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Published in: Pediatric Radiology 11/2015

01-10-2015 | Original Article

Retrospective comparison of gradient recalled echo R2* and spin-echo R2 magnetic resonance analysis methods for estimating liver iron content in children and adolescents

Authors: Suraj D. Serai, Robert J. Fleck, Charles T. Quinn, Bin Zhang, Daniel J. Podberesky

Published in: Pediatric Radiology | Issue 11/2015

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Abstract

Background

Serial surveillance of liver iron concentration (LIC) provides guidance for chelation therapy in patients with iron overload. The diagnosis of iron overload traditionally relies on core liver biopsy, which is limited by invasiveness, sampling error, cost and general poor acceptance by pediatric patients and parents. Thus noninvasive diagnostic methods such as MRI are highly attractive for quantification of liver iron concentration.

Objective

To compare two MRI-based methods for liver iron quantification in children.

Materials and methods

64 studies on 48 children and young adults (age range 4–21 years) were examined by gradient recalled echo (GRE) R2* and spin-echo R2 MRI at 1.5T to evaluate liver iron concentration. Scatter plots and Bland–Altman difference plots were generated to display and assess the relationship between the methods.

Results

With the protocols used in this investigation, Bland–Altman agreement between the methods is best when LIC is <20 mg/g dry tissue. Scatter plots show that all values with LIC <20 mg/g dry tissue fall within the 95% prediction limits.

