The Impact of Region-of-Interest Selection on MRI T₂* Quantification of Hepatic Iron Overload in Thalassemia Major

Accurate quantification of hepatic iron overload is essential for managing patients with thalassemia major to prevent severe complications such as liver and cardiac failure. Magnetic resonance imaging (MRI) T₂* has emerged as the noninvasive gold standard for assessing tissue iron concentration. This study aimed to localize and validate MRI T₂* measurement protocols and to evaluate the impact of region-of-interest (ROI) selection on iron overload classification in patients with thalassemia. A cohort of 39 patients with confirmed thalassemia from Imam Ali Hospital, Zahedan, underwent liver MRI with T₂* imaging. The effect of ROI variation on T₂* values and patient classification was analyzed. Validation was performed using healthy volunteers and iron phantoms with known concentrations. Statistical analyses compared results with those from hospital reports and from phantom and healthy subjects. ROI selection significantly affected T₂* values, resulting in reclassification in 35.9% of patients. Phantom studies demonstrated a strong linear correlation (R² ≈ 0.98) between T₂* values and iron concentration, confirming measurement accuracy. Healthy volunteers showed T₂* values within normal ranges, consistent with published data. Discrepancies between hospital reports and study findings highlighted the necessity for standardized imaging protocols and automated data processing to reduce variability. ROI selection critically affects hepatic T₂* measurements and the clinical classification of iron overload in patients with thalassemia. Standardized protocols, rigorous equipment calibration, and localized analytical tools are essential for enhancing diagnostic precision and patient management. This approach reduces dependence on external services and supports the provision of sustainable, high-quality care for patients with thalassemia.