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Evaluation of MR imaging with T1 and T2* mapping for the determination of hepatic iron overload

  • Gastrointestinal
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Abstract

Objectives

To evaluate MRI using T1 and T2* mapping sequences in patients with suspected hepatic iron overload (HIO).

Methods

Twenty-five consecutive patients with clinically suspected HIO were retrospectively studied. All underwent MRI and liver biopsy. For the quantification of liver T2* values we used a fat-saturated multi-echo gradient echo sequence with 12 echoes (TR = 200 ms, TE = 0.99 ms +  n × 1.41 ms, flip angle 20°). T1 values were obtained using a fast T1 mapping sequence based on an inversion recovery snapshot FLASH sequence. Parameter maps were analysed using regions of interest.

Results

ROC analysis calculated cut-off points at 10.07 ms and 15.47 ms for T2* in the determination of HIO with accuracy 88 %/88 %, sensitivity 84 %/89.5 % and specificity 100 %/83 %. MRI correctly classified 20 patients (80 %). All patients with HIO only had decreased T1 and T2* relaxation times. There was a significant difference in T1 between patients with HIO only and patients with HIO and steatohepatitis (P = 0.018).

Conclusions

MRI-based T2* relaxation diagnoses HIO very accurately, even at low iron concentrations. Important additional information may be obtained by the combination of T1 and T2* mapping. It is a rapid, non-invasive, accurate and reproducible technique for validating the evidence of even low hepatic iron concentrations.

Key Points

• Hepatic iron overload causes fibrosis, cirrhosis and increases hepatocellular carcinoma risk.

• MRI detects iron because of the field heterogeneity generated by haemosiderin.

• T2* relaxation is very accurate in diagnosing hepatic iron overload.

• Additional information may be obtained by T1 and T2* mapping.

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Abbreviations

HH:

hereditary haemochromatosis

HII:

hepatic iron index

HIC:

hepatic iron concentration

HIO:

hepatic iron overload

LIC:

liver iron concentration

MRI:

magnetic resonance imaging

SH:

steatohepatitis

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Authors and Affiliations

  1. Department of Radiology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria

    B. Henninger, C. Kremser, S. Rauch, R. Eder & M. Schocke

  2. Department of Internal Medicine, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria

    H. Zoller & A. Finkenstedt

  3. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim – Heidelberg University, Mannheim, Germany

    H. J. Michaely

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  1. B. Henninger
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  2. C. Kremser
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  3. S. Rauch
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  4. R. Eder
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Correspondence to B. Henninger.

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Henninger, B., Kremser, C., Rauch, S. et al. Evaluation of MR imaging with T1 and T2* mapping for the determination of hepatic iron overload. Eur Radiol 22, 2478–2486 (2012). https://doi.org/10.1007/s00330-012-2506-2

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  • DOI: https://doi.org/10.1007/s00330-012-2506-2

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