Conclusion

Liver iron concentration as determined by the R2* and R2 MR methods is statistically comparable, with no statistical difference between these methods for LIC <20 mg/g.
Literature
1.
go back to reference Lieu PT, Heiskala M, Peterson PA et al (2001) The roles of iron in health and disease. Mol Aspects Med 22:1–87CrossRefPubMed Lieu PT, Heiskala M, Peterson PA et al (2001) The roles of iron in health and disease. Mol Aspects Med 22:1–87CrossRefPubMed
2.
go back to reference Towbin AJ, Serai SD, Podberesky DJ (2013) Magnetic resonance imaging of the pediatric liver: imaging of steatosis, iron deposition, and fibrosis. Magn Reson Imaging Clin N Am 21:669–680CrossRefPubMed Towbin AJ, Serai SD, Podberesky DJ (2013) Magnetic resonance imaging of the pediatric liver: imaging of steatosis, iron deposition, and fibrosis. Magn Reson Imaging Clin N Am 21:669–680CrossRefPubMed
3.
go back to reference Brown K, Subramony C, May W et al (2009) Hepatic iron overload in children with sickle cell anemia on chronic transfusion therapy. J Pediatr Hematol Oncol 31:309–312CrossRefPubMed Brown K, Subramony C, May W et al (2009) Hepatic iron overload in children with sickle cell anemia on chronic transfusion therapy. J Pediatr Hematol Oncol 31:309–312CrossRefPubMed
4.
go back to reference Jensen PD, Jensen FT, Christensen T et al (2003) Relationship between hepatocellular injury and transfusional iron overload prior to and during iron chelation with desferrioxamine: a study in adult patients with acquired anemias. Blood 101:91–96CrossRefPubMed Jensen PD, Jensen FT, Christensen T et al (2003) Relationship between hepatocellular injury and transfusional iron overload prior to and during iron chelation with desferrioxamine: a study in adult patients with acquired anemias. Blood 101:91–96CrossRefPubMed
5.
go back to reference Perifanis V, Tziomalos K, Tsatra I et al (2005) Prevalence and severity of liver disease in patients with b thalassemia major. A single-institution fifteen-year experience. Haematologica 90:1136–1138PubMed Perifanis V, Tziomalos K, Tsatra I et al (2005) Prevalence and severity of liver disease in patients with b thalassemia major. A single-institution fifteen-year experience. Haematologica 90:1136–1138PubMed
6.
go back to reference Crownover BK, Covey CJ (2013) Hereditary hemochromatosis. Am Fam Physician 87:183–190PubMed Crownover BK, Covey CJ (2013) Hereditary hemochromatosis. Am Fam Physician 87:183–190PubMed
7.
go back to reference Powell LW (2002) Diagnosis of hemochromatosis. Semin Gastrointest Dis 13:80–88PubMed Powell LW (2002) Diagnosis of hemochromatosis. Semin Gastrointest Dis 13:80–88PubMed
8.
go back to reference Brittenham GM, Badman DG (2003) Noninvasive measurement of iron: report of an NIDDK workshop. Blood 101:15–19CrossRefPubMed Brittenham GM, Badman DG (2003) Noninvasive measurement of iron: report of an NIDDK workshop. Blood 101:15–19CrossRefPubMed
9.
go back to reference Mazza P, Giua R, De Marco S et al (1995) Iron overload in thalassemia: comparative analysis of magnetic resonance imaging, serum ferritin and iron content of the liver. Haematologica 80:398–404PubMed Mazza P, Giua R, De Marco S et al (1995) Iron overload in thalassemia: comparative analysis of magnetic resonance imaging, serum ferritin and iron content of the liver. Haematologica 80:398–404PubMed
10.
go back to reference Ware HM, Kwiatkowski JL (2013) Evaluation and treatment of transfusional iron overload in children. Pediatr Clin North Am 60:1393–1406CrossRefPubMed Ware HM, Kwiatkowski JL (2013) Evaluation and treatment of transfusional iron overload in children. Pediatr Clin North Am 60:1393–1406CrossRefPubMed
11.
go back to reference Zhou HB (2014) Hemobilia and other complications caused by percutaneous ultrasound-guided liver biopsy. World J Gastroenterol 20:3712–3715 Zhou HB (2014) Hemobilia and other complications caused by percutaneous ultrasound-guided liver biopsy. World J Gastroenterol 20:3712–3715
12.
go back to reference Castera L, Pinzani M (2010) Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? Gut 59:861–866CrossRefPubMed Castera L, Pinzani M (2010) Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? Gut 59:861–866CrossRefPubMed
13.
go back to reference Regev A, Berho M, Jeffers LJ et al (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97:2614–2618CrossRefPubMed Regev A, Berho M, Jeffers LJ et al (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97:2614–2618CrossRefPubMed
14.
go back to reference Ratziu V, Charlotte F, Heurtier A et al (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906CrossRefPubMed Ratziu V, Charlotte F, Heurtier A et al (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906CrossRefPubMed
15.
go back to reference Xanthakos SA, Podberesky DJ, Serai SD et al (2014) Use of magnetic resonance elastography to assess hepatic fibrosis in children with chronic liver disease. J Pediatr 164:186–188CrossRefPubMed Xanthakos SA, Podberesky DJ, Serai SD et al (2014) Use of magnetic resonance elastography to assess hepatic fibrosis in children with chronic liver disease. J Pediatr 164:186–188CrossRefPubMed
16.
go back to reference Serai SD, Towbin AJ, Podberesky DJ (2012) Pediatric liver MR elastography. Dig Dis Sci 57:2713–2719CrossRefPubMed Serai SD, Towbin AJ, Podberesky DJ (2012) Pediatric liver MR elastography. Dig Dis Sci 57:2713–2719CrossRefPubMed
17.
