Cardiovascular magnetic resonance T2* for tissue iron assessment in the heart

Until recently, even in Europe and the US, iron induced cardiomyopathy was the most common cause of death for patients with thalassemia major (TM). In order to prevent deaths from this potentially reversible condition, accurate measurement of myocardial iron is needed to detect iron early and guide chelation therapy. Cardiovascular magnetic resonance (CMR) T2* is the method of choice for the assessment of cardiac iron and in the UK, where it was first introduced clinically, 60% reductions in overall mortality for TM have been observed. The history of T2* development is described in this article. T2* image acquisition and post processing techniques are reviewed. Remaining challenges and emerging techniques to potentially improve characterization of tissue iron are also discussed.