Pancreatic iron and fat assessment by MRI-R2∗ in patients with iron overload diseases

Charlotte D. Pfeifer, Bjoern P. Schoennagel, Regine Grosse, Zhiyue J. Wang, Joachim Graessner, Peter Nielsen, Gerhard Adam, Roland Fischer, Jin Yamamura

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background To determine the pancreatic iron (R2) and fat content (FC) in comparison to hepatic and cardiac R2∗ in patients with iron overload disorders like β-thalassemia major (TM), Diamond-Blackfan anemia (DBA) or hereditary hemochromatosis. Methods R2∗ rates were assessed in the liver, heart and pancreas of 42 patients with TM, 29 subjects with other iron overload diseases, and 10 controls using an ECG-gated breathhold sequence (12 echo time [TE]=1.3-25.7 ms, readout repetition time [TR]=244 ms). Pancreatic R2∗ and FC were assessed from TE dependent region of interest based signal intensities performing water-fat chemical shift relaxometry and were compared with laboratory parameters (glucose, HbA1c, amylase and lipase). Results A pancreatic iron gradient from tail (R2=122 s<sup>-1</sup>) to head (R2=114 s<sup>-1</sup>, P<10<sup>-4</sup>) was found. The close association between cardiac and pancreatic R2∗ was also confirmed in patients with TM and other iron overload diseases (r<inf>s</inf>=0.64, P<10<sup>-4</sup>). Receiver operator characteristic analysis (area: 0.89, P<10<sup>-4</sup>) identified patients with elevated cardiac iron at a pancreatic R2∗ cut-off level of 131s<sup>-1</sup> (sensitivity=specificity at 81%). Highest pancreatic R2∗ (211s<sup>-1</sup>) and FC (36%) were found in the tail region of diabetic patients with TM. Conclusion Pancreatic tail showed highest R2∗ rates and fat contents, especially in patients with thalassemia. Besides iron accumulation fatty degeneration might be an additional risk factor for the development of diabetes in β-thalassemia major, but this hypothesis needs further studies in prediabetic patients.

Original languageEnglish (US)
Pages (from-to)196-203
Number of pages8
JournalJournal of Magnetic Resonance Imaging
Volume42
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Iron Overload
beta-Thalassemia
Iron
Fats
Diamond-Blackfan Anemia
Thalassemia
Hemochromatosis
Liver
Amylases
Lipase
Pancreas
Electrocardiography
Head
Glucose
Sensitivity and Specificity
Water

Keywords

  • fat infiltration
  • iron overload
  • pancreas
  • pancreatic tail
  • R2
  • thalassemia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Pfeifer, C. D., Schoennagel, B. P., Grosse, R., Wang, Z. J., Graessner, J., Nielsen, P., ... Yamamura, J. (2015). Pancreatic iron and fat assessment by MRI-R2∗ in patients with iron overload diseases. Journal of Magnetic Resonance Imaging, 42(1), 196-203. https://doi.org/10.1002/jmri.24752

Pancreatic iron and fat assessment by MRI-R2∗ in patients with iron overload diseases. / Pfeifer, Charlotte D.; Schoennagel, Bjoern P.; Grosse, Regine; Wang, Zhiyue J.; Graessner, Joachim; Nielsen, Peter; Adam, Gerhard; Fischer, Roland; Yamamura, Jin.

In: Journal of Magnetic Resonance Imaging, Vol. 42, No. 1, 01.07.2015, p. 196-203.

