Advertisement

European Radiology

, Volume 17, Issue 8, pp 2079–2087 | Cite as

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

  • Eleni E. Drakonaki
  • Thomas G. Maris
  • Alex Papadakis
  • Apostolos H. Karantanas
Magnetic Resonance

Abstract

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.

Keywords

Bone marrow Iron MR imaging Thalassemia 

References

  1. 1.
    Weatherall DJ, Clegg JB, Na-Nakorn S, Wasi P (1969) The pattern of disordered haemoglobin synthesis in homozygous and heterozygous beta-thalassaemia. Br J Haematol 16:251–267PubMedGoogle Scholar
  2. 2.
    Siegelman ES, Mitchell DG, Rubin R, Hann HW, Kaplan KR, Steiner RM, Rao VM, Schuster SJ, Burk DL Jr, Rifkin MD (1991) Parenchymal versus reticuloendothelial iron overload in the liver: distinction with MR imaging. Radiology 179:361–366PubMedGoogle Scholar
  3. 3.
    Yoon DY, Choi BI, Han JK, Han MC, Park MO, Suh SJ (1994) MR findings of secondary hemochromatosis: transfusional vs. erythropoietic. J Comput Assist Tomogr 18:416–419PubMedCrossRefGoogle Scholar
  4. 4.
    Mazza P, Giua R, De Marco S, Bonetti MG, Amurri B, Masi C, Lazzari G, Rizzo C, Cervellera M, Peluso A et al (1995) Iron overload in thalassemia: comparative analysis of magnetic resonance imaging, serum ferritin and iron content of the liver. Haematologica 80:398–404PubMedGoogle Scholar
  5. 5.
    Gandon Y, Guyader D, Heautot JF, Reda MI, Yaouanq J, Buhe T, Brissot P, Carsin M, Deugnier Y (1994) Hemochromatosis: diagnosis and quantification of liver iron with gradient echo MR imaging. Radiology 193:533–538PubMedGoogle Scholar
  6. 6.
    Gomori JM, Grossman RI, Drott HR (1988) MR relaxation times and iron content of thalassemic spleens: an in vitro study. AJR Am J Roentgenol 150:567–569PubMedGoogle Scholar
  7. 7.
    Johnston DL, Rice L, Vick GW 3rd, Hedrick TD, Rokey R (1989) Assessment of tissue iron overload by nuclear magnetic resonance imaging. Am J Med 87:40–70PubMedCrossRefGoogle Scholar
  8. 8.
    Gandon Y, Olivie D, Guyader D, Aube C, Oberti F, Sebille V, Deugnier Y (2004) Non-invasive assessment of hepatic iron stores by MRI. Lancet 363:357–362PubMedCrossRefGoogle Scholar
  9. 9.
    Ooi GC, Khong PL, Chan GC, Chan KN, Chan KL, Lam W, Ng I, Ha SY (2004) Magnetic resonance screening of iron status in transfusion-dependent beta-thalassemia patients. Br J Haematol 124:385–390PubMedCrossRefGoogle Scholar
  10. 10.
    Westwood M, Anderson LJ, Firmin DN, Gatehouse PD, Charrier CC, Wonke B, Pennell DJ (2003) A single breath-hold multiecho T2* cardiovascular magnetic resonance technique for diagnosis of myocardial iron overload. J Magn Reson Imaging 18:33–39PubMedCrossRefGoogle Scholar
  11. 11.
    Argyropoulou MI, Kiortsis DN, Efremidis SC (2003) MRI of the liver and the gland in patients with beta-thalassemia major: Does hepatic siderosis predict pituitary iron deposition? Eur Radiol 13:12–16PubMedCrossRefGoogle Scholar
  12. 12.
    Midiri M, Lo Casto A, Sparacia G, D’Angelo P, Malizia R, Finazzo M, Montalto G, Solbiati L, Lagalla R, De Maria M (1999) MR imaging of pancreatic changes in patients with transfusion-dependent beta-thalassemia major. AJR Am J Roentgenol 173:187–192PubMedGoogle Scholar
  13. 13.
    Drakonaki E, Papakonstantinou O, Maris T, Vasiliadou A, Papadakis A, Gourtsoyiannis N (2005) Adrenal glands in beta-thalassemia major: magnetic resonance (MR) imaging features and correlation with iron stores. Eur Radiol 15:2462–2468PubMedCrossRefGoogle Scholar
  14. 14.
    Papakonstantinou O, Maris TG, Kostaridou S, Ladis V, Vasiliadou A, Gourtsoyiannis NC (2005) Abdominal lymphadenopathy in beta-thalassemia: MRI features and correlation with liver iron overload and posttransfusion chronic hepatitis C. AJR Am J Roentgenol 185:219–224PubMedGoogle Scholar