go back to reference Kim HK, Lindquist DM, Serai SD et al (2013) Magnetic resonance imaging of pediatric muscular disorders: recent advances and clinical applications. Radiol Clin North Am 51:721–742CrossRefPubMedPubMedCentral Kim HK, Lindquist DM, Serai SD et al (2013) Magnetic resonance imaging of pediatric muscular disorders: recent advances and clinical applications. Radiol Clin North Am 51:721–742CrossRefPubMedPubMedCentral
18.
go back to reference Serai SD, Wallihan DB, Venkatesh SK et al (2014) Magnetic resonance elastography of the liver in patients status-post fontan procedure: feasibility and preliminary results. Congenit Heart Dis 9:7–14CrossRefPubMed Serai SD, Wallihan DB, Venkatesh SK et al (2014) Magnetic resonance elastography of the liver in patients status-post fontan procedure: feasibility and preliminary results. Congenit Heart Dis 9:7–14CrossRefPubMed
19.
go back to reference Wallihan DB, Podberesky DJ, Marino BS et al (2013) Relationship of MR elastography determined liver stiffness with cardiac function after Fontan palliation. J Magn Reson Imaging J Magn Reson Imaging 40:1328–1335CrossRefPubMed Wallihan DB, Podberesky DJ, Marino BS et al (2013) Relationship of MR elastography determined liver stiffness with cardiac function after Fontan palliation. J Magn Reson Imaging J Magn Reson Imaging 40:1328–1335CrossRefPubMed
20.
21.
go back to reference Hernando D, Levin YS, Sirlin CB et al (2014) Quantification of liver iron with MRI: State of the art and remaining challenges. J Magn Reson Imaging J Magn Reson Imaging 40:1003–1021CrossRefPubMed Hernando D, Levin YS, Sirlin CB et al (2014) Quantification of liver iron with MRI: State of the art and remaining challenges. J Magn Reson Imaging J Magn Reson Imaging 40:1003–1021CrossRefPubMed
22.
go back to reference St. Pierre TG, Clark PR, Chua-anusorn W et al (2005) Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood 105:855–861 St. Pierre TG, Clark PR, Chua-anusorn W et al (2005) Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood 105:855–861
23.
go back to reference Wood JC, Enriquez C, Ghugre N et al (2005) MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients. Blood 106:1460–1465CrossRefPubMedPubMedCentral Wood JC, Enriquez C, Ghugre N et al (2005) MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients. Blood 106:1460–1465CrossRefPubMedPubMedCentral
24.
go back to reference Cheng HL, Holowka S, Moineddin R et al (2012) Liver iron overload assessment by T *2 magnetic resonance imaging in pediatric patients: an accuracy and reproducibility study. Am J Hematol 87:435–437CrossRefPubMed Cheng HL, Holowka S, Moineddin R et al (2012) Liver iron overload assessment by T *2 magnetic resonance imaging in pediatric patients: an accuracy and reproducibility study. Am J Hematol 87:435–437CrossRefPubMed
25.
go back to reference St. Pierre TG, Clark PR, Chua-Anusorn W (2005) Measurement and mapping of liver iron concentrations using magnetic resonance imaging. Ann NY Acad Sci 1054:379–385 St. Pierre TG, Clark PR, Chua-Anusorn W (2005) Measurement and mapping of liver iron concentrations using magnetic resonance imaging. Ann NY Acad Sci 1054:379–385
26.
go back to reference Bassett ML, Halliday JW, Powell LW (1986) Value of hepatic iron measurements in early hemochromatosis and determination of the critical iron level associated with fibrosis. Hepatology 6:24–29 Bassett ML, Halliday JW, Powell LW (1986) Value of hepatic iron measurements in early hemochromatosis and determination of the critical iron level associated with fibrosis. Hepatology 6:24–29
27.
go back to reference Lambing A, Kachalsky E, Mueller ML (2012) The dangers of iron overload: bring in the iron police. J Am Acad Nurse Pract 24:175–183CrossRefPubMed Lambing A, Kachalsky E, Mueller ML (2012) The dangers of iron overload: bring in the iron police. J Am Acad Nurse Pract 24:175–183CrossRefPubMed
28.
go back to reference Shander A, Sazama K (2010) Clinical consequences of iron overload from chronic red blood cell transfusions, its diagnosis, and its management by chelation therapy. Transfusion 50:1144–1155CrossRefPubMed Shander A, Sazama K (2010) Clinical consequences of iron overload from chronic red blood cell transfusions, its diagnosis, and its management by chelation therapy. Transfusion 50:1144–1155CrossRefPubMed
29.
go back to reference Hoffbrand AV, Taher A, Cappellini MD (2012) How I treat transfusional iron overload. Blood 120:3657–3669CrossRefPubMed Hoffbrand AV, Taher A, Cappellini MD (2012) How I treat transfusional iron overload. Blood 120:3657–3669CrossRefPubMed
31.
go back to reference Robson MD, Gatehouse PD, Bydder M et al (2003) Magnetic resonance: an introduction to ultrashort TE (UTE) imaging. J Comput Assist Tomogr 27:825–846CrossRefPubMed Robson MD, Gatehouse PD, Bydder M et al (2003) Magnetic resonance: an introduction to ultrashort TE (UTE) imaging. J Comput Assist Tomogr 27:825–846CrossRefPubMed
32.
go back to reference Serai SD, Laor T, Dwek JR et al (2014) Feasibility of ultrashort TE (UTE) imaging of children at 1.5 T. Pediatr Radiol 44:103–108CrossRefPubMed Serai SD, Laor T, Dwek JR et al (2014) Feasibility of ultrashort TE (UTE) imaging of children at 1.5 T. Pediatr Radiol 44:103–108CrossRefPubMed
Metadata
Title
Retrospective comparison of gradient recalled echo R2* and spin-echo R2 magnetic resonance analysis methods for estimating liver iron content in children and adolescents
Authors
Suraj D. Serai
Robert J. Fleck
Charles T. Quinn
Bin Zhang
Daniel J. Podberesky
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 11/2015
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-015-3378-9

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