Quantification of Liver Iron Overload with MRI: Review and Guidelines from the ESGAR and SAR

Scott B Reeder¹, Takeshi Yokoo¹, Manuela França¹, Diego Hernando¹, Ángel Alberich-Bayarri¹, José María Alústiza¹, Yves Gandon¹, Benjamin Henninger¹, Claudia Hillenbrand¹, Kartik Jhaveri¹, Musturay Karçaaltıncaba¹, Jens-Peter Kühn¹, Amirkasra Mojtahed¹, Suraj D Serai¹, Richard Ward¹, John C Wood¹, Jin Yamamura¹, Luis Martí-Bonmatí¹

Affiliations

Affiliation

¹ From the Departments of Radiology (S.B.R., D.H.), Medical Physics (S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology, Centro Hospitalar Universitário do Porto, Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI), Instituto de Investigación Sanitaria La Fe, Valencia, Spain (Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia University Hospital, San Sebastián, Spain (J.M.A.); Department of Radiology, University Hospital and University of Rennes 1, Rennes, France (Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise, University of New South Wales, Sydney, Australia (C.H.); Joint Department of Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.); Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic & Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging Research Group, Hospital Universitario y Politécnico La Fe and Health Research Institute, Valencia, Spain (L.M.B.).

PMID: 36809220
PMCID: PMC10068892
DOI: 10.1148/radiol.221856

Review

Quantification of Liver Iron Overload with MRI: Review and Guidelines from the ESGAR and SAR

Scott B Reeder et al. Radiology. 2023 Apr.

. 2023 Apr;307(1):e221856.

doi: 10.1148/radiol.221856. Epub 2023 Feb 21.

Authors

Affiliation

¹ From the Departments of Radiology (S.B.R., D.H.), Medical Physics (S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology, Centro Hospitalar Universitário do Porto, Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI), Instituto de Investigación Sanitaria La Fe, Valencia, Spain (Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL, Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia University Hospital, San Sebastián, Spain (J.M.A.); Department of Radiology, University Hospital and University of Rennes 1, Rennes, France (Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise, University of New South Wales, Sydney, Australia (C.H.); Joint Department of Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.); Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic & Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging Research Group, Hospital Universitario y Politécnico La Fe and Health Research Institute, Valencia, Spain (L.M.B.).

PMID: 36809220
PMCID: PMC10068892
DOI: 10.1148/radiol.221856

Abstract

Accumulation of excess iron in the body, or systemic iron overload, results from a variety of causes. The concentration of iron in the liver is linearly related to the total body iron stores and, for this reason, quantification of liver iron concentration (LIC) is widely regarded as the best surrogate to assess total body iron. Historically assessed using biopsy, there is a clear need for noninvasive quantitative imaging biomarkers of LIC. MRI is highly sensitive to the presence of tissue iron and has been increasingly adopted as a noninvasive alternative to biopsy for detection, severity grading, and treatment monitoring in patients with known or suspected iron overload. Multiple MRI strategies have been developed in the past 2 decades, based on both gradient-echo and spin-echo imaging, including signal intensity ratio and relaxometry strategies. However, there is a general lack of consensus regarding the appropriate use of these methods. The overall goal of this article is to summarize the current state of the art in the clinical use of MRI to quantify liver iron content and to assess the overall level of evidence of these various methods. Based on this summary, expert consensus panel recommendations on best practices for MRI-based quantification of liver iron are provided.

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Conflict of interest statement

Disclosures of conflicts of interest: S.B.R. Grants from the National Institutes of Health (R01 DK117354 and R01 DK100691); ownership interests in Calimetrix, Reveal Pharmaceuticals, Cellectar Biosciences, Elucent Medical, HeartVista, and RevOps; support to institution from GE Healthcare and Bracco Diagnostics; Romnes Faculty Fellow with an award provided by the University of Wisconsin-Madison Office of the Vice Chancellor for Research and Graduate Education with funding from the Wisconsin Alumni Research Foundation. T.Y. Grant from NIDDK (R01 DK100651). M.F. No relevant relationships. D.H. Grants from the National Institutes of Health (R01 DK100651 and R01 DK117354); ownership interests in Calimetrix; support to institution from GE Healthcare and Bracco Diagnostics. A.A.B. CEO of Quibin SL, shareholder at Quibin SL. J.M.A. No relevant relationships. Y.G. No relevant relationships. B.H. No relevant relationships. C.H. No relevant relationships. K.J. No relevant relationships. M.K. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Bayer and GE Healthcare. J.P.K. No relevant relationships. A.M. No relevant relationships. S.D.S. No relevant relationships. R.W. Payment for invited lecture from the Society of Abdominal Radiology; support for attending meetings and/or travel from the Society of Abdominal Radiology; chair, peer review subcommittee for the Canadian Hemoglobinopathy Association; participation on a Data Safety Monitoring Board or advisory board at Canada’s Drug and Health Technology Agency. J.C.W. Grants from the National Heart Lung and Blood Institute, Additional Ventures Single Ventricular Research Fund, and Philips Medical Systems; Dean’s Pilot Award, USC Keck School of Medicine; Strategic Directions for Research Reward, USC Provost’s Office; consulting fees from Celgene (Bristol-Meyer-Squibb), World Care Clinical, Imago Biosciences, Regeneron, Vifor Pharma, Pharmacosmos, Hillhurst Pharamceuticals and Agios; support for attending meetings and/or travel from Cooley’s Anemia Foundation; patent under review; participation on a data safety monitoring board or review board at Bayer Healthcare Pharmaceuticals, Hillhurst Pharmaceuticals, and NHLBI; research support from In Kind and Philips Medical Systems. J.Y. No relevant relationships. L.M.B. No relevant relationships.

Figures

Graphical representation of commonly used liver iron concentration
(LIC) thresholds summarized by St Pierre et al (11) and Henninger et al
(85). Units of LIC are shown in both milligrams per gram and micromolars per
gram. From left to right, color scale corresponds to normal, borderline
overload, mild overload, moderate overload, moderate-to-severe overload, and
severe overload. — **Figure 1:**
Graphical representation of commonly used liver iron concentration (LIC) thresholds summarized by St Pierre et al (11) and Henninger et al (85). Units of LIC are shown in both milligrams per gram and micromolars per gram. From left to right, color scale corresponds to normal, borderline overload, mild overload, moderate overload, moderate-to-severe overload, and severe overload.

The field strength dependence of R2*-based liver iron
concentration (LIC) mapping is removed after conversion of R2* to LIC
maps. Shown are R2* and LIC maps from three patients imaged at 1.5 T
and 3.0 T on the same day. R2-based LIC values are also shown
(top). — **Figure 2:**
The field strength dependence of R2*-based liver iron concentration (LIC) mapping is removed after conversion of R2* to LIC maps. Shown are R2* and LIC maps from three patients imaged at 1.5 T and 3.0 T on the same day. R2-based LIC values are also shown (top).

See this image and copyright information in PMC

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Quantification of Liver Iron Overload with MRI: Review and Guidelines from the ESGAR and SAR

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Quantification of Liver Iron Overload with MRI: Review and Guidelines from the ESGAR and SAR

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