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Published on: May 19, 2023
Non-invasive depiction of hepatic and myocardial iron overload using MRI
M S Elfeshawy1, M Abdelfattah2, M M Alsakka1
1Diagnostic and Intervention Radiology, Faculty of Medicine (for boys). Al-Azhar University, Cairo, Egypt.
Background And Aim:
In T2* MRI sequences, the susceptibility effect produced by iron accumulation results in a signal loss in the affected tissues. This effect aids the diagnosis of iron overload noninvasively, avoiding repeated invasive biopsies. The study aimed to document our initial experience of using MRI for measuring myocardial and hepatic iron for early management before severe cardiomyopathy and hepatic dysfunction.
Patient And Methods:
The study included 40 patients with chronic hemolytic anemias (36 ß thalassemia and 4 sickle cell anemia), 20 male and 20 female. The transfusion of all patients was dependent on regular and frequent blood transfusions.
Results:
About 90% of patients have no myocardial iron overload, 5% have mild myocardial iron overload, and 5% have moderate to extreme myocardial iron overload. There was a negative correlation between myocardial iron overload and serum ferritin level among the studied patients. There was a positive correlation between hepatic iron overload and serum ferritin level. There was an insignificant positive correlation between hepatic and myocardial iron overload.
Conclusion:
The myocardial and hepatic iron quantification can be reproducibly evaluated utilizing MRI to anticipate the iron chelation requirement and treatment of ventricular dysfunction. Myocardial iron overload can not be anticipated from the serum ferritin level or liver iron. Patients with advanced illnesses can only be detected using traditional heart function tests. The early increase of chelation treatment ought to decrease mortality from reversible cardiomyopathy.
Insights
Magnetic Resonance Imaging (MRI) accurately measures heart and liver iron in patients with chronic anemias. Early iron quantification via MRI aids timely treatment, preventing severe organ damage and reducing mortality.
Area of Science:
- Cardiovascular Imaging
- Hematology
- Radiology
Background:
- Iron accumulation in T2* MRI sequences causes signal loss, enabling noninvasive diagnosis of iron overload.
- This method avoids invasive biopsies, crucial for managing chronic conditions.
Purpose of the Study:
- To assess the initial use of MRI for quantifying myocardial and hepatic iron in patients with chronic anemias.
- To facilitate early management and prevent severe cardiac and liver dysfunction.
Main Methods:
- The study involved 40 patients (36 ß-thalassemia, 4 sickle cell anemia) requiring regular blood transfusions.
- T2* MRI sequences were used to measure iron levels in the heart and liver.
Main Results:
- 90% of patients showed no or mild myocardial iron overload; 5% had moderate to extreme overload.
- Serum ferritin correlated positively with hepatic iron but negatively with myocardial iron.
- Hepatic and myocardial iron overload showed an insignificant positive correlation.
Conclusions:
- MRI reliably quantifies myocardial and hepatic iron, guiding chelation therapy and management of ventricular dysfunction.
- Serum ferritin and liver iron levels do not predict myocardial iron overload.
- Early detection and treatment of iron overload via MRI can decrease mortality from reversible cardiomyopathy.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...