Abstract
Objective: The purpose of this study was to identify the difference between dual energy spectral computed tomography (DECT) and magnetic resonance imaging (MRI) used to detect liver/cardiac iron content in Myelodysplastic syndrome (MDS) patients with differently adjusted serum ferritin (ASF) levels.Method: Liver and cardiac iron content were detected by DECT and MRI. Patients were divided into different subgroups according to the level of ASF. The receiver operating characteristic curve (ROC) analysis was applied in each subgroup. The correlation between iron content detected by DECT/MRI and ASF was analyzed in each subgroup.Result: ROC curves showed that liver virtual iron content (LVIC) Az was significantly less than liver iron concentration (LIC) Az in the subgroup with ASF < 1,000 ng/ml. There was no significant difference between LVIC Az and LIC Az in the subgroup with 1,000 ≤ ASF < 2,500 ng/ml and 2,500 ≤ ASF < 5,000 ng/ml. LVIC Az was significantly higher than LIC Az in the subgroup with ASF <5,000 and 5,000 ≤ ASF ng/ml. In patients undergoing DECT and MRI examination on the same day, ASF was significantly correlated with LVIC, whereas no significant correlation was observed between ASF and LIC. After removing the data of ASF > 5,000 mg/L in LIC, LIC became correlated with ASF. There was no significant difference between the subgroup with 2,500 ≤ ASF < 5,000 ng/ml and 5,000 ng/ml ≤ ASF in LIC expression. Furthermore, both LIC and liver VIC had significant correlations with ASF in patients with ASF < 2,500 ng/ml, while LVIC was still correlated with ASF, LIC was not correlated with ASF in patients with 2,500 ng/ml ≤ ASF. Moreover, neither cardiac VIC nor myocardial iron content (MIC) were correlated with ASF in these subgroups.Conclusion: MRI and DECT were complementary to each other in liver iron detection. In MDS patients with high iron content, such as ASF ≥ 5,000 ng/ml, DECT was more reliable than the MRI in the assessment of iron content. But in patients with low iron content, such as ASF < 1,000 ng/ml, MRI is more reliable than DECT. Therefore, for the sake of more accurately evaluating the iron content, the appropriate detection method can be selected according to ASF.
Highlights
MDS patients may suffer from iron overload as a result of a longterm transfusion of red blood cells (RBC) and/or combined with abnormal iron metabolism
Liver biopsy analysis is used as the reference standard for the measurement of liver iron concentration; it is difficult to implement in clinical practice, as there is an increase in bleeding risk
The analysis of myocardial iron content showed that there was no significant correlation between cardiac virtual iron content (VIC) and ASF in the subgroup with ASF
Summary
MDS patients may suffer from iron overload as a result of a longterm transfusion of red blood cells (RBC) and/or combined with abnormal iron metabolism. Liver biopsy analysis is used as the reference standard for the measurement of liver iron concentration; it is difficult to implement in clinical practice, as there is an increase in bleeding risk. Serum ferritin (SF) is the most commonly used and convenient method to estimate iron stores, the results are affected by other factors (such as infection, inflammation, tumor, etc.) which sometimes mean they cannot reflect the amount of iron in the body. The qualitative detection of iron using MRI is widely used in clinical practice and is considered an indicator for initiating iron chelation therapy (ICT). In vitro experiments show that DECT have higher accuracy in evaluating iron overload compared with 1.5T MRI [4]. 3.0T MRI is widely used in clinical practice. What are the advantages and disadvantages of these two methods in patients with high and low iron deposition? What are the differences between 3.0T MRI and DECT in the detection of iron content? What are the advantages and disadvantages of these two methods in patients with high and low iron deposition? Can these two methods complement each other? This study hopes to answer these questions
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