Z Gastroenterol 2018; 56(01): E2-E89
DOI: 10.1055/s-0037-1612710
Poster Visit Session II Clinical Hepatology – Friday, January 26, 2018, 2:35pm – 3:20pm, Room 120
Georg Thieme Verlag KG Stuttgart · New York

Comparison between Room-temperature susceptometry and MRI with respect to the cell-specific detection of liver iron

J Mueller
1   Salem Medical Center and Center for Alcohol Research and Liver Disease, Heidelberg
,
H Raisi
1   Salem Medical Center and Center for Alcohol Research and Liver Disease, Heidelberg
,
V Rausch
1   Salem Medical Center and Center for Alcohol Research and Liver Disease, Heidelberg
,
D Simons
2   Deutsches Krebsforschungszentrum (DKFZ), Dept. of Radiology, Heidelberg
,
C Ziener
2   Deutsches Krebsforschungszentrum (DKFZ), Dept. of Radiology, Heidelberg
,
H Schlemmer
2   Deutsches Krebsforschungszentrum (DKFZ), Dept. of Radiology, Heidelberg
,
H Seitz
1   Salem Medical Center and Center for Alcohol Research and Liver Disease, Heidelberg
,
B Straub
3   University of Heidelberg, Institute of Pathology, Heidelberg
4   University of Mainz, Institute of Pathology, Mainz
,
N Waldburger
3   University of Heidelberg, Institute of Pathology, Heidelberg
,
S Mueller
1   Salem Medical Center and Center for Alcohol Research and Liver Disease, Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2018 (online)

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Objectives:

Liver iron not only accumulates in hemochromatosis but also in various chronic liver diseases such as HCV and ALD where it has been identified as an important prognostic and cancerogenic factor. Unfortunately, the non-invasive and cost-efficient assessment of liver iron is still insufficiently resolved. We here compare the non-invasive methods Room-temperature Susceptometry (RTS) and Magnetic Resonance Imaging (MRI) with the invasive liver biopsy and lab parameters and their association to the cellular distribution of iron in the liver tissue.

Methods:

106 patients with various diseases such as alcoholic and non-alcoholic liver disease or hemochromatosis were prospectively enrolled. All 106 patients underwent liver biopsy with quantitative iron determination via atomic absorption spectroscopy (AAS) and blood serum markers such as serum ferritin were determined. In 78 patients liver iron was determined histologically by semi-quantitative Prussian Blue staining (grade 0 – 3). In 95 patients, liver iron concentration (LIC) was also determined by RTS and in 34 patients via MRI (1.5T Magnetom Aera, Software: LiverLab, Siemens).

Results:

Both MRI and RTS correlated well with AAS with Pearson correlation coefficients of 0.75 (P < 0.001) and 0.48 (P < 0.001), respectively. AAS, MRI and RTS all correlated better with hepatocellular iron scores from Prussian Blue Staining than with RES-iron. The Spearman correlation coefficients with hepatocellular iron scores for AAS, MRI and RTS are 0.60 (P < 0.001), 0.62 (P < 0.001) and 0.55 (P < 0.001), respectively, and in comparison with RES-iron scores are r = 0.47 (P < 0.001), 0.26 (P > 0.05) and 0.48 (P < 0.001). Serum ferritin on the other hand correlated equally well with hepatocellular and RES-iron scores with correlation coefficients of 0.52 and 0.56 (P < 0.001), respectively. This is also reflected in the diagnostic accuracies for the detection of the pathologic hepatocellular iron. When using a hepatocellular iron grade 2 as cutoff value, the diagnostic accuracies are as follows: AAS: 92%, cutoff 4 mg/g dry weight; RTS: 88%, cutoff 400 µg/g wet weight; MRI: 80%, cutoff 33 s-1; Ferritin: 67%, cutoff 890 ng/ml.

Conclusion:

RTS, MRI and AAS are primarily detecting hepatocellular iron and not macrophage iron most likely due to the abundance of hepatocytes in the liver tissue. On the opposite side, serum ferritin is more dependent on RES-iron than on hepatocellular iron. Since RTS reaches good diagnostic accuracies in the detection of severe pathological hepatocellular iron we consider it as a promising bedside method for the screening of liver iron overload.