  15. 15.
    Papakonstantinou OG, Maris TG, Kostaridou V, Gouliamos AD, Koutoulas GK, Kalovidouris AE, Papavassiliou GB, Kordas G, Kattamis C, Vlahos LJ et al (1995) Assessment of liver iron overload by T2-quantitative magnetic resonance imaging: correlation of T2-QMRI measurements with serum ferritin concentration and histologic grading of siderosis. Magn Reson Imaging 13:967–977PubMedCrossRefGoogle Scholar
  16. 16.
    Fenzi A, Bortolazzi M, Marzola P (2003) Comparison between signal-to-noise ratio, liver-to-muscle ratio, and 1/T2 for the noninvasive assessment of liver iron content by MRI. J Magn Reson Imaging 17:589–592PubMedCrossRefGoogle Scholar
  17. 17.
    Alustiza JM, Artetxe J, Castiella A, Agirre C, Emparanza JI, Otazua P, Garcia-Bengoechea M, Barrio J, Mujica F, Recondo JA; Gipuzkoa Hepatic Iron Concentration by MRI Study Group (2004) MR quantification of hepatic iron concentration. Radiology 230:479–484PubMedCrossRefGoogle Scholar
  18. 18.
    Jensen PD (2004) Evaluation of iron overload. Br J Haematol 124(6):697–711PubMedCrossRefGoogle Scholar
  19. 19.
    Graumann R, Oppelt A, Stetter E (1986) Multiple-spin-echo imaging with a 2D Fourier method. Magn Reson Med 3:707–721PubMedCrossRefGoogle Scholar
  20. 20.
    Levin TL, Sheth SS, Ruzal-Shapiro C, Abramson S, Piomelli S, Berdon WE (1995) MRI marrow observations in thalassemia: the effects of the primary disease, transfusional therapy, and chelation. Pediatr Radiol 25:607–613PubMedCrossRefGoogle Scholar
  21. 21.
    Brasch RC, Wesbey GE, Gooding CA, Koerper MA (1984) Magnetic resonance imaging of transfusional hemosiderosis complicating thalassemia major. Radiology 150:767–771PubMedGoogle Scholar
  22. 22.
    Kaneko K, Humbert JH, Kogutt MS, Robinson AE (1993) Iron deposition in cranial bone marrow with sickle cell disease: MR assessment using a fat suppression technique. Pediatr Radiol 23:435–438PubMedCrossRefGoogle Scholar
  23. 23.
    Sebag GH, Moore SG (1990) Effect of trabecular bone on the appearance of marrow in gradient-echo imaging of the appendicular skeleton. Radiology 174:855–859PubMedGoogle Scholar
  24. 24.
    Levin TL, Sheth SS, Hurlet A, Comerci SC, Ruzal-Shapiro C, Piomelli S, Berdon WE (1995) MR marrow signs of iron overload in transfusion-dependent patients with sickle cell disease. Pediatr Radiol 25:614–619PubMedCrossRefGoogle Scholar
  25. 25.
    Ueda F, Takashima T, Suzuki M, Kadoya M (1994) MR diagnosis of myelofibrosis. Radiat Med 12:135–137PubMedGoogle Scholar
  26. 26.
    Techawiboonwong A, Song HK, Magland JF, Saha PK, Wehrli FW (2005) Implications of pulse sequence in structural imaging of trabecular bone. J Magn Reson Imaging 22:647–655PubMedCrossRefGoogle Scholar
  27. 27.
    Majumdar S, Thomasson D, Shimakawa A, Genant HK (1991) Quantitation of the susceptibility difference between trabecular bone and bone marrow: experimental studies. Magn Reson Med 22:111–127PubMedCrossRefGoogle Scholar
  28. 28.
    Majumdar S, Newitt D, Jergas M, Gies A, Chiu E, Osman D, Keltner J, Keyak J, Genant H (1995) Evaluation of technical factors affecting the quantification of trabecular bone structure using magnetic resonance imaging. Bone 17:417–430PubMedCrossRefGoogle Scholar
  29. 29.
    Long JA, Doppman JL, Nienhus AW, Mills SR (1980) Computed tomographic analysis of beta-thalassemic syndromes with hemochromatosis: pathologic findings with clinical and laboratory correlations. J Comput Assist Tomogr 4:159–165PubMedCrossRefGoogle Scholar
  30. 30.
    Guyader D, Gandon Y, Deugnier Y, Jouanolle H, Loreal O, Simon M, Bourel M, Carsin M, Brissot P (1989) Evaluation of computed tomography in the assessment of liver iron overload: a study of 46 cases of idiopathic hemochromatosis. Gastroenterology 97:737–743PubMedGoogle Scholar
