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Comparison of Inline R2* MRI versus FerriScan for liver iron quantification in patients on chelation therapy for iron overload: preliminary results

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

MRI quantification of liver iron concentration (LIC) using R2 or R2* relaxometry requires offline post-processing causing reporting delays, administrative overhead, and added costs. A prototype 3D multi-gradient-echo pulse sequence, with inline post-processing, allows immediate calculation of LIC from an R2* map (inline R2*-LIC) without offline processing. We compared inline R2*-LIC to FerriScan and offline R2* calibration methods.

Methods

Forty patients (25 women, 15 men; age 18–82 years), prospectively underwent FerriScan and the prototype sequence, which produces two R2* maps, with and without fat modeling, as well as an inline R2*-LIC map derived from the R2* map with fat modeling, with informed consent. For each map, the following contours were drawn: ROIs, whole-axial-liver contour, and an exact copy of contour utilized by FerriScan. LIC values from the FerriScan report and those calculated using an alternative R2 calibration were the reference standards. Results were compared using Pearson and interclass correlation coefficients (PCC, ICC), linear regression, Bland-Altman analysis, and estimation of area under the receiver operator curve (ROC-AUC).

Results

Inline R2*-LIC demonstrated good agreement with the reference standards. Compared to FerriScan, inline R2*-LIC with whole-axial-liver contour, ROIs, and FerriScan contour demonstrated PCC of 94.8%, 94.8%, and 92%; ICC 93%, 92.7%, and 90.2%; regression slopes 1.004, 0.974, and 1.031; mean bias 5.54%, 10.91%, and 0.36%; and ROC-AUC estimates 0.903, 0.906, and 0.890 respectively. Agreement was maintained when adjusted for sex, age, diagnosis, liver fat content, and fat-water swap.

Conclusion

Inline R2*-LIC provides robust and comparable quantification of LIC compared to FerriScan, without the need for offline post-processing.

Key Points

• In patients being treated for iron overload with chelation therapy, liver iron concentration (LIC) is regularly assessed in order to monitor and adjust therapy.

• Magnetic resonance imaging (MRI) is commonly used to quantify LIC. Several R 2 and R 2 * methods are available, all of which require offline post-processing.

• A novel R 2 * MRI method allows for immediate calculation of LIC and provides comparable quantification of LIC to the FerriScan and recently published alternative R 2 * methods.

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Abbreviations

Alternative- R2-LIC:

LIC result calculated using the R2 result from FerriScan and the alternative R2-to-LIC calibration equation

AUC:

Area under the curve

FerriScan-LIC:

LIC result reported in the FerriScan report

Inline R2*-LIC:

Inline post-processing of values from the R2* effective map, generating an LIC result in milligrams of iron per gram of liver

LIC:

Liver iron concentration

ME-GRE:

Multiecho gradient recalled echo

Offline R2*effective-LIC:

LIC result calculated using the values from the R2* effective map and an offline post-processing calibration equation. Further subdivided into calibration equation 1 or 2

Offline R2*mono-LIC:

LIC result calculated using the values from the R2* monoexponential map and an offline post-processing calibration equation. Further subdivided into calibration equation 1 or 2

PDFF:

Proton density fat fraction

R2*effective map:

noise-corrected R2* map of the liver, with fat modelling

R2*mono map:

noise-corrected R2* map of the liver, without fat modelling

ROC:

Receiver operator characteristic

VIBE:

Volumetric interpolated breath-hold examination

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Funding

GMH is a Clinical Research Fellow who is funded by a research grant from the Faculty of Radiologists, Royal College of Surgeons in Ireland.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women’s College Hospital, University of Toronto, Toronto, ON, Canada

    Gerard M. Healy & Kartik S. Jhaveri

  2. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Gerard M. Healy & Kartik S. Jhaveri

  3. MR Application Development, Siemens Healthcare GmbH, Erlangen, Germany

    Stephan A. R. Kannengiesser

  4. Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Osvaldo Espin-Garcia

  5. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Osvaldo Espin-Garcia

  6. Division of Medical Oncology & Hematology, University Health Network, University of Toronto, Toronto, ON, Canada

    Richard Ward & Kevin H. M. Kuo

Authors
  1. Gerard M. Healy
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  2. Stephan A. R. Kannengiesser
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  3. Osvaldo Espin-Garcia
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  4. Richard Ward
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  5. Kevin H. M. Kuo
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  6. Kartik S. Jhaveri
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Corresponding author

Correspondence to Kartik S. Jhaveri.

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Guarantor

The scientific guarantor of this publication is Dr Kartik Jhaveri.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: SK is an employee of Siemens Healthcare GmbH. The remaining authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Osvaldo Espin-Garcia (a co-author) kindly provided statistical advice for this manuscript.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• Prospective

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• Performed at one institution

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Healy, G.M., Kannengiesser, S.A.R., Espin-Garcia, O. et al. Comparison of Inline R2* MRI versus FerriScan for liver iron quantification in patients on chelation therapy for iron overload: preliminary results. Eur Radiol 31, 9296–9305 (2021). https://doi.org/10.1007/s00330-021-08019-0

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  • DOI: https://doi.org/10.1007/s00330-021-08019-0

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