Abstract
Objective:We aimed to evaluate the feasibility of quantification of liver, pancreas, spleen, vertebral bone marrow, and renal cortex R2* and magnetic resonance imaging-proton density fat fraction (MRI-PDFF) and to evaluate the correlations among them in patients with transfusion-related iron overload.Materials and Methods:A total of 9 patients (5 boys, 4 girls) who were referred to our clinic with suspicion of hepatic iron overload were included in this study. All patients underwent T1-independent volumetric multi-echo gradient-echo imaging with T2* correction and spectral fat modeling. MRI examinations were performed on a 1.5 T MRI system.Results:All patients had hepatic iron overload. Severe hepatic iron overload was recorded in 5/9 patients (56%), and when we evaluated the PDFF maps of these patients, we observed an extensive patchy artifact in the liver in 4 of 5 patients (R2* greater than 671 Hz). When we performed MRI-PDFF measurements despite these artifacts, we observed artifactual high MRI-PDFF values. There was a close correlation between average pancreas R2* and average pancreas MRI-PDFF (p=0.003, r=0.860). There was a significant correlation between liver R2* and average pancreas R2* (p=0.021, r=0.747), liver R2* and renal cortex R2* (p=0.020, r=0.750), and average pancreas R2* and renal cortex R2* (p=0.003, r=0.858). There was a significant negative correlation between vertebral bone marrow R2* and age (p=0.018, r=-0.759).Conclusion:High iron content of the liver, especially with a T2* value shorter than the first echo time can spoil the efficacy of PDFF calculation. Fat deposition in the pancreas is accompanied by pancreatic iron overload. There is a significant correlation between hepatic siderosis and pancreatic siderosis. Renal cortical and pancreatic siderosis are correlated, too.
Highlights
Iron is an essential nutrient for all human cells [1,2]
Severe hepatic iron overload was recorded in 5/9 patients (56%), and when we evaluated the PDFF maps of these patients, we observed an extensive patchy artifact in the liver in 4 of 5 patients (R2* greater than 671 Hz)
High iron content of the liver, especially with a T2* value shorter than the first echo time can spoil the efficacy of PDFF calculation
Summary
Iron is an essential nutrient for all human cells [1,2]. Intake and excretion of iron is balanced within a daily range of 1-2 mg [3]. There is no effective way of excretion of iron from the body; if the total amount of income exceeds outcome, such as in cases of increased intestinal absorption, long-term transfusion therapies, or excess parenteral iron treatment, total body iron increases. It primarily depends on repetitive transfusions that bring a burden of excess iron, especially after 40 to 50 transfusions that saturate the capacity of reticuloendothelial system [4]. Iron accumulates in parenchymal organs like the liver, pancreas, myocardium, and endocrine glands, which leads to tissue damage and fibrosis [3]
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