MR imaging of pancreatic changes in patients with transfusion-dependent beta-thalassemia major.

Midiri, Massimo; Casto, Antonio Lo; Sparacia, Gianvincenzo; D’Angelo, Paolo; Malizia, R; Finazzo, M; Montalto, Giuseppe; Solbiati, Luigi; Lagalla, Roberto; Maria, Marcello De

doi:10.2214/ajr.173.1.10397124

Cited by 51 publications

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“…It is known that pancreatic hemosiderosis results in abnormal MRI signal intensity, and there is iron overload in the pancreas in up to 75-100% of thalassemia major cases. [7][8][9] The signal intensity ratio results showed correlation with ferritin levels 9 and also related to iron load in other organs. 7 They also correlated with exocrine pancreatic secretion function 9 and endocrine function as assessed by oral glucose tolerance test (OGTT).…”

Section: Resultsmentioning

confidence: 91%

“…[7][8][9] The signal intensity ratio results showed correlation with ferritin levels 9 and also related to iron load in other organs. 7 They also correlated with exocrine pancreatic secretion function 9 and endocrine function as assessed by oral glucose tolerance test (OGTT). 8 Pancreatic abnormalities in thalassemia major patients can also be defined by other imaging modalities such as ultrasound echogenicity.…”

Section: Resultsmentioning

confidence: 91%

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A T2* magnetic resonance imaging study of pancreatic iron overload in thalassemia major

Au¹,

Lam²,

Chu³

et al. 2008

Haematologica

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We studied the utility of pancreatic magnetic resonance imaging (MRI) in 72 thalassemia major patients (21 diabetic, 51 normoglycemic). Diabetic patients were significantly older (p<0.0001) and had smaller pancreas volume (p<0.0001). The two groups were comparable for ferritin and MRI-T2* heart, liver and pancreas. Pancreatic T2* signals were abnormal in 80% of both groups, and correlated with heart T2*. In normoglycemic patients, cardiac T2* and log-pancreatic T2* values correlated with homeostatic model assessments HOMA-B (␤ cell reserve), HOMA-IR (insulin resistance) and fasting insulin/C-peptide levels. This suggested that improved chelation may improve ␤ cell reserve and prevent pancreatic atrophy.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 91%

A T2* magnetic resonance imaging study of pancreatic iron overload in thalassemia major

Au¹,

Lam²,

Chu³

et al. 2008

Haematologica

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“…24 Over time, iron-mediated oxidative stress triggers apoptosis, volume loss, and fatty replacement, leading to pancreatic dysfunction. 4,24,25 Prospective, longitudinal studies are necessary to fully characterize the links between pancreatic R2* and pancreatic function; we are currently enrolling patients in a prospective trial to assess this question.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic iron loading predicts cardiac iron loading in thalassemia major

