Utility of Transient Elastography in Estimating Hepatic Iron Concentration in Comparison to Magnetic Resonance Imaging in Patients Who are Transfusion-Dependent: A Canadian Center Experience

To evaluate the usefulness of magnetic resonance imaging for the quantitative determination of hepatic iron, we examined 43 patients with thalassemia major and assessed the influence of pathologic changes in the liver on the precision of estimates of the hepatic iron concentration. Tissue signal intensities were measured from magnetic resonance T1-weighted images derived from gradient-echo (GE) pulse sequences and the ratio of the signal intensity of liver to muscle calculated. By excluding patients (n = 9) having a signal intensity ratio (SIR) less than or equal to 0.2, a linear relationship with hepatic iron was found and subsequent analyses were limited to these 34 patients. In 27 patients with hepatic fibrosis, an overall correlation of −0.848 was found between hepatic iron and SIR. By contrast, in the seven patients with no fibrosis, the correlation coefficient (−0.993) was significantly greater (P < .0001). Despite the differences in correlation, the regression line between hepatic iron and SIR for the patients with no fibrosis did not differ significantly with respect to either slope or intercept from that of the patients with fibrosis. Thus, the presence of fibrosis did not seem to affect the pattern of the relationship between hepatic iron and the SIR, but rather to increase the variability of the relationship. Clinically, the presence of fibrosis makes estimates of hepatic iron derived from magnetic resonance imaging so variable as to be of little practical use in the management of transfusional iron overload.

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Limitations of Magnetic Resonance Imaging in Measurement of Hepatic Iron

Blood ◽

10.1182/blood.v90.12.4736 ◽

1997 ◽

Vol 90 (12) ◽

pp. 4736-4742 ◽

Cited By ~ 50

Author(s):

Emanuele Angelucci ◽

Andrea Giovagnoni ◽

Gianluca Valeri ◽

Enrico Paci ◽

Marta Ripalti ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Signal Intensity ◽

Regression Line ◽

Iron Concentration ◽

Pulse Sequences ◽

Thalassemia Major ◽

Hepatic Iron ◽

Resonance Imaging ◽

The Relationship

Abstract To evaluate the usefulness of magnetic resonance imaging for the quantitative determination of hepatic iron, we examined 43 patients with thalassemia major and assessed the influence of pathologic changes in the liver on the precision of estimates of the hepatic iron concentration. Tissue signal intensities were measured from magnetic resonance T1-weighted images derived from gradient-echo (GE) pulse sequences and the ratio of the signal intensity of liver to muscle calculated. By excluding patients (n = 9) having a signal intensity ratio (SIR) less than or equal to 0.2, a linear relationship with hepatic iron was found and subsequent analyses were limited to these 34 patients. In 27 patients with hepatic fibrosis, an overall correlation of −0.848 was found between hepatic iron and SIR. By contrast, in the seven patients with no fibrosis, the correlation coefficient (−0.993) was significantly greater (P < .0001). Despite the differences in correlation, the regression line between hepatic iron and SIR for the patients with no fibrosis did not differ significantly with respect to either slope or intercept from that of the patients with fibrosis. Thus, the presence of fibrosis did not seem to affect the pattern of the relationship between hepatic iron and the SIR, but rather to increase the variability of the relationship. Clinically, the presence of fibrosis makes estimates of hepatic iron derived from magnetic resonance imaging so variable as to be of little practical use in the management of transfusional iron overload.

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Iron overload in Brazilian thalassemic patients

Einstein (São Paulo) ◽

10.1590/s1679-45082011ao1897 ◽

2011 ◽

Vol 9 (2) ◽

pp. 165-172 ◽

Cited By ~ 2

Author(s):

Reijane Alves de Assis ◽

Fernando Uliana Kay ◽

Laércio Alberto Rosemberg ◽

Alexandre Henrique C. Parma ◽

Cesar Higa Nomura ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Iron Overload ◽

Serum Ferritin ◽

Iron Concentration ◽

Resonance Imaging ◽

Plasma Iron ◽

Imaging Results ◽

The Mean ◽

Hepatic Iron Concentration

ABSTRACT Objectives: To evaluate the use of magnetic resonance imaging in patients with β-thalassemia and to compare T2* magnetic resonance imaging results with serum ferritin levels and the redox active fraction of labile plasma iron. Methods: We have retrospectively evaluated 115 chronically transfused patients (65 women). We tested serum ferritin with chemiluminescence, fraction of labile plasma iron by cellular fluorescence and used T2* MRI to assess iron content in the heart, liver, and pancreas. Hepatic iron concentration was determined in liver biopsies of 11 patients and the results were compared with liver T2* magnetic resonance imaging. Results: The mean serum ferritin was 2,676.5 +/- 2,051.7 ng/mL. A fraction of labile plasma iron was abnormal (> 0,6 Units/mL) in 48/83 patients (57%). The mean liver T2* value was 3.91 ± 3.95 ms, suggesting liver siderosis in most patients (92.1%). The mean myocardial T2* value was 24.96 ± 14.17 ms and the incidence of cardiac siderosis (T2* < 20 ms) was 36%, of which 19% (22/115) were severe cases (T2* < 10 ms). The mean pancreas T2* value was 11.12 ± 11.20 ms, and 83.5% of patients had pancreatic iron deposition (T2* < 21 ms). There was significant curvilinear and inverse correlation between liver T2* magnetic resonance imaging and hepatic iron concentration (r= −0.878; p < 0.001) and moderate correlation between pancreas and myocardial T2* MRI (r = 0.546; p < 0.0001). Conclusion: A high rate of hepatic, pancreatic and cardiac impairment by iron overload was demonstrated. Ferritin levels could not predict liver, heart or pancreas iron overload as measured by T2* magnetic resonance imaging. There was no correlation between liver, pancreas, liver and myocardial iron overload, neither between ferritin and fraction of labile plasma iron with liver, heart and pancreas T2* values

