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Quantification of liver iron concentration with magnetic resonance imaging by combining T1-, T2-weighted spin echo
H G Kreeftenberg1, E L Mooyaart, J R Huizenga
1Department of Internal Medicine, University Hospital, P.O. Box 30001, 9700 RB, Groningen, The Netherlands. h.g.kreeftenberg@int.azg.nl
Background:
The aim of the study was to quantify hepatic iron by MRI for practical use.
Methods:
In twenty-three patients with various degrees of iron overload, measurements were carried out with a 1.5 Tesla MR unit. A combination of pulse sequences (T1, T2 and gradient echo) enabled us to quantify smaller amounts of liver iron as accurately as larger amounts of liver iron. The gradient echo sequence provided us with a good correlation when detecting smaller amounts of iron in the liver where the T1 sequence provided a good correlation when larger amounts of iron were present.
Results:
The combination of the three sequences showed a nice correlation (r=-0. 93, P<0.001) and provided us with an accurate estimate of the liver iron content (LIC). This correlation was achieved with a LIC from the lower range of normal up to LIC of 146 mmol/kg dry weight, which seems the highest measurable liver iron content for a 1.5 Tesla MRI. Measuring in the lower range makes it possible to decide whether further invasive diagnostic investigations by a liver biopsy are indicated.
Conclusion:
MRI is a useful tool to quantify iron overload non-invasively. In cases where a liver biopsy is hazardous MRI can easily be used to obtain reliable, quantitative information about the initial LIC. Quantification by MRI could also be used for follow up of the iron content during depletion treatment by phlebotomy or iron chelation. The stronger the magnet the more sensitive the detection of concentrations up to 150 mmol/kg is. A semi-quantitative judgement will only be possible with severe iron overload over 150 mmol/kg. If such an iron excess is found, a liver biopsy should be performed to exclude cirrhosis.
Insights
Magnetic Resonance Imaging (MRI) accurately quantifies liver iron content (LIC) non-invasively. This method aids in diagnosing iron overload and monitoring treatment, potentially reducing the need for invasive liver biopsies.
Area of Science:
- Radiology
- Medical Imaging
- Hepatology
Background:
- Iron overload disorders require accurate quantification of hepatic iron.
- Non-invasive methods for measuring liver iron content (LIC) are clinically valuable.
Purpose of the Study:
- To evaluate the efficacy of Magnetic Resonance Imaging (MRI) for quantifying liver iron content (LIC).
- To establish MRI as a practical tool for assessing iron overload.
Main Methods:
- Utilized a 1.5 Tesla MR unit with a combination of T1, T2, and gradient echo pulse sequences.
- Assessed 23 patients with varying degrees of iron overload.
- Correlated MRI findings with established methods for LIC measurement.
Main Results:
- A strong correlation (r=-0.93, P<0.001) was observed between MRI-derived LIC and actual liver iron levels.
- MRI accurately quantified LIC across a wide range, from normal to 146 mmol/kg dry weight.
- The study identified the upper limit of accurate quantification for a 1.5 Tesla MRI system.
Conclusions:
- MRI is a reliable, non-invasive tool for quantifying liver iron content (LIC).
- MRI can guide decisions regarding invasive diagnostic procedures like liver biopsy.
- Quantification of LIC by MRI is beneficial for monitoring treatment response in iron overload conditions.
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