Diagnostic and interventional radiology (Ankara, Turkey) · 2026
Magnetic resonance imaging evaluation of myocardial and hepatic tissue remodeling and cardiac function in sickle cell anemia.
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Başaran Serhat, Esen Kaan, Akdeniz Aydan, Yüksek Hasan H, Balcı Yüksel
Аннотация
PURPOSE: To assess myocardial and hepatic tissue remodeling in patients with sickle cell anemia (SCA) using T1 mapping and extracellular volume (ECV) measurements, and to evaluate diastolic dysfunction (DD) using magnetic resonance imaging (MRI).
METHODS: This prospective study enrolled 32 patients with SCA (19 women; mean age: 37 years) and 12 healthy controls (8 men; mean age: 31 years). Myocardial T1, T2, and T2* values and hepatic T1 and T2* values were measured in both groups. Myocardial and hepatic ECV measurements were performed in the patient group. DD was evaluated using transmitral flow (TMF) curves and left atrial volume index (LAVI).
RESULTS: In patients with SCA, the mean myocardial T1 value was 1,030.91 ms, significantly higher than in controls, and the mean ECV was 31.7% ± 3.1%, higher than published reference ranges. Moreover, LAVI was significantly higher in patients than in controls (46.48 ± 15.35 vs. 30.58 ± 5.0 mL/m²; P < 0.001). Diastolic function assessment revealed findings suggestive of a restrictive filling pattern in 10 individuals, who had an average age of 33 years. Within the SCA cohort, patients with TMF-derived early/late ratio >2 (n = 10) had significantly higher LAVI than the remaining patients (54.05 ± 10.12 vs. 43.0 ± 16.26 mL/m²; P = 0.027). Myocardial ECV was significantly higher in patients with findings suggestive of a restrictive filling pattern than in the remaining patients (34.14% ± 2.39% vs. 30.62% ± 2.67%; P = 0.001). The mean myocardial T2* value was 39.25 ± 5.9 ms, and no cardiac iron accumulation was detected. The mean hepatic T2* value was 12.20 ms, with iron accumulation observed in 16 patients. Iron accumulation can have an impact on T1 values, and measurements in patients without iron accumulation revealed a mean liver T1 value (626.5 ms) that was significantly higher than that in controls (P < 0.001). These patients also had an ECV (40.4%) that was higher than published reference ranges (P < 0.001).
CONCLUSION: Increased myocardial and hepatic T1 and ECV values were observed in patients with SCA, suggesting expansion of the extracellular space, largely consistent with diffuse interstitial fibrosis in this clinical context. Diastolic function assessment revealed a restrictive filling pattern in a substantial proportion of patients, supporting a possible association between SCA and this pattern. Myocardial ECV was significantly higher in patients with findings suggestive of a restrictive filling pattern than in the remaining patients, suggesting an association between diffuse interstitial fibrosis and advanced DD patterns. MRI may be a valuable modality for evaluating myocardial and hepatic fibrosis and assessing cardiac function.
CLINICAL SIGNIFICANCE: MRI with mapping and ECV quantification may contribute to a non-invasive, quantitative assessment of myocardial and hepatic fibrosis-related tissue remodeling in patients with SCA. Moreover, TMF analysis may provide valuable insights into diastolic function. Together, these methods could contribute to the clinical evaluation and management of SCA and other diseases characterized by fibrosis-related remodeling.
METHODS: This prospective study enrolled 32 patients with SCA (19 women; mean age: 37 years) and 12 healthy controls (8 men; mean age: 31 years). Myocardial T1, T2, and T2* values and hepatic T1 and T2* values were measured in both groups. Myocardial and hepatic ECV measurements were performed in the patient group. DD was evaluated using transmitral flow (TMF) curves and left atrial volume index (LAVI).
RESULTS: In patients with SCA, the mean myocardial T1 value was 1,030.91 ms, significantly higher than in controls, and the mean ECV was 31.7% ± 3.1%, higher than published reference ranges. Moreover, LAVI was significantly higher in patients than in controls (46.48 ± 15.35 vs. 30.58 ± 5.0 mL/m²; P < 0.001). Diastolic function assessment revealed findings suggestive of a restrictive filling pattern in 10 individuals, who had an average age of 33 years. Within the SCA cohort, patients with TMF-derived early/late ratio >2 (n = 10) had significantly higher LAVI than the remaining patients (54.05 ± 10.12 vs. 43.0 ± 16.26 mL/m²; P = 0.027). Myocardial ECV was significantly higher in patients with findings suggestive of a restrictive filling pattern than in the remaining patients (34.14% ± 2.39% vs. 30.62% ± 2.67%; P = 0.001). The mean myocardial T2* value was 39.25 ± 5.9 ms, and no cardiac iron accumulation was detected. The mean hepatic T2* value was 12.20 ms, with iron accumulation observed in 16 patients. Iron accumulation can have an impact on T1 values, and measurements in patients without iron accumulation revealed a mean liver T1 value (626.5 ms) that was significantly higher than that in controls (P < 0.001). These patients also had an ECV (40.4%) that was higher than published reference ranges (P < 0.001).
CONCLUSION: Increased myocardial and hepatic T1 and ECV values were observed in patients with SCA, suggesting expansion of the extracellular space, largely consistent with diffuse interstitial fibrosis in this clinical context. Diastolic function assessment revealed a restrictive filling pattern in a substantial proportion of patients, supporting a possible association between SCA and this pattern. Myocardial ECV was significantly higher in patients with findings suggestive of a restrictive filling pattern than in the remaining patients, suggesting an association between diffuse interstitial fibrosis and advanced DD patterns. MRI may be a valuable modality for evaluating myocardial and hepatic fibrosis and assessing cardiac function.
CLINICAL SIGNIFICANCE: MRI with mapping and ECV quantification may contribute to a non-invasive, quantitative assessment of myocardial and hepatic fibrosis-related tissue remodeling in patients with SCA. Moreover, TMF analysis may provide valuable insights into diastolic function. Together, these methods could contribute to the clinical evaluation and management of SCA and other diseases characterized by fibrosis-related remodeling.