Article Text


006 Role of T1 mapping as a complementary tool to T2* for non-invasive cardiac iron overload assessment


Background Iron overload-related heart failure is the principal cause of death in transfused Thalassemia Major1–2 and other iron overload patients. Linking cardiac siderosis measured by T2* to therapy improves outcome in Thalassemia Major. Aim of our study is to compare T1 mapping (Modified Lock Locker Inversion recovery, MOLLI) to dark (DB) and bright (BB) blood T2*3–4 in cardiac iron overload and to support the hypothesis that T1 mapping has higher sensibility to T2* for small amount of iron, which would make it a complementary tool to T2* in borderline iron overload patients.5–6

Methods In a prospectively large single centre study of 138 Thalassemia Major patients and 32 healthy controls, we compared MOLLI to DB and BB T2* acquired on an Avanto 1.5T scanner (Siemens Healthcare, Erlangen, Germany). Linear regression analysis was used to assess the association between DBT2* and either BBT2* and MOLLI, and the determination coefficient was computed in a log-log scale with moving windows to detect the point where this association decreases.

Results The relationship between T2* (here DB) and MOLLI is described by a log-log linear regression, which can be split in three different slopes: 1) T2* low, <20ms: r2=0.92; 2) T2*=20–28 ms: r2=0.80; 3) T2*>28 ms, no relationship. All subjects with T2*<20 ms had low T1; of those with T2*>20 ms, 38% had low T1.

Conclusions These data support the former proposal that T1 detects missed iron 1 in 3 subjects with normal T2* and that T1 mapping is a complementary tool for non-invasive assessment of cardiac iron. The clinical significance of a low T1, normal T2* should be further investigated. A trend toward LV end diastolic volume increase was observed in the patients with low T1 and normal T2* at 24 months, but the sample was too small to be analysed (n=9).


  1. . Modell B, Khan M, Darlison M, Westwood MA, Ingram D, Pennell DJ. Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson2008;10:42.

  2. . Carpenter JP, Pennell DJ. On T2* Magnetic Resonance and Cardiac Iron. Circulation2011;14:1519–28.

  3. . Wood JC, Otto-Duessel M, Aguilar M, et al. Cardiac Iron Determines Cardiac T2*, T2, and T1 in the Gerbil Model of Iron Cardiomyopathy. Circulation2005;112(4):535–543.

  4. . Carpenter JP, He T, Kirk P, et al. Calibration of myocardial T2 and T1 against iron concentration. J Cardiovasc Magn Reson2014;16:62.

  5. . Alam MH, Auger D, Smith GC, et al. T1 at 1.5T and 3T compared with conventional T2* at 1.5T for cardiac siderosis. J Cardiovasc Magn Reson. 2015;17:102.

  6. . Messroghli DR, Radjenovic A, Kozerke S, Higgins DM, Sivananthan MU, Ridgway JP. Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart. Magn Reson Med2004;52(1):141–6.

  7. . Alam MH, Auger D, Smith GC, et al. T1 at 1.5T and 3T compared with conventional T2* at 1.5T for cardiac siderosis. J Cardiovasc Magn Reson2015;17(24):102.

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.