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. 2020 Oct;36(4):667-673.
doi: 10.1007/s12288-020-01256-1. Epub 2020 Feb 22.

Quantification of Liver Iron Overload: Correlation of MRI and Liver Tissue Biopsy in Pediatric Thalassemia Major Patients Undergoing Bone Marrow Transplant

Varun Bafna  1 , Sunil Bhat  1 , Vimal Raj  2 , Shobha Badiger  1 , Vellaichamy Muthupandi Annapandian  3 , K S Nataraj  1 , Sharat Damodar  1
Affiliations

Quantification of Liver Iron Overload: Correlation of MRI and Liver Tissue Biopsy in Pediatric Thalassemia Major Patients Undergoing Bone Marrow Transplant

Varun Bafna et al. Indian J Hematol Blood Transfus. 2020 Oct.

Abstract

Determination of the magnitude of body iron stores helps to identify individuals at risk of iron-induced organ damage in Thalassemia patients. The most direct clinical method of measuring liver iron concentration (LIC) is through chemical analysis of needle biopsy specimens. Here we present a noninvasive method for the measurement of LIC in vivo using magnetic resonance imaging (MRI). Twenty-three pediatric Thalassemia major patients undergoing bone marrow transplantation at our centre were studied. All 23 patients had MRI T2* and R2* decay time for evaluation of LIC on a 1.5 Tesla MRI system followed by liver tissue biopsy for the assessment of iron concentration using an atomic absorption spectrometry. Simultaneously, serum ferritin levels were measured by enzymatic assay. We have correlated biopsy LIC with liver T2* and serum ferritin values with liver R2*. Of the 23 patients 11 were males, the mean age was 8.3 ± 3.7 years. The study results showed a significant correlation between biopsy LIC and liver T2* MRI (r = 0.768; p < 0.001). Also, there was a significant correlation between serum ferritin levels and liver R2* MRI (r = 0.5647; p < 0.01). Two patients had high variance in serum ferritin levels (2100 and 4100 mg/g) while their LIC was around 24 mg/g, whereas the difference was not seen in T2* MRI. Hence, the liver T2* MRI is a better modality for assessing LIC. Serum ferritin is less reliable than quantitative MRI. The liver T2* MRI is a safe, reliable, feasible and cost-effective method compared to liver tissue biopsy for LIC assessment.

Keywords: Bone marrow transplant; Liver iron concentration; Magnetic resonance image; R2* MRI; T2* MRI; Thalassemia.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Image showing decay of signal (liver getting darker) with time in a patient with moderate LIC
Fig. 2
Fig. 2
Image showing decay of signal (liver getting darker) with time in a patient with severe LIC
Fig. 3
Fig. 3
Magnetic resonance image with three regions of interests where the signal was pcalculated to determine the magnitude and speed of the signal decay
Fig. 4
Fig. 4
Correlation between serum ferritin and R2* (r = 0.5647; p < 0.01)
Fig. 5
Fig. 5
Correlation between biopsy LIC and serum ferritin (r = 0.661; p < 0.001)
Fig. 6
Fig. 6
Correlation between biopsy LIC and MRI LIC (r = 0.768; p < 0.001)
See this image and copyright information in PMC

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