Top

European Radiology

Published in:

01-09-2015 | Experimental

Virtual iron concentration imaging based on dual-energy CT for noninvasive quantification and grading of liver iron content: An iron overload rabbit model study

Authors: Xian Fu Luo, Yi Yang, Jing Yan, Xue Qian Xie, Huan Zhang, Wei Min Chai, Li Wang, Bernhard Schmidt, Fu Hua Yan

Published in: European Radiology | Issue 9/2015

Abstract

Objectives

To assess the accuracy of liver iron content (LIC) quantification and grading ability associated with clinical LIC stratification using virtual iron concentration (VIC) imaging on dual-energy CT (DECT) in an iron overload rabbit model.

Methods

Fifty-one rabbits were prepared as iron-loaded models by intravenous injection of iron dextran. DECT was performed at 80 and 140 kVp. VIC images were derived from an iron-specific algorithm. Postmortem LIC assessments were conducted on an inductively coupled plasma (ICP) spectrometer. Correlation between VIC and LIC was analyzed. VIC were stratified according to the corresponding clinical LIC thresholds of 1.8, 3.2, 7.0, and 15.0 mg Fe/g. Diagnostic performance of stratification was evaluated by receiver operating characteristic analysis.

Results

VIC linearly correlated with LIC (r = 0.977, P < 0.01). No significant difference was observed between VIC-derived LICs and ICP (P > 0.05). For the four clinical LIC thresholds, the corresponding cutoff values of VIC were 19.6, 25.3, 36.9, and 61.5 HU, respectively. The highest sensitivity (100 %) and specificity (100 %) were achieved at the threshold of 15.0 mg Fe/g.

Conclusions

Virtual iron concentration imaging on DECT showed potential ability to accurately quantify and stratify hepatic iron accumulation in the iron overload rabbit model.

Key Points

• Virtual iron concentration (VIC) linearly correlates with liver iron content (LIC).

• VIC accurately quantifies LIC.

• VIC accurately grades LIC based on clinical LIC stratification.

Angelucci E, Brittenham GM, McLaren CE et al (2000) Hepatic iron concentration and total body iron stores in thalassemia major. N Engl J Med 343:327–331PubMedCrossRef

Hamed MA, Ali SA (2013) Non-viral factors contributing to hepatocellular carcinoma. World J Hepatol 5:311–322PubMedCentralPubMed

Pietrangelo A (2005) Non-invasive assessment of hepatic iron overload: are we finally there? J Hepatol 42:153–154PubMedCrossRef

St Pierre TG, Clark PR, Chua-anusorn W et al (2005) Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood 105:855–861PubMedCrossRef

Angelucci E, Baronciani D, Lucarelli G et al (1995) Needle liver biopsy in thalassaemia: analyses of diagnostic accuracy and safety in 1184 consecutive biopsies. Br J Haematol 89:757–761PubMedCrossRef

Brittenham GM, Farrell DE, Harris JW et al (1982) Magnetic-susceptibility measurement of human iron stores. N Engl J Med 307:1671–1675PubMedCrossRef

Gandon Y, Olivié D, Guyader D et al (2004) Non-invasive assessment of hepatic iron stores by MRI. Lancet 363:357–362PubMedCrossRef

Goldberg HI, Cann CE, Moss AA, Ohto M, Brito A, Federle M (1982) Noninvasive quantitation of liver iron in dogs with hemochromatosis using dual-energy CT scanning. Investig Radiol 17:375–380CrossRef

Chapman RW, Williams G, Bydder G, Dick R, Sherlock S, Kreel L (1980) CT for determining liver iron content in primary haemochromatosis. Br Med J 280:440–442PubMedCentralPubMedCrossRef

10.

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 106:1460–1465PubMedCentralPubMedCrossRef

11.

Nielsen P, Engelhardt R, Duerken M, Janka GE, Fischer R (2000) Using SQUID biomagnetic liver susceptometry in the treatment of thalassemia and other iron loading diseases. Transfus Sci 23:257–258PubMedCrossRef

12.

