Abstract
BackgroundHepatic cirrhosis is a common pathway of progressive liver destruction from multiple causes. Iron uptake can occur within the hepatic parenchyma or within the various nodules that form in a cirrhotic liver, termed siderotic nodules. Siderotic nodule formation has been shown to correlate with inflammatory activity, and while the relationship between siderotic nodule formation and malignancy remains unclear, iron distribution within hepatic nodules has known implications for the detection of hepatocellular carcinoma. We aimed to evaluate the role of abdominal susceptibility-weighted imaging in the detection of siderotic nodules in cirrhotic patients.Methodology/Principal FindingsForty-six (46) cirrhotic patients with at least one siderotic nodule detected on previous imaging underwent both computed tomography and magnetic resonance imaging (T1-, T2-, T2*-, and susceptibility-weighted imaging) at 3.0 Tesla. Imaging data was independently analyzed by two radiologists. Siderotic nodule count was determined for each modality and imaging sequence. For each magnetic resonance imaging technique, siderotic nodule conspicuity was assessed on a 3 point scale (1 = weak, 2 = moderate, 3 = strong). More nodules were detected by susceptibility weighted imaging (n = 2935) than any other technique, and significantly more than by T2* weighted imaging (n = 1696, p<0.0001). Lesion conspicuity was also highest with susceptibility-weighted imaging, with all nodules found to be moderate (n = 6) or strong (n = 40); a statistically significant difference (p<0.001).ConclusionsSusceptibility-weighted imaging had the greatest lesion conspicuity and detected the highest number of siderotic nodules suggesting it is the most sensitive imaging technique to detect siderotic nodules in cirrhotic patients.
Highlights
Iron is a critical element for human life, and the majority of human iron exists in heme-based proteins or ferritin, an iron storage protein
The goal of this study is to evaluate whether abdominal Susceptibility-weighted imaging (SWI) allows greater sensitivity for the detection of siderotic nodules than other computed tomography (CT) and MRI techniques, including T2* weighted gradientecho magnetic resonance (MR) imaging
The comparison of siderotic nodules’’ (SN) detected by CT, T1, T2, T2*-weighted and SWI imaging is illustrated in Figure 1, for both independent readers
Summary
Iron is a critical element for human life, and the majority of human iron exists in heme-based proteins (predominantly hemoglobin) or ferritin, an iron storage protein. Numerous human diseases are associated with abnormalities of iron metabolism, and in the liver, the pathogenesis of many hepatic diseases result in the accumulation of excess hepatic iron. Excess hepatic iron can result from genetic predisposition (hemochromatosis) or from excess circulating iron, which is typically due to excess breakdown of hemoglobin (hemosiderosis). Many techniques have been developed to detect and quantify hepatic iron content because of its importance in the diagnosis and prognosis of related diseases and for monitoring and evaluating treatment response. We aimed to evaluate the role of abdominal susceptibilityweighted imaging in the detection of siderotic nodules in cirrhotic patients
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