  31. 31.
    Nielsen P, Engelhardt R, Fischer R, Heinrich HC, Langkowski JH, Bucheler E (1992) Noninvasive liver-iron quantification by computed tomography in iron-overloaded rats. Invest Radiol 27:312–317PubMedCrossRefGoogle Scholar
  32. 32.
    Stark DD (1991) Hepatic iron overload: paramagnetic pathology. Radiology 179:333–335PubMedGoogle Scholar
  33. 33.
    Bonkovsky HL, Rubin RB, Cable EE, Davidoff A, Rijcken TH, Stark DD (1999) Hepatic iron concentration: noninvasive estimation by means of MR imaging techniques. Radiology 212:227–234PubMedGoogle Scholar
  34. 34.
    Ernst O, Sergent G, Bonvarlet P, Canva-Delcambre V, Paris JC, L’Hermine C (1997) Hepatic iron overload: diagnosis and quantification with MR imaging. AJR Am J Roentgenol 168:1205–1208PubMedGoogle Scholar
  35. 35.
    McDonald RA, Mallory GK (1960) Hemochromatosis and hemosiderosis: study of 211 autopsied cases. Arch Intern Med 105:686–700Google Scholar
  36. 36.
    Metz S, Lohr S, Settles M, Beer A, Woertler K, Rummeny EJ, Daldrup-Link HE (2006) Ferumoxtran-10-enhanced MR imaging of the bone marrow before and after conditioning therapy in patients with non-Hodgkin lymphomas. Eur Radiol 16:598–607PubMedCrossRefGoogle Scholar
  37. 37.
    Tanimoto A, Oshio K, Suematsu M, Pouliquen D, Stark DD (2001) Relaxation effects of clustered particles. J Magn Reson Imaging 14:72–77PubMedCrossRefGoogle Scholar
  38. 38.
    Hundt W, Petsch R, Helmberger T, Reiser M (2000) Effect of superparamagnetic iron oxide on bone marrow. Eur Radiol 10:1495–1500PubMedCrossRefGoogle Scholar
  39. 39.
    Anderson LJ, Westwood MA, Holden S, Davis B, Prescott E, Wonke B, Porter JB, Walker JM, Pennell DJ (2004) Myocardial iron clearance during reversal of siderotic cardiomyopathy with intravenous desferrioxamine: a prospective study using T2* cardiovascular magnetic resonance. Br J Haematol 127:348–355PubMedCrossRefGoogle Scholar
  40. 40.
    Martins R, Picanco I, Fonseca A, Ferreira L, Rodrigues O, Coelho M, Seixas T, Miranda A, Nunes B, Costa L, Romao L, Faustino P (2004) The role of HFE mutations on iron metabolism in beta-thalassemia carriers. J Hum Genet 49:651–655PubMedCrossRefGoogle Scholar
  41. 41.
    Melis MA, Cau M, Deidda F, Barella S, Cao A, Galanello R (2002) H63D mutation in the HFE gene increases iron overload in beta-thalassemia carriers. Haematologica 87:242–245PubMedGoogle Scholar
  42. 42.
    Cohen A, Gallanello R, Pennell D, Cunningham M, Vichinsky E (2004) Thalassemia. Hematology (Am Soc Hematol Educ Program Book), pp 14–34Google Scholar
  43. 43.
    Isokawa M, Kimura F, Matsuki T, Omoto E, Otsuka K, Kurokawa H, Togami I, Hiraki Y, Kimura I, Harada M (1997) Evaluation of bone marrow iron by magnetic resonance. Ann Hematol 74:269–274PubMedCrossRefGoogle Scholar
  44. 44.
    Harju E, Pakarinen A, Larmi T (1984) A comparison between serum ferritin concentration and the amount of bone marrow stainable iron. Scand J Clin Lab Invest 44:555–556PubMedGoogle Scholar
  45. 45.
    Krause JR, Stolc V (1980) Serum ferritin and bone marrow biopsy iron stores. II. Correlation with low serum iron and Fe/TIBC ratio less than 15%. Am J Clin Pathol 74:461–464PubMedGoogle Scholar
  46. 46.
    Jensen PD, Jensen FT, Christensen T, Ellegaard J (1994) Non-invasive assessment of tissue iron overload in the liver by magnetic resonance imaging. Br J Haematol 87:171–184PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Eleni E. Drakonaki
    • 1
  • Thomas G. Maris
    • 2
  • Alex Papadakis
    • 3
  • Apostolos H. Karantanas
    • 1
  1. 1.Radiology DepartmentUniversity Hospital of HeraklionHeraklionGreece
  2. 2.Department of Medical PhysicsUniversity of CreteHeraklionGreece
  3. 3.Venizelion General HospitalHeraklionGreece

Personalised recommendations