Quantification of Liver Iron Overload: Correlation of MRI and Liver Tissue Biopsy in Pediatric Thalassemia Major Patient
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ORIGINAL ARTICLE
Quantification of Liver Iron Overload: Correlation of MRI and Liver Tissue Biopsy in Pediatric Thalassemia Major Patients Undergoing Bone Marrow Transplant Varun Bafna1 • Sunil Bhat1 • Vimal Raj2 • Shobha Badiger1 Vellaichamy Muthupandi Annapandian3 • K. S. Nataraj1 • Sharat Damodar1
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Received: 13 October 2019 / Accepted: 14 January 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
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
& Sharat Damodar [email protected] 1
Department of Hematology and Bone Marrow Transplant Unit, Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, Karnataka, India
2
Department of Radiology, Narayana Health City, Bangalore, Karnataka, India
3
Department of Academic Research, Narayana Hrudayalaya Foundations, Bangalore, Karnataka, India
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 Thalassemia Bone marrow transplant Liver iron concentration Magnetic resonance image T2* MRI R2* MRI
Introduction Iron overload is associated with hereditary hemochromatosis, Thalassemia, sickle cell disease, aplastic anemia, myelodysplasia, and others [1]. The body iron burden is a principal determinant of clinical outcome in all forms of systemic iron overload, whether from red blood cell transfusion or increased dietary iron absorption or both. Accurate assessment of the body iron burden is an essential step for managing iron chelation therapy to prevent iron toxicity and to avoid the adverse effects of excess chelator administration. In Thalassemia Major patients, determin
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