Is MRI becoming the new gold standard for diagnosing iron overload in hemochromatosis and other liver iron disorders?

Abstract

This article addresses whether or not determination of liver iron concentration by MRI is becoming the new gold standard for diagnosing iron overload in hereditary hemochromatosis and other liver iron-surcharge diseases. Hepatic iron concentration obtained by liver biopsy has been the gold standard for years. In recent years the development of MRI techniques, via signal intensity ratio methods or by relaxometry, has provided a noninvasive and more accurate approach to the diagnosis of liver iron overload. Nowadays, liver biopsy indications have diminished and only prognostic purposes or diagnostic difficulties may justify its indication. We comment on the difficulty that liver steatosis creates for liver iron determination, a paper on MR elastography for fibrosis prognosis in hemochromatosis, the relationship between iron-free nodules and hepatocarcinoma, and the importance of the MR machine's calibration for accurate liver iron concentration determinations. Finally, based on the available evidence, we co...