The role of MRI-R2* in the detection of subclinical pancreatic iron loading among transfusion-dependent sickle cell disease patients and correlation with hepatic and cardiac iron loading

Abstract

Objectives Pancreatic reserve could be preserved by early assessment of pancreatic iron overload among transfusion-dependent sickle cell disease (SCD) patients. This study aimed to measure pancreatic iron load and correlate its value with patients’ laboratory and radiological markers of iron overload. Materials and methods Sixty-six SCD children and young adults underwent MRI T2* relaxometry using a simple mathematical spreadsheet and laboratory assessment. Results The results indicated moderate-to-severe hepatic iron overload among 65.2% of studied cases. None had cardiac iron overload. Normal-to-mild iron overload was present in the pancreas in 86% of cases, and 50% had elevated serum ferritin > 2500 ug/L. There was no significant correlation between pancreatic R2* level, serum ferritin, and hepatic iron overload. Patients with higher levels of hemolysis markers and lower pre-transfusion hemoglobin levels showed moderate-to-severe pancreatic iron overload. Conclusion Chronically transfused patients with SCD have a high frequency of iron overload complications including pancreatic iron deposition, thereby necessitating proper monitoring of the body’s overall iron balance as well as detection of extrahepatic iron depositions.

Oral phytate supplementation on the progression of mild cognitive impairment, brain iron deposition and diabetic retinopathy in patients with type 2 diabetes: a concept paper for a randomized double blind placebo controlled trial (the PHYND trial)

“…QSM describes the magnetizability of a material to an applied magnetic field and is a substance-specific value ( 54 ). Iron causes MRI images to darken at a rate proportional to the iron load, with the half-life of this darkening defined as T2* ( 55 ). The rate of darkening, designated as R2*, is the reciprocal of T2* and is proportional to the iron content of the tissues ( 55 ).…”

“…Iron causes MRI images to darken at a rate proportional to the iron load, with the half-life of this darkening defined as T2* ( 55 ). The rate of darkening, designated as R2*, is the reciprocal of T2* and is proportional to the iron content of the tissues ( 55 ). MRI scanning estimates tissue iron concentration both by gradient echo imaging, which provides T2*, and spin echo imaging, which provides T2, the reciprocal of R2 ( 55 ).…”

“…The rate of darkening, designated as R2*, is the reciprocal of T2* and is proportional to the iron content of the tissues ( 55 ). MRI scanning estimates tissue iron concentration both by gradient echo imaging, which provides T2*, and spin echo imaging, which provides T2, the reciprocal of R2 ( 55 ). Novel NMR techniques allowed an improvement of tissue metal mapping methods and also the understanding of the ferroptosis mechanisms ( 53 , 55 ).…”

Kidney R2* Mapping for Noninvasive Evaluation of Iron Overload in Paroxysmal Nocturnal Hemoglobinuria

“…36,37 In addition, R2* values of the heart, 38 pancreas, 39 and liver 40 have been reported to increase in patients with β-thalassemia major. Moreover, the R2* values of the spleen, 41 pancreas, 42 and liver 43 were reported to increase significantly in patients with sickle cell disease. However, no previous study has reported kidney R2* values in PNH patients.…”