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Quantification of Liver Iron Overload with MRI: Review and Guidelines from the ESGAR and SAR
Scott B Reeder1, Takeshi Yokoo1, Manuela França1
1From the Departments of Radiology (S.B.R., D.H.), Medical Physics (S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology, Centro Hospitalar Universitário do Porto, Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI), Instituto de Investigación Sanitaria La Fe, Valencia, Spain (Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia University Hospital, San Sebastián, Spain (J.M.A.); Department of Radiology, University Hospital and University of Rennes 1, Rennes, France (Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise, University of New South Wales, Sydney, Australia (C.H.); Joint Department of Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.); Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic & Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging Research Group, Hospital Universitario y Politécnico La Fe and Health Research Institute, Valencia, Spain (L.M.B.).
Abstract:
Accumulation of excess iron in the body, or systemic iron overload, results from a variety of causes. The concentration of iron in the liver is linearly related to the total body iron stores and, for this reason, quantification of liver iron concentration (LIC) is widely regarded as the best surrogate to assess total body iron. Historically assessed using biopsy, there is a clear need for noninvasive quantitative imaging biomarkers of LIC. MRI is highly sensitive to the presence of tissue iron and has been increasingly adopted as a noninvasive alternative to biopsy for detection, severity grading, and treatment monitoring in patients with known or suspected iron overload. Multiple MRI strategies have been developed in the past 2 decades, based on both gradient-echo and spin-echo imaging, including signal intensity ratio and relaxometry strategies. However, there is a general lack of consensus regarding the appropriate use of these methods. The overall goal of this article is to summarize the current state of the art in the clinical use of MRI to quantify liver iron content and to assess the overall level of evidence of these various methods. Based on this summary, expert consensus panel recommendations on best practices for MRI-based quantification of liver iron are provided.
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