Talasemi Hastalarında Karaciğer Demir Ölçümünde T2*-ADC Karşılaştırması

Abstract

Amaç: Talasemi, hastalarında tekrarlayıcı transfüzyon bir tedavi opsiyonudur, fakat bu durum başta karaciğer olmak üzere değişik organlarda demir birikimine neden olmaktadır. Bu çalışmada talasemi hastalarında, serum ferritin konsantrasyonları ile karaciğer T2* MR ölçümleri ve ADC değerlerinin korelasyonu konusundaki kendi deneyimimizin sunulması amaçlanmıştır. Gereç ve yöntem: Beta talasemi nedeni ile karaciğere yönelik T2* MR tetkiki yapılan ardışık 74 olgu çalışmaya dahil edilmiştir. Olguların karaciğer T2* ve ADC ölçümleri ile ferritin ölçümleri karşılaştırıldı. MR incelemesi 3T tarayıcı ile yapıldı. T2* MR incelemelerinde multieko gradyan eko kullanıldı. Karaciğer sol lob medial ve lateral segmentten birer ve sağ lob anterior ve posterior segmentlerden birer adet olmak üzere toplam 4 farklı bölgeden T2* ve ADC ölçümleri yapıldı. Serum ferritin düzeyleri ile R2* ve ADC ölçümleri arasındaki korelasyonu değerlendirmek için Spearman korelasyon analizi yapıldı. Bulgular: Hastaların 32’si (%43,24) kadın, 42’si (%56,76) erkekti. Serum ferritin ile karaciğer T2* ölçümleri arasında orta düzeyde negatif bir korelasyon vardı (r= -0,52 p<0,01). En yüksek T2* değeri 7,85 ms ile karaciğerin sol lob medial segmentinde, en düşük T2* değeri ise 6,5 ms ile karaciğerin sağ lob arka segmentinde ölçüldü. Serum ferritini ile ADC arasında negatif zayıf bir korelasyon vardı (r= -0.41, p<0.01). En yüksek ADC değeri 908,90 mm2/s ile karaciğerin sol lob medial segmentinde, en düşük ADC değeri ise 766,78 ile karaciğerin sağ lob ön segmentinde ölçüldü. Karaciğer T2* ölçümleri ile ADC ölçümleri arasında orta-yüksek korelasyon mevcuttu. Bu korelasyon serum ferritin ile karaciğer T2* ölçümleri arasındaki korelasyondan daha yüksekti. Sonuç: Serum ferritin ölçümleri ile hem ADC hem de T2* ölçümleri arasındaki korelasyonlar literatürde 1,5T ile bulunanlardan daha düşüktür. ADC’nin serum ferritin ile korelasyonu, serum ferritin ve T2*MR arasındaki korelasyondan daha düşük olduğundan, talasemi hastalarında karaciğer demir birikiminin değerlendirilmesinde ADC’nin T2* ölçümleri kadar yararlı olduğunu düşünmüyoruz.

Keywords

• T2* MRI
• ADC
• demir yüklü karaciğer

Project Number

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T2*-ADC Comparison in Liver Iron Quantification in Thalassemia Patients

Abstract

Objective: Repetitive transfusion is a treatment option in patients with thalassemia, but this causes iron accumulation in various organs, especially the liver. In this study, it is aimed to present our own experience in the correlation of serum ferritin concentrations with liver T2* MR measurements and ADC values in thalassemia patients. Materials and methods: Seventy-four consecutive patients who underwent T2* MR examination of the liver due to beta thalassemia were included in the study. Liver T2* and ADC measurements and ferritin measurements of the patients included in the study were compared. MRI examination was performed with 3T scanner. Multiecho gradient echo was used for T2* MRI examinations. T2* and ADC measurements were made from 4 different regions of the liver, one each from the medial and lateral segments of the left lobe and one each from the anterior and posterior segments of the right lobe. Spaerman correlation analysis was performed to evaluate the correlation between serum ferritin levels and R2* and ADC measurements. Results: Thirty-two patients (43.24%) were female and and forty-two (56.76%) were male. There was moderate correlation between serum ferritin and liver T2* measurements (r= -0.52 p<0.01). The highest T2 value was measured in the left lobe medial segment of the liver as 7.85 ms and the lowest was measured in the right lobe posterior segment of the liver as 6.5 ms. There was weak correlation between serum ferritin and ADC (r= -0.41, p<0.01). The highest ADC value was measured in the left lobe medial segment of the liver as 908.90 mm2/s and the lowest was measured in the right lobe anterior segment of the liver as 766.78. There was a moderate-high correlation between liver T2* measurements and ADC measurements. This correlation was higher than the correlation between serum ferritin and liver T2* measurements. Conclusion: Correlations between the serum ferritin measurements and both ADC and T2* measurements are lower than those found with 1.5T in the literature. The correlation of ADC with serum ferritin is lower than the correlation between serum ferritin and T2*MR, so we do not think ADC is as useful as T2* measurements in assessing liver iron accumulationin in thalassemia patients.

