Renal Iron Load Estimation in Thalassemia Patients Using T2* Magnetic Resonance Imaging

Purpose: Multi-organ hemosiderosis is a known complication in thalassemia patients with chronic blood transfusion. T2-Star (T2*) MRI has been introduced as a non-invasive tool for detecting iron overload in the liver and heart in these patients. This study is to determine and assess renal iron overload by MRI and its relation to liver and heart iron and serum ferritin in Iranian thalassemia patients. Methods: Total 821 transfusion dependent major and intermediate thalassemia patients (age range 10-50 years) were included in this study and calculations were done on their MRI data in a medical imaging center through 2014-2016. Iron values were calculated and averaged in a different region of interests (ROI) using fast-gradient-echo multi-echo T2* sequences. Results: Pathological renal iron content less than 36 ms was around 19.6%. The mean T2* kidney of the total population was 50.26 ms. A moderate negative, statistically significant correlation between kidney T2* relaxation time and serum ferritin was noted. For liver and heart, T2* relaxation time weakly, a statistically significant correlation was acquired by renal T2* relaxation time. Conclusions: Renal hemosiderosis was shown in numerous thalassemia patients. Since the frequency of renal iron deposition was approximately 20% in TM patients in a general population study, it might shed light that frequently monitors the renal iron loading merit hematologists in preventing the secondary side effects.

Relieving pain in oral lesions of pemphigus vulgaris using the non-ablative, non-thermal, co2 laser therapy [NTCLT]: preliminary results of a novel approach

Introduction: Pemphigus vulgaris [PV] is a chronic, serious autoimmune mucocutaneous bullous disease. Oral lesions in PV may be extremely painful. This pain may adversely affect the patients' oral intake and quality of life. This before-after clinical trial was designed to assess the pain relieving effects of single session of non-ablative, non-thermal CO2 laser therapy [NTCLT] in oral lesions of PV

Methods: Fifty painful oral lesions of fourteen patients with PV were illuminated by CO2 laser [power: 1 W, scanning the lesions with rapid circular motion of the handpiece] passing through a thick layer of transparent gel with high water content. The pain severity of the oral lesions was reported by the patients up to the fourth postoperative day. They were also asked to continue their existing systemic treatment during the course of this study as a precondition for the participation

Results: The severity of contact and non-stimulate [non-contact] pain declined immediately and significantly after NTCLT [P < 0.001]. The pain relieving effect was sustained during the four successive days of follow-up. The procedure was pain free and no kind of analgesics was required. Following NTCLT, there were no visible thermal complications such as destruction, ablation or irritation of the oral lesions

Conclusion: The results of the trial proposed that single session of NTCLT could immediately and significantly relieve pain in oral lesions of PV, without any visible thermal complications

T2-star [T2*] magnetic resonance imaging for assessment of kidney iron overload in thalassemic patients

Improved survival in thalassemic patients has lead to the manifestation of morbidities such as renal dysfunction. This involvement suggests the need for a reliable and non-invasive method to assess the degree of kidney iron overload. We conducted the present study to evaluate the relationship between serum ferritin levels, liver, heart, and kidney MRI gradient echo [T2*] relaxation times in thalassemic patients, as a step to evaluate the feasibility of using MRI T2* to assess the degree of kidney iron overload. This was a prospective study of 120 [60 males, 60 females] regularly transfused thalassemic patients [mean age: 25.9 +/- 9 years] who suffered from major and intermediate thalassemia. Patients attended an adult thalassemia clinic located in Tehran, Iran. Cardiac, hepatic and renal MRI T2* were performed. Serum ferritin levels were measured. Our results indicated a moderate correlation between kidney MRI T2* relaxation time and serum ferritin [r = -0.446, P < 0.001]. Kidney MRI T2* relaxation time weakly correlated with liver MRI T2* relaxation time [r = 0.388, P < 0.001] and cardiac MRI T2* relaxation time [r = 0.338, P = 0.023]. The moderate correlation between kidney MRI T2* relaxation time and serum ferritin, and its weak correlation with liver and heart T2* relaxation times indicate that relying on liver and heart MRI T2*, as well as serum ferritin levels to predict the exact condition of kidney iron overload might not be a reliable approach. Our findings suggest the use of kidney MRI T2* as a noninvasive method for evaluating renal iron overload in thalassemic patients. Further studies to investigate the relation between kidney MRI T2* relaxation times and renal function, as well as the cost benefit of using this method, are suggested