Use of an accelerated protocol for rapid analysis of iron overload in the heart and liver: the All Iron Detected (AID) Multicenter Study

• Grant number: 16/01098-2
• Support Opportunities: Regular Research Grants
• Start date: October 01, 2016
• End date: April 30, 2018
• Field of knowledge: Health Sciences - Medicine - Medical Radiology
• Principal Investigator: Juliano de Lara Fernandes
• Grantee: Juliano de Lara Fernandes
• Host Institution: Instituto de Ensino e Pesquisa José Michel Kalaf (IEPJMK). Campinas , SP, Brazil

Abstract

Background: One of the current limitations of iron overload assessment treatment is availability of MRI scanners especially in countries with limited resources. Because the cost of an MRI is directly linked to the time of the exam and the use of the scanner itself, any acquisition protocol should become more cost-effective if it can gain the essential information provided by the exam in the shortest time possible. Besides that, another limitation also involves transporting single patients or a reduced number of them from their local homes to larger cities where normally these scanners are operated. Many times, this requires hours of travelling with difficult to plan logistics and arrangements.Objectives: We propose one action to allow for a significant number of patients to be scanned in a single day using an optimized MRI protocol which should effectively produce liver and myocardial iron concentration values in patients at risk for iron overload. The project's main objective is to facilitate access to the exam for patients which would not routinely be scanned in a regular fashion thus having the ambitious goal of scanning all patients at risk in Brazil. The main idea is that no patient that requires an MRI scan for iron overload is left behind. Another objective is to reduce the cost of the scan as this would be a much more productive way of using the available scanner installed base.Methods: To accomplish this we propose the scheduling and transportation of 200 patients to be scanned in 6 patients per hour. The optimized protocol consists of only 4 sequences: localizers - 2 chamber localizer - heart short axis multiecho T2* imaging - axial liver multiecho T2* imaging. The whole protocol should require only 4 breath-holds with a total scan time of no more than 4 minutes (Figure 1). All images would be processed off-line for the calculation of LIC and MIC. No left ventricular function would be evaluated and any patient identified as high risk (heart T2* < 10ms, qualitative increase in heart volumes, indirect signs of heart failure, liver nodules, etc) would be notified for further testing depending on the finding.This would be possible with the use of a Siemens 1.5T scanner where these sequences are easily calibrated and acquired allowing for this time frame. If more patients request the exam for that day, we can use our second scanner which has the same configuration and increase the total number of patients scanned to 150 in a day.The patients would be invited by their local physicians and patient associations in a large campaign and could have access to the MRI site using buses to transport large number of patients or discounted airline tickets bought in bulk number if necessary. A pilot version of the project is expected to test for pre- and post-exam logistics where we plan to scan 12 patients in two hours before the AID day.Hypothesis: An optimized and dedicated protocol to scan a high number of patients for the assessment of iron overload is feasible and could help reduce costs and increase availability of the exam compared to routinely scheduled exams. This protocol could be exported to other countries besides Brazil where the number of patients at risk for iron overload is significantly higher and MRI machines are even more scarce. (AU)