenic (r = 0.63, P < 0.001), VBM (r = 0.52, P < 0.001), but not with myocardial and pancreatic R2 values. CONCLUSION: Despite positive correlations between the degree of hepatic, splenic, and VBM siderosis, as expressed by respective R2 values, there was variability of iron distribution patterns in thalassemic patients. Unpredictable patterns of iron distribution may be seen, such as normal signal of the spleen in the presence of siderotic liver, resembling primary hemochromatosis. Fatty degeneration of the pancreas was not uncommon.

Measurement of systolic and diastolic arterial wall shear stress in the ascending aorta.

PURPOSE: Wall shear stress (WSS) appears to contribute significantly in the initiation and progression of atherosclerotic disease. The purpose of this work is to present in vivo systolic and diastolic WSS calculations in the human ascending aorta by the application of three straightforward methodologies based on Poiseuille's theory of flow. MATERIALS AND METHODS: Blood flow measurements were performed retrospectively in the ascending aorta of 20 non-atherosclerotic patients using phase-contrast MRI. WSS calculations were performed assuming Poiseuille's theory of flow based on average flow volume, average flow velocity and maximum flow velocity. Systolic and diastolic WSS values were calculated and compared with the calculated maximum and minimum values of WSS throughout the cardiac cycle. RESULTS: Systolic WSS values calculated by average flow volume, average flow velocity and maximum flow velocity were similar (0.4+/-0.2N/m(2), 0.4+/-0.3N/m(2)and 0.4+/-0.2N/m(2), respectively). Diastolic WSS values calculated by maximum flow velocity were significantly higher (11.6+/-7.0x10(-2)N/m(2)) compared to values calculated by average flow volume (0.3+/-0.9x10(-2)N/m(2)) and average flow velocity (0.3+/-1.0x10(-2)N/m(2)). Comparison of systolic and diastolic WSS values with maximum and minimum WSS values showed that time instances of maximum and minimum blood flow velocities do not coincide with time instances of maximum and minimum blood flow volume. CONCLUSION: In vivo calculation of WSS in the ascending aorta is feasible by phase-contrast MRI flow measurements and straightforward methodologies based on Poiseuille's theory of flow. However, measurements based on maximum flow velocity show larger deviations compared to measurements based on mean flow volume or mean flow velocity.

Wall shear stress calculation in ascending aorta using phase contrast magnetic resonance imaging. Investigating effective ways to calculate it in clinical practice.

INTRODUCTION: There is growing evidence that atherosclerosis, as well as endothelial biology, depend on arterial wall shear stress (WSS). Several methods of WSS calculation with varying degrees of complexity have been proposed. This study aimed at investigating whether the most straightforward and easier to apply of these methods give comparable results in clinical practice. METHODS: Complete velocity encoding measurements using phase contrast magnetic resonance imaging were performed in 20 patients at a level perpendicular to the long axis of the ascending aorta approximately 2cm above the aortic valve. WSS was calculated at this location on maximum systole. MR imaging was accomplished on a 1.5T scanner. Four methods were applied to calculate WSS; three of them are based on the predictions of Poiseuille's theory of flow, while the last one is based on calculations resulting by the application of the definition of WSS. RESULTS: WSS calculated with the above mentioned methods was found to be in the range 4.2+/-1.8 to 3.5+/-1.7dynes/m(2). The velocity profile at the site of measurements can be described with a parabolic equation of the form u=ar(2)+br+c with an average r(2)=0.83, which is in good agreement with Poiseuille's theory of flow. Comparison of the results shows no statistically significant differences between WSS measurements calculated with these methods. DISCUSSION: The four methods are equivalent in calculating WSS at the ascending aorta when blood flow velocities have a good parabolic distribution.