Keywords

• T2* MRI
• ADC
• İron loaded liver

Supporting Institution

yok

Project Number

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Thanks

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References

1. Mavrogeni S, Bratis K, van Wijk K, Kyrou L, Kattamis A, Reiber JH. The reproducibility of cardiac and liver T2* measurement in thalassemia major using two different software packages. Int J Cardiovasc Imaging. 2013; 29: 1511-1516.
2. Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis 2010; 5: 11.
3. Zurlo MG, De Stefano P, Borgna-Pignatti C, Di Palma A, Piga A, Melevendi C, et al. Survival and causes of death in thalassaemia major. The Lancet 1989; 334: 27-30.
4. Liu P, Olivieri N. Iron overload cardiomyopathies: new insights into an old disease. Cardiovasc Drugs Ther 1994;8 : 101-110.
5. Karimi M, Amirmoezi F, Haghpanah S, Ostad S, Lotfi M, Sefidbakht S, Rezaian S. Correlation of serum ferritin levels with hepatic MRI T2 and liver iron concentration in nontransfusion beta-thalassemia intermediate patients: A contemporary issue. Pediatr Hematol Oncol 2017; 34: 292-297
6. Roghi A, Poggiali E, Pedrotti P, Milazzo A, Quattrocchi G, Cassinerio E, Cappellini MD. Myocardial and hepatic iron overload assessment by region-based and pixel-wise T2* mapping analysis: technical pitfalls and clinical warnings. J Comput Assist Tomogr 2015; 39: 128-133.
7. Baksi AJ, Pennell DJ. Randomized controlled trials of iron chelators for the treatment of cardiac siderosis in thalassaemia major. Front Pharmacol 2014; 5: 217.
8. Modell B, Khan M, Darlison M, Westwood MA, Ingram D, Pennell DJ. Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2008; 10: 42.

9. Brittenham GM. Iron-chelating therapy for transfusional iron overload. N Engl J Med 2011; 364: 146-156.
10. Fischer R, Harmatz PR. Non-invasive assessment of tissue iron overload. ASH Education Program Book 2009 215-221.
11. Kaltwasser JP, Gottschalk R, Schalk KP, Hartl W. Non‐invasive quantitation of liver iron‐overload by magnetic resonance imaging. Br J Haematol 1990; 74: 360-363
12. Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH, et al. Cardiovascular T2* magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J 2001; 22: 2171-2179.
13. Akpinar S, Yilmaz G, Bulakbasi N, Kocaoglu M. The role of diffusion‐weighted imaging in prediction liver iron concentration in beta‐thalassaemia patients. J Med Imaging Radiat Oncol 2018; 62: 169-173.
14. Clark PR, Chua-Anusorn W, St Pierre TG. Proton transverse relaxation rate (R2) images of liver tissue; mapping local tissue iron concentrations with MR. Magn Reson Med 2003; 49: 572–575.
15. Wood JC, Enriquez C, Ghugre N, Tyzka JM, Carson S, Nelson MD, Coates TD. MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients. Blood 2005; 106: 1460-1465.
16. Hinkle DE, Wiersma W, Jurs SG. Applied Statistics for the Behavioral Sciences. 5th ed. Boston: Houghton Mifflin; 2003.
17. Fernandes J. L. MRI for Iron Overload in Thalassemia. Hematology/oncology clinics of North America 2018; 32(2): 277–295.
18. Karakas Z, Yilmaz Y, Bayramoglu Z, Karaman S, Aydogdu S, Karagenc AO, et al. Magnetic resonance imaging during management of patients with transfusion-dependent thalassemia: a single-center experience. Radiol Med 2018; 123: 572-576.
19. Majd Z, Haghpanah S, Ajami GH, Matin S, Namazi H, Bardestani M, Karimi M. Serum ferritin levels correlation with heart and liver MRI and LIC in patients with transfusion-dependent thalassemia. 2015 Apr 25; 17(4):e24959. doi: 10.5812/ircmj.17(4)2015.24959.
20. Storey P, Thompson AA, Carqueville CL, Wood JC, de Freitas RA, Rigsby CK. R2* imaging of transfusional iron burden at 3T and comparison with 1.5 T. J Magn Reson Imaging 2007; 25: 540-547.
21. Patel S, Patel S, Jadav H, Mahwana K. Role of MRI T2* Imaging in evaluation of liver and cardiac iron overload, its correlation with serum ferritin and cardiac 2d echo correlation. J Evol Med Dent Sci. 2018; 7: 462-466.
22. Triadyaksa, P, Oudkerk, M, Sijens, PE. Cardiac T2 * mapping: Techniques and clinical applications. Journal of magnetic resonance imaging : JMRI 2020; 52(5): 1340–1351.