Correlation of Transient Elastography With MRI T2* and Serum Ferritin Levels in Children With Transfusion-Dependent Thalassemia

Objectives: We investigated the correlation of transient elastography (TE) with MRI R2* values and serum ferritin in patients with transfusion-dependent thalassemia (TDT) Methods: We reviewed hospital records of 59 patients with TDT aged ?8 years without any evidence of chronic liver disease and who had fibroscan within 3 months of MRI T2*, who seen at our center between January, 2014 and December, 2019. Spearman correlation and linear regression analysis were used to evaluate the correlation between TE liver stiffness measurements and R2* MRI values and with serum ferritin. Results: Mean (SD) age of the subjects was 13.0 (3.1) years and body mass index was 16.6 (2.3) kg/m2. Mean liver stiffness measurement, MRI T2*(3T), corresponding MRI R2*(3T), and ferritin values were 6.55 (3.10) kPa, 3.4 (4.6) milliseconds, 616.20 (383.9) Hz, and 2874.69 (1570.7) ng/ mL, respectively. TE measurements correlated with MRI R2* values (r=0.61; P=0.001) and with serum ferritin level (r=0.59, P=0.001). Conclusion: TE is a reliable tool to estimate hepatic iron overload in patients with TDT.

Estimation and quantification of liver iron concentration by magnetic resonance imaging

Background: Liver iron overload is considered to be the histological hallmark of genetic hemochromatosis. The accurate estimation of iron overload is important to establish the diagnosis of hemochromatosis. The aim of the present study was to estimate T2* liver value, quantify liver iron concentration (in milligram of iron per gram dry weight) and find out the appropriate therapy for patients with iron overload according to severity index.Methods: A cross-sectional observational study was carried out in Department of Radio Diagnosis, at B.Y.L. Nair Hospital and medical college, Mumbai from June 2017 to August 2018. A total of 50 cases were enrolled for the present study.Results: Male predominance (66.0%) was seen. Mean duration of disease among the studied cases was 10.52±6.06 years, with minimum and maximum duration of disease of 1 and 26 years respectively. Eight percent had compliance to visit and treatment among the enrolled cases.Conclusions: MRI was concluded to be potentially useful non-invasive method for evaluating liver iron stones in a wide spectrum of haematological and liver diseases.

Proton MR Spectroscopic Features According to Change of Hepatic Parenchymal Iron Content after SPIO Injection

PURPOSE: To determine the effect of iron on proton MR spectra (1H-MRS) by evaluating changes in 1H-MRS of the liver according to changes in hepatic parenchymal iron content. MATERIALS AND METHODS: We evaluated serial changes in 1H-MRS of the liver after intravenous infusion of SPIO in 40 rabbits. These were divided into eight groups of five, and in each group, respectively, 1H-MRS and T2WI MR images were acquired prior to SPIO infusion, just after infusion, and at 15 minutes and 1, 2, 4, 24 and 96 hours after infusion. MR spectra were evaluated with particular attention to the curve pattern observed at specific times after the infusion of SPIO, and the results were correlated with the signal intensity observed on T2W1 images and the histologic giade of ilon content of samples of resected liver parenchyma. RESULTS: As observed on T2WI, the mean signal intensity of rabbit liver in its pre-SPIO infusion state, just after infusion, at 15 minutes, and at 1, 2, 4, 24 and 96 hours after SPIO infusion was 121.3 +/-15.5, 41.5 +/-12.7, 30.3 +/-7.9, 31.3 +/-3.5, 33.6 +/-9.4, 45.5 +/-10.9, 80.3 +/-15.7 and 110.4 +/-22.9, respectively(p<0.05). Mean standard deviation of the ratio of the area of the peak (3.9-4.1 ppm) / lipid peak (1.3 ppm) peak at each of the above times except for the pre-infusion state was 1.10 +/-0.13, 1.86 +/-0.21, 1.80 +/-0.30, 1.76 +/-0.27, 1.74 +/-0.20, 0.07 +/-0.02 and 0.03 +/-0.01, respectively(p<0.05). The hepatic parenchymal iron content increased rapidly from just after SPIO infusion, reaching its maximal level (as revealed by histologic specimens) at 15 minutes, sustaining this for up to 4 hours, and then decreasing gradually over periods of 24 and 96 hours. These results show that serial changes in patterns of MR spectra and the signal intensity seen on T2WI images correlate closely with changes in hepatic parenchymal iron content. CONCLUSION: Elevated hepatic parenchymal iron content leads to increases in the relative intensity of unknown peaks at around 4.0 ppm and decreases in the relative intensity of lipid peaks.

CT Finding of Transfusional Hemosiderosis in Patients with Chronic Renal Failure: Clinical Correlation

PURPOSE: To evaluate whether there is any correlation between the CT features of hemosiderosis and clinical findings in patients with chronic renal failure who have received multiple blood transfusions. MATERIALS AND METHODS: Among chronic renal failure patients who had undergone long-term dialysis and received multiple blood transfusions, CT findings in 16 cases in which increased liver attenuation was seen on images obtained for other purpose, were analyzed by three radiologic specialists. The attenuation values of liver, spleen and pancreas compared with that of back muscle were correlated with the amount and duration of transfusion, and blood ferritin level. RESULTS: In 15 of these 16 case, blood ferritin level was examined; 14 showed more than 300ng/ml. Increased attenuation of the spleen was noted in 11 cases, and of the pancreas, in six. All these six also showed increased value for the spleen; the amount of blood transfusion was less than 40 units in three case and more than 40 units in the other three. None showed glucose intolerance. Between the two groups, there were no statistically significant difference in the amount and duration of transfusion, or blood ferritin level. CONCLUSION: There is no correlation between the CT features of hemosiderosis and clinical findings. In patients with chronic renal failure and no clinical symptoms, the status of iron overload was relatively easily detected on CT. Close observation of CT findings is thus thought to prevent significant permanent functional deformity of organs in patients with chronic renal failure who have received multiple blood transfusions.