The purpose of this study was to compare clinical decision-making in iron overload patients using FerriScan and an R2*-based approach.
One-hundred and six patients were imaged at two consecutive timepoints (454 ± 158 days) on a 1.5-T Siemens MAGNETOM Avanto Fit scanner. For both timepoints, patients underwent the standard FerriScan MRI protocol. During the second exam, each patient additionally underwent R2*-MRI mapping. For each patient, a retrospective (simulated) decision was made to increase, decrease, or maintain chelator levels. Two different decision models were considered: The fixed threshold model assumed that chelator adjustments are based strictly on fixed liver iron concentration (LIC) thresholds. Decisions made with this model depend only on the most recent LIC value and do not require any clinician input. The second model utilized decisions made by two hematologists retrospectively based on trends between two consecutive LIC values. Agreement (κA) between hematologists (i.e., interobserver variability) was compared with the agreement (κB) between a single hematologist using the two different LIC techniques.
Good agreement between R2*- and FerriScan-derived decisions was achieved for the fixed threshold model. True positive/negative rates were greater than 80%, and false positive/negative rates were less than 10%. ROC analysis yielded areas under the curve greater than 0.95. In the second model, the agreement in clinical decision-making for the two scenarios (κA vs. κB) was equal at the 95% confidence level.
Switching to R2*-based LIC estimation from FerriScan has the same level of agreement in patient management decisions as does switching from one hematologist to another.
• Good agreement between R2*- and FerriScan-derived decisions in liver iron overload patient management
• Switching to R2*-based LIC estimation from FerriScan has the same level of agreement in patient management decisions as does switching from one hematologist to another.
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- κ :
Area under the curve
Liver iron concentration
R2*-derived estimate of FerriScan LIC
- LIC FerriScan :
FerriScan-derived estimate of LIC
Magnetic resonance imaging
Receiver operating characteristic
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The authors state that this work has not received any funding.
The scientific guarantor of this publication is Kartik Jhaveri.
Conflict of interest
The 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
One of the authors has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
All MRI data used in this manuscript were acquired as part of a previous study (Jhaveri et al, JMRI 2018, pp. 1467–1474). The purpose of this previous study was twofold: first, to define a calibration curve that related R2*-derived liver iron concentration (LIC) values to FerriScan-derived LIC values; second, to characterize the nature of the uncertainty in the relationship between those two quantities. In the present manuscript, (simulated) clinical decisions were made using the R2*- and FerriScan-derived LIC values respectively. An analysis was performed to determine the agreement in clinical decision-making between these two approaches. Although the same data is used for both studies, there is no overlap in the nature or scope of the work.
• diagnostic or prognostic study
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Sussman, M.S., Ward, R., Kuo, K.H.M. et al. Impact of MRI technique on clinical decision-making in patients with liver iron overload: comparison of FerriScan- versus R2*-derived liver iron concentration. Eur Radiol 30, 1959–1968 (2020). https://doi.org/10.1007/s00330-019-06450-y
- Magnetic resonance imaging (MRI)