title: Myocardial and liver iron overload, assessed using T2* magnetic resonance imaging with an excel spreadsheet for post processing in Tunisian thalassemia major patients.
abstract: Thalassemia is a common genetic disorder in Tunisia. Early iron concentration assessment is a crucial and challenging issue. Most of annual deaths due to iron overload occurred in underdeveloped regions of the world. Limited access to liver and heart MRI monitoring might partially explain these poor prognostic results. Standard software programs are not available in Tunisia. This study is the first to evaluate iron overload in heart and liver using the MRI T2* with excel spreadsheet for post processing. Association of this MRI tool results to serum ferritin level, and echocardiography was also investigated. One hundred Tunisian-transfused thalassemia patients older than 10 years (16.1 ± 5.2) were enrolled in the study. The mean myocardial iron concentration (MIC) was 1.26 ± 1.65 mg/g dw (0.06-8.32). Cardiac T2* (CT2*) was under 20 ms in 30 % of patients and under 10 ms in 21 % of patients. Left ventricular ejection function was significantly lower in patients with CT2* <10 ms. Abnormal liver iron concentration (LIC >3 mg/g dw) was found in 95 % of patients. LIC was over 15 mg/g dw in 25 % of patients. MIC was more correlated than CT2* to LIC and serum ferritin. Among patients with SF <1000 μg/l, 13 % had CT2* <20 ms. Our data showed that 30 % of the Tunisian thalassemia major patients enrolled in this cohort had myocardial iron overload despite being treated by iron chelators. SF could not reliably predict iron overload in all thalassemia patients. MRI T2* using excel spreadsheet for routine follow-up of iron overload might improve the prognosis of thalassemia major patients in developing countries, such as Tunisia, where standard MRI tools are not available or expensive.
authors.affiliation: Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia. moniahasan@yahoo.fr.|Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia. moniahasan@yahoo.fr.
authors.forename: Monia
authors.identifier: http://orcid.org/0000-0003-3642-6743
authors.initials: M
authors.lastname: Ouederni
authors.affiliation: Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.|Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia.
authors.forename: Monia
authors.initials: M
authors.lastname: Ben Khaled
authors.affiliation: Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.|Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia.
authors.forename: Fethi
authors.initials: F
authors.lastname: Mellouli
authors.affiliation: Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia.
authors.forename: Elhem
authors.initials: E
authors.lastname: Ben Fraj
authors.affiliation: Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia.
authors.forename: Nawel
authors.initials: N
authors.lastname: Dhouib
authors.affiliation: Department of Radiology, Charles Nicole Hospital, Tunis, Tunisia.
authors.forename: Ismehen Ben
authors.initials: IB
authors.lastname: Yakoub
authors.affiliation: Laboratory of Hematology, Pasteur Institute, Tunis, Tunisia.
authors.forename: Selem
authors.initials: S
authors.lastname: Abbes
authors.affiliation: Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.|Department of Radiology, Charles Nicole Hospital, Tunis, Tunisia.
authors.forename: Nejla
authors.initials: N
authors.lastname: Mnif
authors.affiliation: Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.|Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bejaoui
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019190:Iron Overload / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D009206:Myocardium / Q000378:metabolism*; D012984:Software; D065227:Transfusion Reaction; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult; D017086:beta-Thalassemia / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology
keywords: Cardiac magnetic resonance T2*; Iron overload; Liver iron concentration; Myocardial iron concentration; Serum ferritin; Thalassemia major