Magnetic Resonance Imaging Assessment of Excess Iron in Thalassemia, Sickle Cell Disease and Other Iron Overload Diseases

Patients with transfusion-dependent anemia develop cardiac and endocrine toxicity from iron overload. Classically, serum ferritin and liver biopsy have been used to monitor patient response to chelation therapy. Recently, magnetic resonance imaging (MRI) has proven effective in detecting and quantifying iron in the heart and liver. Tissue iron is paramagnetic and increases the MRI relaxation rates R2 and R2* in a quantifiable manner. This review outlines the principles and validation of non invasive iron estimation by MRI, as well as discussing some of the technical considerations necessary for accurate measurements. Specifically, the use of R2 or R2* methods, choice of echo times, appropriate model for data fitting, the use of a pixel-wise or region-based measurement, and the choice of field strength are discussed.

[1]  P. Storey,et al.  R2* imaging of transfusional iron burden at 3T and comparison with 1.5T , 2007, Journal of magnetic resonance imaging : JMRI.

[2]  T. Coates,et al.  Improved R2* measurements in myocardial iron overload , 2006, Journal of magnetic resonance imaging : JMRI.

[3]  D. Pennell,et al.  Development of Thalassaemic Iron Overload Cardiomyopathy despite Low Liver Iron Levels and Meticulous Compliance to Desferrioxamine , 2006, Acta Haematologica.

[4]  Mark A Westwood,et al.  Multi-center validation of the transferability of the magnetic resonance T2* technique for the quantification of tissue iron. , 2006, Haematologica.

[5]  Marvin D Nelson,et al.  Mechanisms of tissue–iron relaxivity: Nuclear magnetic resonance studies of human liver biopsy specimens , 2005, Magnetic resonance in medicine.

[6]  David N. Firmin,et al.  Intercentre Reproducibility of Magnetic Resonance T2* Measurements of Myocardial Iron in Thalassaemia , 2005, The International Journal of Cardiovascular Imaging.

[7]  N. Gourtsoyiannis,et al.  Adrenal glands in beta-thalassemia major: magnetic resonance (MR) imaging features and correlation with iron stores , 2005, European Radiology.

[8]  T. Coates,et al.  MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients. , 2005, Blood.

[9]  Thomas D. Coates,et al.  Cardiac Iron Determines Cardiac T2*, T2, and T1 in the Gerbil Model of Iron Cardiomyopathy , 2005, Circulation.

[10]  T. S. St. Pierre,et al.  Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. , 2005, Blood.

[11]  D. Pennell,et al.  Myocardial iron clearance during reversal of siderotic cardiomyopathy with intravenous desferrioxamine: a prospective study using T2* cardiovascular magnetic resonance , 2004, British journal of haematology.

[12]  I. Papassotiriou,et al.  Magnetic resonance imaging in the evaluation of iron overload in patients with beta thalassaemia and sickle cell disease , 2004, British journal of haematology.

[13]  Marvin D Nelson,et al.  Myocardial iron loading in transfusion-dependent thalassemia and sickle cell disease. , 2004, Blood.

[14]  T. Meade,et al.  Mimicking liver iron overload using liposomal ferritin preparations , 2004, Magnetic resonance in medicine.

[15]  G. Ooi,et al.  Magnetic resonance screening of iron status in transfusion‐dependent β‐thalassaemia patients , 2004, British journal of haematology.

[16]  L. Vlahos,et al.  Myocardial iron deposition in β-Thalassemia studied by magnetic resonance imaging , 1998, The International Journal of Cardiac Imaging.

[17]  Mark A Westwood,et al.  Interscanner reproducibility of cardiovascular magnetic resonance T2* measurements of tissue iron in thalassemia , 2003, Journal of magnetic resonance imaging : JMRI.

[18]  D. Pennell,et al.  A single breath‐hold multiecho T2* cardiovascular magnetic resonance technique for diagnosis of myocardial iron overload , 2003, Journal of magnetic resonance imaging : JMRI.

