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Magnetic resonance iron-free nodules in genetic hemochromatosis
1Clinique des Maladies du Foie and Inserm U49, Department of Radiology, Hôpital Universitaire Pontchaillou, Rennes, France.
Objective:
In hemochromatosis, areas of normal hepatic magnetic resonance (MR) signal intensity indicate the presence of iron-free-nodules, which are strongly suspected of being neoplastic. The goal of the study was to define the prevalence and the nature of these iron-free MR nodules at the time of diagnosis in 116 patients included in a prospective study assessing the accuracy of MR imaging (MRI) in the quantification of liver iron overload.
Methods:
Seventy-nine of the 116 patients had homozygous hemochromatosis on a phenotypic basis. Fifteen-millimeter-thick contiguous slices were performed using T1- and T2-weighted gradient echo sequences with a 0.5 Tesla magnet.
Results:
Six of 79 homozygous hemochromatotic patients had one or more MR iron-free nodules. Five of the six patients proved to have malignant tumors. Four of six iron-free nodules were hepatocellular carcinoma (5% in the hemochromatosis group and 17.5% in hemochromatotic patients with severe fibrosis).
Conclusions:
The present data confirm the high prevalence of liver cancer at the time of diagnosis, mainly in cirrhotic patients greater than 45 years of age, and indicate that, when performing MRI for liver iron quantification, a complete hepatic MRI examination is preferable to a simple signal measurement in patients at risk for hepatocellular carcinoma.
Insights
Iron-free nodules found during liver magnetic resonance imaging (MRI) in hemochromatosis patients may indicate cancer. A full hepatic MRI is recommended for early detection of hepatocellular carcinoma in at-risk individuals.
Area of Science:
- Hepatology
- Radiology
- Oncology
Background:
- Hemochromatosis is an iron overload disorder.
- Iron-free hepatic nodules on MRI are suspected of being neoplastic.
- Accurate quantification of liver iron overload is crucial for hemochromatosis management.
Purpose of the Study:
- To determine the prevalence and nature of iron-free MR nodules in hemochromatosis patients.
- To assess the diagnostic accuracy of MRI in quantifying liver iron overload.
- To investigate the association between iron-free nodules and neoplastic lesions.
Main Methods:
- Prospective study of 116 hemochromatosis patients.
- Phenotypic assessment for homozygous hemochromatosis in 79 patients.
- 15-mm thick contiguous slices using T1- and T2-weighted gradient echo sequences on a 0.5 Tesla MRI scanner.
Main Results:
- Six of 79 homozygous hemochromatotic patients had iron-free MR nodules.
- Five of these six patients were diagnosed with malignant tumors.
- Hepatocellular carcinoma was identified in 4 of 6 nodules (5% of hemochromatosis group, 17.5% with severe fibrosis).
Conclusions:
- Iron-free hepatic nodules in hemochromatosis are frequently associated with malignancy.
- Hepatocellular carcinoma is prevalent at diagnosis, especially in cirrhotic patients over 45.
- Complete hepatic MRI examinations are recommended for early detection of liver cancer in at-risk patients.
