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MR imaging assessment and quantification of liver iron
Manuela França1,2, João Gomes Carvalho3
1Radiology Department - Centro Hospitalar Universitário do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal. mariamanuela.franca@gmail.com.
Insights
Accurately measuring iron overload is vital for diagnosis and treatment monitoring. Magnetic Resonance (MR) imaging is the non-invasive standard for assessing liver iron concentration, guiding patient care.
Area of Science:
- Medical Imaging
- Hematology
- Radiology
Background:
- Iron overload disorders, including hereditary hemochromatosis and secondary hemosiderosis, pose significant health risks.
- Excess iron accumulation in organs like the liver, pancreas, and heart can lead to severe complications such as cirrhosis, diabetes, and cardiomyopathy.
- Accurate quantification of iron levels is essential for diagnosing iron overload and monitoring the effectiveness of iron-reducing therapies.
Purpose of the Study:
- To highlight the importance of accurate iron quantification in managing iron overload disorders.
- To discuss the role of Magnetic Resonance (MR) imaging as a non-invasive standard for assessing liver iron concentration.
- To address the lack of consensus on optimal MR techniques and post-processing tools for hepatic iron quantification.
Main Methods:
- Review of current literature and clinical practices regarding iron overload assessment.
- Comparison of liver biopsy (invasive) versus MR imaging (non-invasive) for iron quantification.
- Discussion of various MR imaging techniques and post-processing tools for hepatic iron measurement.
Main Results:
- MR imaging is the accepted non-invasive standard of care for assessing iron overload, surpassing invasive liver biopsy.
- Multiple MR techniques exist for hepatic iron quantification, but a universal consensus on the best method or post-processing tool is lacking.
- The selection of MR technique often depends on local expertise, equipment, and software availability.
Conclusions:
- Consistent use of a chosen MR imaging method is crucial for reliable patient follow-up over time.
- Standardization of MR techniques and post-processing is needed to improve the comparability of hepatic iron quantification results.
- Non-invasive MR imaging offers a vital tool for managing patients with iron overload disorders, despite current methodological variations.
Abstract:
Iron overload is a common clinical problem resulting from hereditary hemochromatosis or secondary hemosiderosis (mainly associated with transfusion therapy), being also associated with chronic liver diseases and metabolic disorders. Excess of iron accumulates in organs like the liver, pancreas and heart. Without treatment, patients with iron overload disorders will develop liver cirrhosis, diabetes and cardiomyopathy. Iron quantification is therefore crucial not only for diagnosis of iron overload but also to monitor iron-reducing therapies. Liver iron concentration is considered the surrogate marker of total body iron stores. Because liver biopsy is invasive and prone to high variability and sampling bias, MR imaging has emerged as a non-invasive method and gained wide acceptance, now being considered the standard of care for assessing iron overload. Nevertheless, there are different MR techniques for iron quantification and there is still no consensus about the best technique or postprocessing tool for hepatic iron quantification, with the choice of imaging technique depending mainly on the local expertise as well on the available equipment and software. Because different methods should not be used interchangeably, it is important to choose one method and use the same one when following up patients over time.