[19]  T. S. St. Pierre,et al.  Bi-exponential proton transverse relaxation rate (R2) image analysis using RF field intensity-weighted spin density projection: potential for R2 measurement of iron-loaded liver. , 2003, Magnetic resonance imaging.

[20]  R. Hider,et al.  Monitoring long‐term efficacy of iron chelation therapy by deferiprone and desferrioxamine in patients with β‐thalassaemia major: application of SQUID biomagnetic liver susceptometry , 2003, British journal of haematology.

[21]  D N Firmin,et al.  Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. , 2001, European heart journal.

[22]  M. Argyropoulou,et al.  T2 relaxation rate as an index of pituitary iron overload in patients with beta-thalassemia major. , 2000, AJR. American journal of roentgenology.

[23]  P D Griffiths,et al.  Brain iron deposition in Parkinson's disease imaged using the PRIME magnetic resonance sequence. , 2000, Brain : a journal of neurology.

[24]  A. Hoffbrand,et al.  Hepatic iron concentration combined with long‐term monitoring of serum ferritin to predict complications of iron overload in thalassaemia major , 2000, British journal of haematology.

[25]  C. McLaren,et al.  Hepatic iron concentration and total body iron stores in thalassemia major. , 2000, The New England journal of medicine.

[26]  T. S. St. Pierre,et al.  Quantitative mapping of transverse relaxivity (1/T(2)) in hepatic iron overload: a single spin-echo imaging methodology. , 2000, Magnetic resonance imaging.

[27]  R. Fischer,et al.  Serum ferritin iron in iron overload and liver damage: correlation to body iron stores and diagnostic relevance. , 2000, The Journal of laboratory and clinical medicine.

[28]  M. Midiri,et al.  MR imaging technique for the diagnosis of pituitary iron overload in patients with transfusion-dependent beta-thalassemia major. , 1998, AJNR. American journal of neuroradiology.

[29]  G. Link,et al.  Pathophysiology of Iron Overload a , 1998, Annals of the New York Academy of Sciences.

[30]  M. Harada,et al.  Evaluation of bone marrow iron by magnetic resonance imaging , 1997, Annals of Hematology.

[31]  J A Frank,et al.  Hepatic hemosiderosis in non‐human primates: Quantification of liver iron using different field strengths , 1997, Magnetic resonance in medicine.

[32]  R. Ordidge,et al.  The measurement of R2, R2* and R2' in HIV-infected patients using the prime sequence as a measure of brain iron deposition. , 1997, Magnetic resonance imaging.

[33]  J. Villeneuve,et al.  Variability in hepatic iron concentration measurement from needle-biopsy specimens. , 1996, Journal of hepatology.

[34]  P. van Eyken,et al.  Uneven hepatic iron and phosphorus distribution in beta-thalassemia. , 1995, Journal of hepatology.

[35]  G. Lucarelli,et al.  Needle liver biopsy in thalassaemia: analyses of diagnostic accuracy and safety in 1184 consecutive biopsies , 1995, British journal of haematology.

[36]  E. Haacke,et al.  Theory of NMR signal behavior in magnetically inhomogeneous tissues: The static dephasing regime , 1994, Magnetic resonance in medicine.

[37]  C. McLaren,et al.  Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. , 1994, The New England journal of medicine.

[38]  A. Castriota-Scanderbeg,et al.  Methods for evaluating iron stores and efficacy of chelation in transfusional hemosiderosis. , 1991, Haematologica.

[39]  B. Bacon,et al.  Iron overload: causes and consequences. , 1987, Annual review of nutrition.

[40]  B. Bacon,et al.  Nuclear magnetic resonance imaging of experimentally induced liver disease. , 1983, Radiology.

[41]  G. McLaren,et al.  Iron overload disorders: natural history, pathogenesis, diagnosis, and therapy. , 1983, Critical reviews in clinical laboratory sciences.

[42]  S. Sherlock,et al.  Effect of ascorbic acid deficiency on serum ferritin concentration in patients with beta-thalassaemia major and iron overload. , 1982, Journal of clinical pathology.