title: MRI assessment of excess cardiac iron in thalassemia major: When to initiate?
abstract: BACKGROUND
  To determine optimal initial age of cardiac iron screening with magnetic resonance imaging (MRI) T2* in patients with thalassemia major (TM).
  
  
  METHODS
  We retrospectively reviewed black blood cardiac T2* assessments from 102 TM patients from the ages of 3 to 32 years. Cases of patients under and above 7 years old with detectable cardiac iron overload were analyzed separately. Associations between cardiac T2* and various factors, such as serum ferritin (SF), patient age and hepatic T2*, were assessed using either scatterplots or regression. Images were evaluated by two independent radiologists.
  
  
  RESULTS
  With a T2* cut-off value of 20 ms, no patient under 5 years old showed cardiac iron overload. Three of 19 (15.8%) patients under 7 years of age had a cardiac T2* ≤ 20 ms (5.5 to 7 years) but none had ≤10 ms, while 35 of 83 (42.2%) patients above 7 years old had a cardiac T2* ≤ 20 ms (8 to 32 years) and 18 of them ≤10 ms. Cardiac T2* correlated weakly with serum ferritin and liver T2* (r = -0.39 and 0.41, respectively, both P < 0.001), but not with patient age (P > 0.05).
  
  
  CONCLUSIONS
  Cardiac iron overload can occur in young TM patients, even as young as 5.5 years old. Assessment of cardiac iron with T2* might need to begin as early as 5 years old if suboptimal chelation therapy is administered.
authors.affiliation: Sun Yat-Sen Memorial Hospital, Guang Zhou, Guang Dong, China.|Guangdong Medical College, Guangdong, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Chen
authors.affiliation: The Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
authors.forename: Zuoquan
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Sun Yat-Sen Memorial Hospital, Guang Zhou, Guang Dong, China.
authors.forename: Jinglian
authors.initials: J
authors.lastname: Zhong
authors.affiliation: Sun Yat-Sen Memorial Hospital, Guang Zhou, Guang Dong, China.
authors.forename: Qihua
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Sun Yat-Sen Memorial Hospital, Guang Zhou, Guang Dong, China.
authors.forename: Taihui
authors.initials: T
authors.lastname: Yu
authors.affiliation: Sun Yat-Sen Memorial Hospital, Guang Zhou, Guang Dong, China.
authors.forename: Ziliang
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: Philips Healthcare, Hong Kong, China.
authors.forename: Queenie
authors.initials: Q
authors.lastname: Chan
authors.affiliation: Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Guo
authors.affiliation: Sun Yat-Sen Memorial Hospital, Guang Zhou, Guang Dong, China.
authors.forename: Biling
authors.initials: B
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015913:Chelation Therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000097:blood / Q000737:chemistry*; D019190:Iron Overload; D008099:Liver / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000378:metabolism; D011871:Radiology; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult; D017086:beta-Thalassemia / Q000097:blood* / Q000473:pathology*
chemical_list: D005293:Ferritins; D007501:Iron
keywords: T2* measurement; heart; iron overload; thalassemia major