Evaluation of bone marrow iron by magnetic resonance imaging

Isokawa, M.; Kimura, Fumiaki; Matsuki, Takashi; Omoto, Eijiro; Otsuka, Kayo; Kurokawa, Hironori; Togami, Izumi; Hiraki, Yoshio; Kimura, Ikuo; Harada, Masaru

doi:10.1007/s002770050298

Cited by 14 publications

(17 citation statements)

References 18 publications

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“…Histologic studies also report that serum ferritin level is proportional to bone marrow iron stores, except in patients with inflammation, liver disease and malignancy [43][44][45].…”

Section: Discussionmentioning

confidence: 96%

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Bone marrow changes in beta-thalassemia major: quantitative MR imaging findings and correlation with iron stores

et al. 2006

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The purpose of this study is to describe the MR imaging features of bone marrow in beta-thalassemia major and investigate their relation to ferritin, liver and spleen siderosis. Spinal bone marrow was prospectively assessed on abdominal MR studies of 40 transfused beta-thalassemic patients and 15 controls using T1-w, Pd, T2*-w Gradient Echo (GRE) and T1-w turbo Spin Echo (TSE) sequences. Signal intensity (SI) ratios of liver, spleen and bone marrow to paraspinous muscles (L/M, S/M, B/M respectively) and the respective T2 relaxation rates (1/T2) were calculated. Serum ferritin levels were recorded. Bone marrow hypointensity in at least T2*-w GRE sequence was noted in 29/40 (72.5%) patients. Eleven/40 patients exhibited normal B/M on all MR sequences. Five/40 patients had normal B/M and low L/M. B/M correlated with L/M in T1-w TSE sequence only (r = 0.471, p = 0.05). B/M correlated with S/M and mean ferritin values in all sequences (r > 0.489, p < 0.01 and r > - 0.496, p < 0.03 respectively). Marrow 1/T2 did not correlate with ferritin values or liver and spleen 1/T2. B/M in transfused beta-thalassemic patients is related to splenic siderosis and ferritin levels. Although marrow is usually hypointense, it may occasionally display normal SI coexisting with liver hypointensity, a pattern typical of primary hemochromatosis.

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“…Histologic studies also report that serum ferritin level is proportional to bone marrow iron stores, except in patients with inflammation, liver disease and malignancy [43][44][45].…”

Section: Discussionmentioning

confidence: 96%

“…It is reported that T2 relaxometry is inappropriate for marrow iron quantification in patients with high marrow iron levels (over 400 μg/ml), due to extreme shortening of T2 relaxation time [43].…”

Section: Discussionmentioning

confidence: 99%

Bone marrow changes in beta-thalassemia major: quantitative MR imaging findings and correlation with iron stores

et al. 2006

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“…MRI has also been used to characterize tissue iron deposits in the brain, pituitary gland, bone marrow, kidney and pancreas [65][66][67][68][69][70][71]. Although less well validated and clinically exploited, these approaches are likely to become increasingly important in the assessment of transfusional iron overload.…”

Section: Other Target Organ Assessmentsmentioning

confidence: 99%

Magnetic resonance imaging measurement of iron overload

Wood

2007

Current Opinion in Hematology

215

197

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Purpose of review-To highlight recent advances in magnetic resonance imaging estimation of somatic iron overload. This review will discuss the need and principles of magnetic resonance imaging-based iron measurements, the validation of liver and cardiac iron measurements, and the key institutional requirements for implementation.Recent findings-Magnetic resonance imaging assessment of liver and cardiac iron has achieved critical levels of availability, utility, and validity to serve as the primary endpoint of clinical trials. Calibration curves for the magnetic resonance imaging parameters R2 and R2* (or their reciprocals, T2 and T2*) have been developed for the liver and the heart. Interscanner variability for these techniques has proven to be on the order of 5-7%.Summary-Magnetic resonance imaging assessment of tissue iron is becoming increasingly important in the management of transfusional iron load because it is noninvasive, relatively widely available and offers a window into presymptomatic organ dysfunction. The techniques are highly reproducible within and across machines and have been chemically validated in the liver and the heart. These techniques will become the standard of care as industry begins to support the acquisition and postprocessing software.

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“…Target Organ-Although MRI is most often used to estimate cardiac and hepatic iron, MRI can also been used to characterize tissue iron deposits in the brain, pituitary gland, bone marrow, kidney and pancreas (36)(37)(38)(39)(40)(41)(42). These approaches observe the same physical principles as cardiac and hepatic iron imaging but present different imaging challenges.…”

Section: Choice Of Field Strength-mostmentioning

confidence: 99%

“…In contrast, splenic iron deposits are quite large and spin-echo (R2) techniques will not yield accurate iron estimates in this organ. The merits and limitations of these other techniques are beyond the scope of this manuscript, but several key references are included for interested readers (36)(37)(38)(39)(40)(41)(42).…”

Section: Choice Of Field Strength-mostmentioning

confidence: 99%

Magnetic Resonance Imaging Assessment of Excess Iron in Thalassemia, Sickle Cell Disease and Other Iron Overload Diseases

2008

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Patients with transfusion-dependent anemia develop cardiac and endocrine toxicity from iron overload. Classically, serum ferritin and liver biopsy have been used to monitor patient response to chelation therapy. Recently, magnetic resonance imaging (MRI) has proven effective in detecting and quantifying iron in the heart and liver. Tissue iron is paramagnetic and increases the MRI relaxation rates R2 and R2* in a quantifiable manner. This review outlines the principles and validation of non invasive iron estimation by MRI, as well as discussing some of the technical considerations necessary for accurate measurements. Specifically, the use of R2 or R2* methods, choice of echo times, appropriate model for data fitting, the use of a pixel-wise or region-based measurement, and the choice of field strength are discussed.

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Evaluation of bone marrow iron by magnetic resonance imaging

Cited by 14 publications

References 18 publications

Bone marrow changes in beta-thalassemia major: quantitative MR imaging findings and correlation with iron stores

Bone marrow changes in beta-thalassemia major: quantitative MR imaging findings and correlation with iron stores

Magnetic resonance imaging measurement of iron overload

Magnetic Resonance Imaging Assessment of Excess Iron in Thalassemia, Sickle Cell Disease and Other Iron Overload Diseases

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