Non-invasive assessment of hepatic iron stores by MRI

Gandon, Y.; Olivié, Damien; Guyader, Dominique; Aubé, Christophe; Oberti, Frédéric; Sebille, Véronique; Deugnier, Yves

doi:10.1016/s0140-6736(04)15436-6

Cited by 607 publications

(606 citation statements)

References 26 publications

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“…The measurement of LIC by highly T2*-weighted MRI was demonstrated to correlate well with the iron content assessed by invasive liver biopsy [24,27,31]. Iron determination by MRI is a reproducible, sensitive, and noninvasive method that can reduce the need for liver biopsies to assess liver iron content especially in thrombocytopenic patients.…”

Section: Discussionmentioning

confidence: 86%

“…Bone marrow iron stores were assessed semiquantitatively on Prussian-blue-stained marrow smears according to the following scale: grade 0= absent; 1=decreased; 2=normal; 3=increased; 4=markedly increased; 5=massively increased. LIC was determined quantitatively by T2*-weighted MRI as described previously [24][25][26]. An LIC >35-µmol/g liver tissue was considered as iron overload.…”

Section: Methodsmentioning

confidence: 99%

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Deferasirox in MDS patients with transfusion-caused iron overload—a phase-II study

et al. 2008

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International audienceBlood transfusions represent a main component of supportive care in myelodysplastic syndromes (MDS). To avoid organ damage caused by transfusion-dependent iron overload, an adequate iron chelation therapy is required. Recently, a new oral iron chelator deferasirox (ICL670, Exjade®) has become available. A study was conducted to demonstrate the efficacy and tolerability of deferasirox in transfusion-dependent iron-overloaded patients with MDS. The efficacy of deferasirox was monitored by changes in serum ferritin, bone marrow iron, and liver iron concentration (LIC), as determined by T2*-weighted magnetic resonance imaging. Twelve patients with MDS of different subtypes (median age 76 years, range 53–91) were enrolled. Deferasirox administered in a once-daily dose of 20–30 mg/kg for 12 months was effective in reducing median ferritin concentration from 1,515 µg/L (range 665–6,900) to 413 µg/L (range 105–3,052). Within the first 4 weeks of treatment before the continuous decline of ferritin levels, the values markedly rose in eight of 12 patients. The median LIC declined from 315 to 230 µmol/g ( = 0.02) at the end of study, accompanied by a reduction of bone marrow siderosis. The most common adverse events were mild and transient gastrointestinal disturbances, skin rash, nonprogressive transient increases in serum creatinine and urine β2-microglobulin, and a temporary reduction of the creatinine clearance. The renal parameters normalized after end of treatment. No hematologic toxicities were observed. Deferasirox proved to be effective in transfusion-dependent iron overload in MDS by mobilizing iron deposits in liver and at least stabilizing iron stores in bone marrow

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Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Deferasirox in MDS patients with transfusion-caused iron overload—a phase-II study

et al. 2008

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“…Numerous MRI methods have been proposed for liver iron evaluation and quantification [10]. Hepatic iron can be assessed by measuring signal intensity ratios (SIRs) of the liver and of a reference tissue with good correlation [11]. Direct measurement of the relaxation time (relaxometry) can also quantify liver iron by either measuring T2 relaxation times from spin echo sequences or T2* relaxation times (or relaxation rates R2*) from gradient echo sequences [4,12].…”

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confidence: 99%

R2* Relaxometry for the Quantification of Hepatic Iron Overload: Biopsy-Based Calibration and Comparison with the Literature

Henninger

Zoller

Rauch

et al. 2015

Fortschr Röntgenstr

107

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We compared the calibration of hepatic iron based on R2* relaxometry and liver biopsy with similar studies that have already been published to investigate the transferability of published calibration curves. Materials and Methods: 17 patients with clinically suspected hepatic iron overload (HIO) were enrolled. All patients underwent liver biopsy and MRI of the liver using a multi-echo gradient echo sequence (TR = 200 ms; TE-initial 0.99 ms; Delta-TE 1.41 ms; 12 echos; flip-angle: 20°). R2* parameter maps were analyzed using manually placed regions of interest and R2* values were correlated with liver iron concentration (LIC) obtained from liver biopsy. In addition, the results of our study were compared with 6 similar, already published studies. Results: A linear relationship between R2* and LIC was found. Regression analysis yielded a correlation coefficient of 0.926, a slope of 0.024 (s mg/g) [95 % CI 0.013 -0.024] and an intercept of 0.277 (mg/g) [95 % CI -0.328 -2.49]. We found a significant correlation between the calibration curves obtained from our study in comparison to 3/6 similar studies. The other 3 studies used a different reference standard or sequence parameters which lead to a significant difference for slope, intercept or both in comparison to our data. Conclusion: Calibration curves from published studies that are based on a correlation of liver biopsy and R2* can be used for the estimation of liver iron concentration, although different scanning parameters and post-processing protocols were used. Low initial TEs might be a prerequisite for pooling data for liver iron quantification.

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“…The method was applied for the first time by Hernandez et al [14] to gradient-echo sequences. A further development of the method was published by Gandon et al [19]. Gandon's method is based on the postulated linear relationship between the LIC and signal intensity ratio (SIR) depending on the protocol.…”

Section: Signal-intensity Ratiomentioning

confidence: 99%

Noninvasive MRI-Based Liver Iron Quantification: Methodic Approaches, Practical Applicability and Significance

Wunderlich

Cario²,

Juchems

et al. 2016

Fortschr Röntgenstr

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Pathophysiology of iron overload ▼Normal iron content plays an important role in the physiological processes of the human body. A disturbance to the precisely regulated iron metabolism system has serious consequences. Therefore, for example, iron overload results in oxidative damage to membrane lipids and proteins and in DNA damage that can cause mitochondrial and lysosomal dysfunction, changes in gene expression, and changes in tumor suppressor genes (p53). Organ damage due to iron overload primarily affects the heart and liver as well as the endocrine organs, i. e., the pituitary gland, pancreas, thyroid, parathyroid, and gonads [1]. Cardiac insufficiency and arrhythmia as a result of myocardial siderosis are the most Abstract ▼Due to the dependence of transverse relaxation times T 2 and T 2 * on tissue iron content, MRI offers different options for the determination of iron concentration. These are the timeconsuming spin-echo sequence as well as the gradient-echo sequence. For the latter, several data analysis approaches have been proposed, with different requirements for acquisition and post-processing: the mathematically challenging R 2 * analysis and the signal-intensity ratio method with its high demand on the signal homogeneity of MR images. Furthermore, special procedures currently under evaluation are presented as future prospects: quantitative susceptibility imaging, as a third approach for analyzing gradient echo data, and multicontrast spin-echo using repeated refocusing pulses. MR theory, as far as needed for understanding the methods, is briefly depicted.

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Non-invasive assessment of hepatic iron stores by MRI

Cited by 607 publications

References 26 publications

Deferasirox in MDS patients with transfusion-caused iron overload—a phase-II study

Deferasirox in MDS patients with transfusion-caused iron overload—a phase-II study

R2* Relaxometry for the Quantification of Hepatic Iron Overload: Biopsy-Based Calibration and Comparison with the Literature

Noninvasive MRI-Based Liver Iron Quantification: Methodic Approaches, Practical Applicability and Significance

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