MRI Measurements of Iron Load in Transfusion-Dependent Patients: Implementation, Challenges, and Pitfalls

Quinn, Charles T.; Pierre, Timothy G. St.

doi:10.1002/pbc.25882

Cited by 27 publications

(44 citation statements)

References 66 publications

(199 reference statements)

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“…Iron-chelating therapy requires careful monitoring of tissue iron concentrations to avoid adverse effects of excessive chelator administration. R2 and R2* methods based on MRI signal magnitude are used for noninvasively evaluating liver and heart iron concentrations (182-185). However, their accuracy can be limited by confounding factors, including fat, fibrosis, and edema.…”

Section: Clinical Applications Enabled By Qsm Biometal Imagingmentioning

confidence: 99%

“…R2 and R2* methods based on MRI signal magnitude are used for noninvasively evaluating liver and heart iron concentrations. [182][183][184][185] However, their accuracy can be limited by confounding factors, including fat, fibrosis, and edema. Both R2 and R2* depend on intravoxel contents in a very complex manner, 186 making it very difficult to resolve iron content from these confounders.…”

Section: Iron In Macrophages and Microglia: Inflammatory Diseases Exementioning

confidence: 99%

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Clinical quantitative susceptibility mapping (QSM): Biometal imaging and its emerging roles in patient care

Wang

Spincemaille

Liu

et al. 2017

Magnetic Resonance Imaging

234

199

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Quantitative susceptibility mapping (QSM) has enabled MRI of tissue magnetic susceptibility to advance from simple qualitative detection of hypointense blooming artifacts to precise quantitative measurement of spatial biodistributions. QSM technology may be regarded to be sufficiently developed and validated to warrant wide dissemination for clinical applications of imaging isotropic susceptibility, which is dominated by metals in tissue, including iron and calcium. These biometals are highly regulated as vital participants in normal cellular biochemistry, and their dysregulations are manifested in a variety of pathologic processes. Therefore, QSM can be used to assess important tissue functions and disease. To facilitate QSM clinical translation, this review aims to organize pertinent information for implementing a robust automated QSM technique in routine MRI practice and to summarize available knowledge on diseases for which QSM can be used to improve patient care. In brief, QSM can be generated with postprocessing whenever gradient echo MRI is performed. QSM can be useful for diseases that involve neurodegeneration, inflammation, hemorrhage, abnormal oxygen consumption, substantial alterations in highly paramagnetic cellular iron, bone mineralization, or pathologic calcification; and for all disorders in which MRI diagnosis or surveillance requires contrast agent injection. Clinicians may consider integrating QSM into their routine imaging practices by including gradient echo sequences in all relevant MRI protocols.

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Section: Clinical Applications Enabled By Qsm Biometal Imagingmentioning

confidence: 99%

Section: Iron In Macrophages and Microglia: Inflammatory Diseases Exementioning

confidence: 99%

Clinical quantitative susceptibility mapping (QSM): Biometal imaging and its emerging roles in patient care

Wang

Spincemaille

Liu

et al. 2017

Magnetic Resonance Imaging

234

199

View full text Add to dashboard Cite

show abstract

“…Complications due to iron overload continues to be a leading cause of morbidity and mortality in patients with transfusion dependent thalassaemia [1,2]. This is no exception in the 2000 or so patients with thalassaemia who attend transfusion centres in Sri Lanka [3]. Liver is a major organ of iron deposition ensuing liver parenchymal damage, fibrosis, cirrhosis, liver failure and hepatocellular carcinoma [3].…”

Section: Introductionmentioning

confidence: 99%

“…This is no exception in the 2000 or so patients with thalassaemia who attend transfusion centres in Sri Lanka [3]. Liver is a major organ of iron deposition ensuing liver parenchymal damage, fibrosis, cirrhosis, liver failure and hepatocellular carcinoma [3].…”

Section: Introductionmentioning

confidence: 99%

Comparison of liver MRI R2(FerriScan®) VS liver MRI T2* as a measure of body iron load in a cohort of beta thalassaemia major patients