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Duration of Hepatic Iron Exposure Increases the Risk of Significant Fibrosis in Hereditary Hemochromatosis: A New Role for Magnetic Resonance Imaging

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2005.41287.x ◽

2005 ◽

Vol 100 (4) ◽

pp. 837-841 ◽

Cited By ~ 63

Author(s):

John K. Olynyk ◽

Timothy G. St. Pierre ◽

Robert S. Britton ◽

Elizabeth M. Brunt ◽

Bruce R. Bacon

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Hereditary Hemochromatosis ◽

Hepatic Iron ◽

Resonance Imaging ◽

Significant Fibrosis

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Magnetic resonance imaging of transfusional hepatic iron overload

British Journal of Radiology ◽

10.1259/0007-1285-67-796-339 ◽

1994 ◽

Vol 67 (796) ◽

pp. 339-341 ◽

Cited By ~ 11

Author(s):

S Bondestam ◽

A Lamminen ◽

V-J Anttila ◽

T Ruutu ◽

P Ruutu

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Iron Overload ◽

Hepatic Iron ◽

Resonance Imaging ◽

Hepatic Iron Overload

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Evaluation of cardiac and hepatic iron overload in thalassemia major patients with T2* magnetic resonance imaging

Hematology ◽

10.1080/10245332.2017.1292614 ◽

2017 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Pustika Amalia Wahidiyat ◽

Felix Liauw ◽

Damayanti Sekarsari ◽

Siti Ayu Putriasih ◽

Vasili Berdoukas ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Iron Overload ◽

Thalassemia Major ◽

Hepatic Iron ◽

Resonance Imaging ◽

Hepatic Iron Overload

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Noninvasive assessment of iron overload by magnetic resonance imaging

Pediatric Hematology/Oncology and Immunopathology ◽

10.24287/1726-1708-2020-19-3-158-163 ◽

2020 ◽

Vol 19 (3) ◽

pp. 158-163

Author(s):

E. E. Nazarova ◽

D. A. Kupriyanov ◽

G. A. Novichkova ◽

G. V. Tereshchenko

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Iron Overload ◽

Serum Ferritin ◽

Serum Ferritin Level ◽

Ferritin Level ◽

Iron Concentration ◽

The Body ◽

Iron Accumulation ◽

Resonance Imaging

The assessment of iron accumulation in the body is important for the diagnosis of iron overload syndrome or planning and monitoring of the chelation therapy. Excessive iron accumulation in the organs leads to their toxic damage and dysfunction. Until recently iron estimation was performed either directly by liver iron concentration and/or indirectly by measuring of serum ferritin level. However, noninvasive iron assessment by Magnetic resonance imaging (MRI) is more accurate method unlike liver biopsy or serum ferritin level test. In this article, we demonstrate the outlines of non-invasive diagnostics of iron accumulation by MRI and its specifications.

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Value of Abdominal Susceptibility-Weighted Magnetic Resonance Imaging for Quantitative Assessment of Hepatic Iron Deposition in Patients with Chronic Hepatitis B: Comparison with Serum Iron Markers

Journal of International Medical Research ◽

10.1177/147323001204000319 ◽

2012 ◽

Vol 40 (3) ◽

pp. 1005-1015 ◽

Cited By ~ 5

Author(s):

W Lv ◽

F Yan ◽

M Zeng ◽

J Zhang ◽

Y Yuan ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Chronic Hepatitis ◽

Magnetic Resonance ◽

Serum Iron ◽

Hbv Infection ◽

Iron Deposition ◽

Hepatic Iron ◽

Healthy Controls ◽

Resonance Imaging ◽

Weighted Magnetic Resonance Imaging

OBJECTIVE: To assess hepatic iron deposition quantitatively in patients with chronic hepatitis B (HBV) infection, using abdominal susceptibility-weighted magnetic resonance imaging (SWI). METHODS: Patients with HBV infection and healthy controls underwent abdominal SWI and were assessed for serum iron markers. Phase values were measured and five grades of hepatic iron deposition were described by SWI. RESULTS: Patients with HBV infection ( n = 327) and healthy controls ( n = 50) were prospectively enrolled. In total, 77 (25.4%) patients with HBV infection had hepatic iron deposition as determined by SWI. Phase values were significantly different between patients with hepatic iron deposition compared with patients without hepatic iron deposition or controls, and were significantly different across different grades of hepatic iron deposition. Serum iron, ferritin, transferrin and transferrin saturation were significantly higher in patients with, versus those without, hepatic iron deposition. Only serum ferritin was significantly different across different grades of hepatic iron deposition, and there was a low inverse correlation between serum ferritin and phase values. CONCLUSIONS: Compared with serum iron markers, abdominal SWI may represent a powerful tool to assess hepatic iron deposition quantitatively in patients with chronic HBV infection.

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