Research output: Contribution to journalArticle

Pfeifer, CD, Schoennagel, BP, Grosse, R, Wang, ZJ, Graessner, J, Nielsen, P, Adam, G, Fischer, R & Yamamura, J 2015, 'Pancreatic iron and fat assessment by MRI-R2∗ in patients with iron overload diseases', Journal of Magnetic Resonance Imaging, vol. 42, no. 1, pp. 196-203. https://doi.org/10.1002/jmri.24752
Pfeifer, Charlotte D. ; Schoennagel, Bjoern P. ; Grosse, Regine ; Wang, Zhiyue J. ; Graessner, Joachim ; Nielsen, Peter ; Adam, Gerhard ; Fischer, Roland ; Yamamura, Jin. / Pancreatic iron and fat assessment by MRI-R2∗ in patients with iron overload diseases. In: Journal of Magnetic Resonance Imaging. 2015 ; Vol. 42, No. 1. pp. 196-203.
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abstract = "Background To determine the pancreatic iron (R2) and fat content (FC) in comparison to hepatic and cardiac R2∗ in patients with iron overload disorders like β-thalassemia major (TM), Diamond-Blackfan anemia (DBA) or hereditary hemochromatosis. Methods R2∗ rates were assessed in the liver, heart and pancreas of 42 patients with TM, 29 subjects with other iron overload diseases, and 10 controls using an ECG-gated breathhold sequence (12 echo time [TE]=1.3-25.7 ms, readout repetition time [TR]=244 ms). Pancreatic R2∗ and FC were assessed from TE dependent region of interest based signal intensities performing water-fat chemical shift relaxometry and were compared with laboratory parameters (glucose, HbA1c, amylase and lipase). Results A pancreatic iron gradient from tail (R2=122 s-1) to head (R2=114 s-1, P<10-4) was found. The close association between cardiac and pancreatic R2∗ was also confirmed in patients with TM and other iron overload diseases (rs=0.64, P<10-4). Receiver operator characteristic analysis (area: 0.89, P<10-4) identified patients with elevated cardiac iron at a pancreatic R2∗ cut-off level of 131s-1 (sensitivity=specificity at 81{\%}). Highest pancreatic R2∗ (211s-1) and FC (36{\%}) were found in the tail region of diabetic patients with TM. Conclusion Pancreatic tail showed highest R2∗ rates and fat contents, especially in patients with thalassemia. Besides iron accumulation fatty degeneration might be an additional risk factor for the development of diabetes in β-thalassemia major, but this hypothesis needs further studies in prediabetic patients.",
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AU - Graessner, Joachim

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N2 - Background To determine the pancreatic iron (R2) and fat content (FC) in comparison to hepatic and cardiac R2∗ in patients with iron overload disorders like β-thalassemia major (TM), Diamond-Blackfan anemia (DBA) or hereditary hemochromatosis. Methods R2∗ rates were assessed in the liver, heart and pancreas of 42 patients with TM, 29 subjects with other iron overload diseases, and 10 controls using an ECG-gated breathhold sequence (12 echo time [TE]=1.3-25.7 ms, readout repetition time [TR]=244 ms). Pancreatic R2∗ and FC were assessed from TE dependent region of interest based signal intensities performing water-fat chemical shift relaxometry and were compared with laboratory parameters (glucose, HbA1c, amylase and lipase). Results A pancreatic iron gradient from tail (R2=122 s-1) to head (R2=114 s-1, P<10-4) was found. The close association between cardiac and pancreatic R2∗ was also confirmed in patients with TM and other iron overload diseases (rs=0.64, P<10-4). Receiver operator characteristic analysis (area: 0.89, P<10-4) identified patients with elevated cardiac iron at a pancreatic R2∗ cut-off level of 131s-1 (sensitivity=specificity at 81%). Highest pancreatic R2∗ (211s-1) and FC (36%) were found in the tail region of diabetic patients with TM. Conclusion Pancreatic tail showed highest R2∗ rates and fat contents, especially in patients with thalassemia. Besides iron accumulation fatty degeneration might be an additional risk factor for the development of diabetes in β-thalassemia major, but this hypothesis needs further studies in prediabetic patients.

AB - Background To determine the pancreatic iron (R2) and fat content (FC) in comparison to hepatic and cardiac R2∗ in patients with iron overload disorders like β-thalassemia major (TM), Diamond-Blackfan anemia (DBA) or hereditary hemochromatosis. Methods R2∗ rates were assessed in the liver, heart and pancreas of 42 patients with TM, 29 subjects with other iron overload diseases, and 10 controls using an ECG-gated breathhold sequence (12 echo time [TE]=1.3-25.7 ms, readout repetition time [TR]=244 ms). Pancreatic R2∗ and FC were assessed from TE dependent region of interest based signal intensities performing water-fat chemical shift relaxometry and were compared with laboratory parameters (glucose, HbA1c, amylase and lipase). Results A pancreatic iron gradient from tail (R2=122 s-1) to head (R2=114 s-1, P<10-4) was found. The close association between cardiac and pancreatic R2∗ was also confirmed in patients with TM and other iron overload diseases (rs=0.64, P<10-4). Receiver operator characteristic analysis (area: 0.89, P<10-4) identified patients with elevated cardiac iron at a pancreatic R2∗ cut-off level of 131s-1 (sensitivity=specificity at 81%). Highest pancreatic R2∗ (211s-1) and FC (36%) were found in the tail region of diabetic patients with TM. Conclusion Pancreatic tail showed highest R2∗ rates and fat contents, especially in patients with thalassemia. Besides iron accumulation fatty degeneration might be an additional risk factor for the development of diabetes in β-thalassemia major, but this hypothesis needs further studies in prediabetic patients.

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