Padeniya

Siriwardana

Ediriweera

et al. 2020

Orphanet J Rare Dis

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To compare the similarity of the non-patented T2* and the high cost patented R2 (Ferriscan®) MRI techniques in the measurement of liver iron concentration (LIC) in heavily transfused patients with thalassaemia major in a reallife Sri Lankan hospital setup. We compared LIC measured by MRI, obtained 2 weeks apart, using both T2* and R2 techniques in 15 patients with beta thalassaemia major. They all had a history of > 100 units of blood transfusions life long and also a history of sub optimal chelation. MRI R2 and MRI T2* scan values showed a negative correlation (co-rrelation coefficient = − 0.63, p = 0.01) This correlation was strong in lower LICs and progressively decreased with upper LIC values. Thus a significant discrepancy was observed between median values of two MRI technologies (p = 0.0005) with T2* tending to underestimate iron overload especially in those with very high LIC identified by R2. The lack of concordance of T2* and R2 especially in those with very high reading on R2 suggest the potential errors in interpretations that can occur in "non-expert centres"; which are likely to lead to errors in clinical judgement on the intensity of chelation therapy needed.

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“…Inflammation may be observed in the context of SCT due to recruitment of macrophages, especially during GvHD. Many other factors, like malnutrition and malignancy, or different liver and kidney diseases are known to affect SF levels as well 4,6,9,11,[14][15][16][17] : It would therefore not be very reliable to consider the upper normal range of SF as the limit for iron overload. Thus, an established, higher threshold for clinically significant iron overload has been defined when the SF level exceeds 1000 µg/L in two subsequent determinations.…”

Section: Introductionmentioning

confidence: 99%

MRI as an alternative to serum ferritin for diagnosis of iron overload in children in the context of immune response after stem cell transplantation

Wurschi

Mentzel

Herrmann

et al. 2019

Pediatric Transplantation

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Multiple blood cell transfusions may cause iron overload or even liver fibrosis, requiring early diagnosis and intervention. SF is the standard for estimating iron levels in the body, but it also increases with inflammation. We hypothesized that T2* magnetic resonance (MR) relaxometry is a more accurate alternative for follow‐up in pediatric patients before and after allogenic SCT. Twenty‐three children (mean age 10.2 years, 10 female, 13 male) were evaluated prospectively before SCT as well as at least 1 year after SCT with T2* relaxometry on a 1.5 T MR‐scanner to estimate liver iron concentrations from the T2* values (“MR‐Fe”). The results were compared with SF, while also considering CRP, and correlated with the number of transfusions. Overall, 24.3 transfusions were administered in average, mainly within 100 days of SCT (mean 10.5 units). Both MR‐Fe and SF increased after SCT and decreased in the absence of new transfusions 1 year later without chelate therapy. This suggests regeneration of LP and iron loss, although the original states were not reached. Additionally, simultaneous peaks of CRP and SF were observed directly after SCT. MR‐Fe did neither reveal these peaks nor was it associated with CRP (P = .39). We postulate that these early CRP and SF peaks after SCT are probably related to inflammatory reactions and not to iron overload. Thus, SF is not reliable for iron overload diagnosis after SCT in every condition. Beside this interaction, SF and MR‐Fe revealed similar accuracy. MRI, however, has practical and economical disadvantages in routine estimation of iron.

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MRI Measurements of Iron Load in Transfusion-Dependent Patients: Implementation, Challenges, and Pitfalls

Cited by 27 publications

References 66 publications

Clinical quantitative susceptibility mapping (QSM): Biometal imaging and its emerging roles in patient care

Clinical quantitative susceptibility mapping (QSM): Biometal imaging and its emerging roles in patient care

Comparison of liver MRI R2(FerriScan®) VS liver MRI T2* as a measure of body iron load in a cohort of beta thalassaemia major patients

MRI as an alternative to serum ferritin for diagnosis of iron overload in children in the context of immune response after stem cell transplantation

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