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.

Preparation and biodistribution study of [99m]Tc-EC-Annexin-SPIO as a tracer of radiation induced apoptosis in mice model

Apoptosis is a major consequence of ionizing radiation in proliferative tissues and quantification of the apoptotic cells could be helpful for noninvasive assessment and estimation of the radiation absorbed dose. Annexin V conjugated with super paramagnetic iron oxide nanoparticles [ANX-SPIO] is a biological probe for detection of apoptotic cells using magnetic resonance imaging. This study aimed at assessing the biodistribution alterations of the labeled ANXSPIO within the mice body shortly after exposure to different doses of ionizing radiation. [99m]Tc-EC-ANX-SPIO was prepared and its in vitro stability was tested. The binding affinity of radiocomplex to apoptotic cells was validated in vitro. Mice irradiated whole body with 2, 4 and 6 Gy [[60]Co gamma rays] and six hours later, radiocomplex was administrated intravenously and the biodistribution study was conducted 0.5, 1 and 2 hours later. The radiochemical purity of radiocomplex was 94% +/- 3.4% and it showed a good stability in PBS and serum. The radiocomplex maintained its efficacy for in vitro binding to apoptotic cells. radiocomplex accumulated in the bone marrow of all irradiated mice [p <0.05]. However, statistical analysis did not show significant correlation between the %ID/g of the femoral bones and the received radiation doses. Quantification of ANX-SPIO in bone marrow can be used as an indicator for radiation exposure but development and optimization of the assay are necessary for discrimination between different radiation doses

Surveillance for hepatocellular carcinoma after autologous stem cell transplantation in Cirrhosis

During the resent years there has been interest in using bone marrow stem cells to treat liver cirrhosis. However, there is a potential concern for malignant transformation after stem cell therapy. The aim of this study was to evaluate the development of hepatocellular carcinoma [HCC] after autologous bone marrow stem cell transplantation for liver cirrhosis. All the patients who underwent autologous stem cell transplantation for liver cirrhosis between 2005 and 2011 at our center were enrolled. Cellular infusion was made through peripheral vein, portal vein, or hepatic artery.The patients were invited to undergo screening for hepatocellular carcinoma. The screening was made with ultrasonography and alpha-feto protein [AFP] measurement. Thirty two patients [18 males] were included in the study. Mean age of patients was 45.7 years. Fifteen patients [47%] received mesenchymal stem cell [MSC], 9 [28%] received bone marrow mononuclear cells, 5 [16%] were given CD 133-positive bone marrow cells, and 3 [9%] patients received CD 34-positive bone marrow cells. Mean duration of follow up was 20.5months. Mean serum level of AFP was 2.8 ng/ml at baseline and 3.4ng/ml at the end of follow up [p= 0.3]. One patient was found to have hepatocellular carcinoma three months after infusion of bone marrow mononuclear cells. The incidence rate for HCC was 1.8 cases per 100 person-years in this study. Autologous bone marrow stem cell infusion does not appear to increase the risk of hepatocellular carcinoma. The incidence rate of HCC in this study is comparable or even less than the reported rates of HCC in cohort studies of cirrhotic patients

[Designing a new CAD system for pulmonary nodule detection in High Resolution Computed Tomography [HRCT] images]

Lung diseases and lung cancer are among the most dangerous diseases with high mortality in both men and women. Lung nodules are abnormal pulmonary masses and are among major lung symptoms. A Computer Aided Diagnosis [CAD] system may play an important role in accurate and early detection of lung nodules. This article presents a new CAD system for lung nodule detection from chest computed tomography [CT] images. Twenty-five adult patients with lung nodules in their CT scan images presented to the National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Tehran, Iran in 2011-2012 were enrolled in the study. The patients were randomly assigned into two experimental [9 female, 6 male, mean age 43 +/- 5.63 yrs] and control [6 female, 4 male, mean age 39 +/- 4.91 yrs] groups. A fully-automatic method was developed for detecting lung nodules by employing medical image processing and analysis and statistical pattern recognition algorithms. Using segmentation methods, the lung parenchyma was extracted from 2-D CT images. Then, candidate regions were labeled in pseudo-color images. In the next step, some features of lung nodules were extracted. Finally, an artificial feed forward neural network was used for classification of nodules. Considering the complexity and different shapes of lung nodules and large number of CT images to evaluate, finding lung nodules are difficult and time consuming for physicians and include human error. Experimental results showed the accuracy of the proposed method to be appropriate [P<0.05] for lung nodule detection

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