Noetzli¹,

Papudesi²,

Coates

et al. 2009

Blood

144

146

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Diabetes mellitus and cardiomyopathy are common in chronically transfused thalassemia major patients, occurring in the second and third decades of life. We postulated that pancreatic iron deposition would precede cardiac iron loading, representing an environment favorable for extrahepatic iron deposition. To test this hypothesis, we examined pancreatic and cardiac iron in 131 thalassemia major patients over a 4-year period. Cardiac iron (R2* > 50 Hz) was detected in 37.7% of patients and pancreatic iron (R2* > 28 Hz) in 80.4% of patients. Pancreatic and cardiac R2* were correlated (r 2 ‫؍‬ 0.52), with significant pancreatic iron occurring nearly a decade earlier than cardiac iron. A pancreatic R2* less than 100 Hz was a powerful negative predictor of cardiac iron, and pancreatic R2* more than 100 Hz had a positive predictive value of more than 60%. In serial analysis, changes in cardiac iron were correlated with changes in pancreatic iron (r 2 ‫؍‬ 0.33, IntroductionIron overload is common in chronically transfused thalassemia major (TM) patients. Liver iron is a surrogate for total body iron burden 1 and has been used for years to monitor chelation therapy in thalassemia patients. 2 Liver iron quantification by magnetic resonance imaging (MRI) is well validated and becoming increasingly routine at major thalassemia centers. 3 It is also now possible to directly image preclinical iron deposition in heart tissue and endocrine glands. 4,5 Extrahepatic tissues have different kinetics of iron uptake and clearance than the liver 6,7 because they selectively, or near selectively, load circulating non-transferrin-bound iron (NTBI). 8 As a result, cardiac iron accumulation exhibits threshold behavior with respect to liver iron concentration 9 and is quite sensitive to the duration of iron chelation therapy. 10 In contrast, the liver is the dominant storage depot for transferrin-mediated iron uptake and fluctuates proportionally to global iron balance. 11 As a result, cross-sectional correlations between heart and liver iron loading are poor 5,12 and longitudinal relationships exhibit complicated, highly nonlinear behaviors. 7 More importantly, dangerous heart iron accumulation and cardiac dysfunction can occur despite apparently superb control of liver iron during prospective longitudinal evaluation. 7,13 These observations demonstrate that iron chelation therapy sufficient for neutral or negative liver iron balance may be inadequate to protect the heart in some patients.Because the heart and pancreas predominantly load NTBI, iron burdens in these organs should be more closely correlated to one another than between the heart and the liver. 8 Recent work by Au et al 4 and by our laboratory 14 supports this hypothesis. Because glucose intolerance/diabetes are common comorbidities with cardiac dysfunction, 11,15 we postulated that pancreatic iron uptake might predict cardiac iron deposition in a clinically useful manner. To test this hypothesis, we compared pancreatic, hepatic, and cardiac iron loading in 131 patients with...

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“…Serum ferritin level can be misleading, as it is influenced by several conditions [4]. MR imaging is considered a very accurate method for detecting iron deposition in various tissues, due to the strong paramagnetic properties of intracellular ferritin and hemosiderin that cause T2 relaxation time shortening and signal intensity (SI) reduction in spin echo (SE) and gradient echo (GRE) sequences [5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Bone marrow changes in beta-thalassemia major: quantitative MR imaging findings and correlation with iron stores

et al. 2006

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The purpose of this study is to describe the MR imaging features of bone marrow in beta-thalassemia major and investigate their relation to ferritin, liver and spleen siderosis. Spinal bone marrow was prospectively assessed on abdominal MR studies of 40 transfused beta-thalassemic patients and 15 controls using T1-w, Pd, T2*-w Gradient Echo (GRE) and T1-w turbo Spin Echo (TSE) sequences. Signal intensity (SI) ratios of liver, spleen and bone marrow to paraspinous muscles (L/M, S/M, B/M respectively) and the respective T2 relaxation rates (1/T2) were calculated. Serum ferritin levels were recorded. Bone marrow hypointensity in at least T2*-w GRE sequence was noted in 29/40 (72.5%) patients. Eleven/40 patients exhibited normal B/M on all MR sequences. Five/40 patients had normal B/M and low L/M. B/M correlated with L/M in T1-w TSE sequence only (r = 0.471, p = 0.05). B/M correlated with S/M and mean ferritin values in all sequences (r > 0.489, p < 0.01 and r > - 0.496, p < 0.03 respectively). Marrow 1/T2 did not correlate with ferritin values or liver and spleen 1/T2. B/M in transfused beta-thalassemic patients is related to splenic siderosis and ferritin levels. Although marrow is usually hypointense, it may occasionally display normal SI coexisting with liver hypointensity, a pattern typical of primary hemochromatosis.

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MR imaging of pancreatic changes in patients with transfusion-dependent beta-thalassemia major.

Cited by 51 publications

References 0 publications

A T2* magnetic resonance imaging study of pancreatic iron overload in thalassemia major

A T2* magnetic resonance imaging study of pancreatic iron overload in thalassemia major

Pancreatic iron loading predicts cardiac iron loading in thalassemia major

Bone marrow changes in beta-thalassemia major: quantitative MR imaging findings and correlation with iron stores

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