Comparison of liver MRI R2(FerriScan®) VS liver MRI T2* as a measure of body iron load in a cohort of beta thalassaemia major patients

Abstract

To compare the similarity of the non-patented T2* and the high cost patented R2 (Ferriscan®) MRI techniques in the measurement of liver iron concentration (LIC) in heavily transfused patients with thalassaemia major in a reallife Sri Lankan hospital setup. We compared LIC measured by MRI, obtained 2 weeks apart, using both T2* and R2 techniques in 15 patients with beta thalassaemia major. They all had a history of > 100 units of blood transfusions life long and also a history of sub optimal chelation. MRI R2 and MRI T2* scan values showed a negative correlation (co-rrelation coefficient = − 0.63, p = 0.01) This correlation was strong in lower LICs and progressively decreased with upper LIC values. Thus a significant discrepancy was observed between median values of two MRI technologies (p = 0.0005) with T2* tending to underestimate iron overload especially in those with very high LIC identified by R2. The lack of concordance of T2* and R2 especially in those with very high reading on R2 suggest the potential errors in interpretations that can occur in "non-expert centres"; which are likely to lead to errors in clinical judgement on the intensity of chelation therapy needed.

MRI‐Based Quantitative R2* Mapping at 3 Tesla Reflects Hepatic Iron Overload and Pathogenesis in Nonalcoholic Fatty Liver Disease Patients

“…Furthermore, by using advanced acquisition protocols (IDEAL method), MRI‐based R2 * mapping enabled reliable and reproducible measurement for predicting hepatic iron content (HIC) 14,15 . R2 * was reported to be strongly correlated with histological iron grades/HIC acquired by liver biopsy and R2‐based method which was approved by the Food and Drug Administration for the measurement of HIC (FerriScan®) 11,15–17 . However, another previous report suggested that R2 * was not useful for quantifying hepatic iron accumulation in NAFLD patients because of the influence of fat deposition 18 .…”

“…14,15 R2 * was reported to be strongly correlated with histological iron grades/HIC acquired by liver biopsy and R2-based method which was approved by the Food and Drug Administration for the measurement of HIC (FerriScan ® ). 11,[15][16][17] However, another previous report suggested that R2 * was not useful for quantifying hepatic iron accumulation in NAFLD patients because of the influence of fat deposition. 18 Therefore, R2 * usefulness in evaluating HIC in NAFLD patients is controversial.…”

Optimisation of T2 and T2* sequences in MRI for better quantification of iron on transfused dependent sickle cell patients

“…The use of magnetic resonance imaging (MRI) techniques involving transverse relaxation times such as the T2 and T2* have shown promising results in estimating iron concentration in transfusion-dependent patients 8 , 9 . It is therefore, expected that the serum ferritin and invasive biopsy methods will be replaced by the MRI methods, however, there is limited data in the literature that systematically compared T2 and T2* sequences in sickle cell anemia (SCA) 10 .…”

Study on the Equation Between Liver MRI T2* Values and Liver Iron Concentration in Thalassemia Patients

“…The LIC F reported by FerriScan (Resonance Health Limited, Burswood, WA, Australia) based on MRI T2/R2 (1000/T2) images has been certi ed by the US Food and Drug Administration (FDA) and has high reliability [3,4]. But this technique also has many limitations [5]: this technique requires sending the patient's MRI data to FerriScan for remote post-processing and analysis. Sending patients data to other places requires the approval of relevant institutions, and the time cost prolongs the time to obtain LIC results.…”