Fischer R, Longo F, Nielsen P, Engelhardt R, Hider RC, Piga A (2003) Monitoring long-term efficacy of iron chelation therapy by deferiprone and desferrioxamine in patients with beta-thalassaemia major: application of SQUID biomagnetic liver susceptometry. Br J Haematol 121:938–948PubMedCrossRef

13.

Hankins JS, McCarville MB, Loeffler RB et al (2009) R2* magnetic resonance imaging of the liver in patients with iron overload. Blood 113:4853–4855PubMedCentralPubMedCrossRef

14.

Johnson TR, Krauss B, Sedlmair M et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517PubMedCrossRef

15.

Johnson TR (2012) Dual-energy CT: general principles. AJR Am J Roentgenol 199:S3–S8PubMedCrossRef

16.

Fischer MA, Reiner CS, Raptis D et al (2011) Quantification of liver iron content with CT-added value of dual-energy. Eur Radiol 21:1727–1732PubMedCrossRef

17.

Stolzmann P, Leschka S, Scheffel H et al (2010) Characterization of urinary stones with dual-energy CT: improved differentiation using a tin filter. Investig Radiol 45:1–6CrossRef

18.

Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160PubMedCrossRef

19.

Schisterman EF, Perkins NJ, Liu A, Bondell H (2005) Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology 16:73–81PubMedCrossRef

20.

Fernandes JL (2012) Iron chelation therapy in the management of transfusion-related cardiac iron overload. Transfusion 52:2256–2268PubMedCrossRef

21.

Pickhardt PJ, Park SH, Hahn L, Lee SG, Bae KT, Yu ES (2012) Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis. Eur Radiol 22:1075–1082PubMedCrossRef

22.

Joe E, Kim SH, Lee KB et al (2012) Feasibility and accuracy of dual-source dual-energy CT for noninvasive determination of hepatic iron accumulation. Radiology 262:126–135PubMedCrossRef

23.

Fischer MA, Gnannt R, Raptis D et al (2011) Quantification of liver fat in the presence of iron and iodine: an ex-vivo dual-energy CT study. Investig Radiol 46:351–358CrossRef

24.

Hoffbrand AV, Taher A, Cappellini MD (2012) How I treat transfusional iron overload. Blood 120:3657–3669PubMedCrossRef

25.

Brittenham GM (2011) Iron-chelating therapy for transfusional iron overload. N Engl J Med 364:146–156PubMedCentralPubMedCrossRef

26.

Castiella A, Alustiza JM, Emparanza JI, Zapata EM, Costero B, Diez MI (2011) Liver iron concentration quantification by MRI: are recommended protocols accurate enough for clinical practice? Eur Radiol 21:137–141PubMedCrossRef

27.

Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263PubMedCrossRef

Title: Virtual iron concentration imaging based on dual-energy CT for noninvasive quantification and grading of liver iron content: An iron overload rabbit model study
Authors: Xian Fu Luo
Yi Yang
Jing Yan
Xue Qian Xie
Huan Zhang
Wei Min Chai
Li Wang
Bernhard Schmidt
Fu Hua Yan
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 9/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-3693-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Virtual iron concentration imaging based on dual-energy CT for noninvasive quantification and grading of liver iron content: An iron overload rabbit model study

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 9/2015

Interreader and inter-test agreement in assessing treatment response following transarterial embolization for hepatocellular carcinoma

Malignancy risk and characteristics of thyroid nodules with two consecutive results of atypia of undetermined significance or follicular lesion of undetermined significance on cytology

Multiple procedures and cumulative individual radiation exposure in interventional cardiology: A long-term retrospective study

Zone-specific logistic regression models improve classification of prostate cancer on multi-parametric MRI

Subcentimeter hypervascular nodule with typical imaging findings of hepatocellular carcinoma in patients with history of hepatocellular carcinoma: natural course on serial gadoxetic acid-enhanced MRI and diffusion-weighted imaging

Posterior fossa abnormalities in high-risk term infants: comparison of ultrasound and MRI