Objective Our goal was to determine the difference in iron distribution between transfusion dependent (TD) and nontransfusion dependent (NT) patients with sickle cell disease (SCD). Materials and Methods The T2-weighted and T2*-weighted abdominal MR images in nine cases of homozygous SCD were reviewed to determine the distribution of low signal from iron in five TD and four NT patients. Results All eight patients with visualized spleens had decreased splenic signal intensity. One patient who had no history of splenectomy had no visualized splenic tissue. The majority of both groups had renal cortex of low signal intensity that was attributable to iron deposition from intravascular hemolysis and was not correlated with clinical renal abnormalities. None of the NT group had liver or pancreas of low signal intensity, while all five TD patients had decreased liver signal intensity and three of five had decreased pancreatic signal intensity. Conclusion Decreased pancreatic signal intensity can occur in TD patients, perhaps suggesting total body iron overload. Nontransfusion dependent sickle cell patients usually have normal hepatic signal intensity and do not have total body iron overload, even in the presence of renal and splenic iron deposition.