Exploring the role of quantitative susceptibility mapping in assessing brain iron deposition in hemodialysis patients

Patients with end-stage renal disease (ESRD) develop brain iron deposition due to iron metabolism disorders induced by long-term hemodialysis. This abnormal iron accumulation accelerates cognitive impairment (CI) and neurodegenerative pathologies. Quantitative susceptibility mapping (QSM), a technique capable of precisely quantifying magnetic susceptibility, provides a novel perspective for the noninvasive and dynamic monitoring of cerebral iron distribution. Monitoring brain iron deposition using QSM facilitates the development of individualized clinical treatment strategies. This review systematically examines the application of QSM in studying brain iron deposition in hemodialysis patients, with a focus on analyzing the dynamic patterns of iron deposition pre- and post-dialysis and during follow-up periods. It further explores the relationship between QSM findings and iron metabolism dysregulation, blood-brain barrier (BBB) injury, and oxidative stress. Additionally, the predictive value of QSM for clinical neurological functional prognosis following iron chelation therapy is discussed. CRITICAL RELEVANCE STATEMENT: QSM studies on cerebral iron deposition in hemodialysis patients require further monitoring of its spatial-temporal dynamics and changes after iron chelation. Future research should focus on technical standardization, longitudinal tracking, and treatment response to establish a precision neuroimaging-guided framework. KEY POINTS: This review exploration is warranted to monitor the spatial distribution and dynamic changes of brain iron deposition in this population. The relationships between QSM findings and iron metabolism dysregulation, blood-brain barrier injury, and oxidative stress are explored. This review focuses on issues in the fields of technology standardization, longitudinal monitoring, and treatment responsiveness.