Cardiovascular MRI in thalassemia major.

MRI assessment of myocardial iron and function has revolutionized the treatment of thalassemia major patients. While knowledge of somatic iron stores is vital for iron chelation management, it does not adequately monitor cardiac risk. MRI monitoring of cardiac T2* allows preclinical recognition of myocardial iron, stratifies prospective cardiac risk, and tracks response to modifications in iron chelation therapy. MRI assessment of cardiac function complements T2* measurements by offering highly accurate and reproducible assessments of ventricular function. This manuscript describes the historical context of cardiac toxicity in thalassemia major, the introduction of cardiac T2* methods in the early 2000s, and the impact of these techniques on patient care as well as our fundamental understanding of iron cardiomyopathy. Technical details regarding T2* image acquisition and postprocessing are also discussed. As barriers to widespread implementation are being overcome, cardiac T2* is rapidly transitioning from a clinical research tool to the standard of care.