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Hattapoğlu S, Çetinçakmak MG. Evaluation of iron overload in visceral organs in thalassemia patients by point shear-wave elastography. Ir J Med Sci 2024; 193:2407-2412. [PMID: 38789665 DOI: 10.1007/s11845-024-03719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION The aim of this study was to investigate the value of point shear-wave elastography (pSWE) in the measurement of iron overload in the liver and other visceral organs in patients with beta thalassemia major (BTM). MATERIALS AND METHODS The study included 103 patients diagnosed with BTM who were referred to our clinic for cardiac and liver T2* measurement and a control group of 120 age- and gender-matched healthy volunteers. Cardiac and hepatic T2* measurements were performed in the patient group. Hepatic, pancreatic, splenic, and renal pSWE values were measured in both groups. The pSWE values were compared between the two groups. In the patient group, correlations between pSWE values, cardiac-hepatic T2* values and hepatic size, patient age, and serum ferritin levels were analyzed. RESULTS Hepatic, pancreatic, splenic, and renal pSWE values were significantly higher in the patient group compared to the control group (p ≤ 0.001, < 0.001, 0.014, 0.026, respectively). In the patient group, hepatic pSWE values established a significant correlation with cardiac T2* values, liver size-T2*, pancreatic pSWE values, serum ferritin levels, and age (p = 0.006, < 0.001, 0.001, 0.042, 0.001, 0.032, respectively). In the ROC analysis, the area under the ROC curve was 0.807 for hepatic pSWE in the discrimination of thalassemia patients and healthy controls, and the cut-off value was 1.42, which gave a sensitivity and specificity of 75.7% and 75%, respectively. CONCLUSıON: Point shear-wave elastography can be a useful technique in the clinical measurement of iron overload in the liver, pancreas, spleen, and kidney.
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Affiliation(s)
- Salih Hattapoğlu
- Department of Radiology, Medical School, Dicle University, Diyarbakır, Turkey.
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Carolin A, Frazer D, Yan K, Bishop CR, Tang B, Nguyen W, Helman SL, Horvat J, Larcher T, Rawle DJ, Suhrbier A. The effects of iron deficient and high iron diets on SARS-CoV-2 lung infection and disease. Front Microbiol 2024; 15:1441495. [PMID: 39296289 PMCID: PMC11408339 DOI: 10.3389/fmicb.2024.1441495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
Introduction The severity of Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often dictated by a range of comorbidities. A considerable literature suggests iron deficiency and iron overload may contribute to increased infection, inflammation and disease severity, although direct causal relationships have been difficult to establish. Methods Here we generate iron deficient and iron loaded C57BL/6 J mice by feeding standard low and high iron diets, with mice on a normal iron diet representing controls. All mice were infected with a primary SARS-CoV-2 omicron XBB isolate and lung inflammatory responses were analyzed by histology, immunohistochemistry and RNA-Seq. Results Compared with controls, iron deficient mice showed no significant changes in lung viral loads or histopathology, whereas, iron loaded mice showed slightly, but significantly, reduced lung viral loads and histopathology. Transcriptional changes were modest, but illustrated widespread dysregulation of inflammation signatures for both iron deficient vs. controls, and iron loaded vs. controls. Some of these changes could be associated with detrimental outcomes, whereas others would be viewed as beneficial. Discussion Diet-associated iron deficiency or overload thus induced modest modulations of inflammatory signatures, but no significant histopathologically detectable disease exacerbations.
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Affiliation(s)
- Agnes Carolin
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - David Frazer
- Molecular Nutrition, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kexin Yan
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Cameron R Bishop
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Bing Tang
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Wilson Nguyen
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Sheridan L Helman
- Molecular Nutrition, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Jay Horvat
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | | | - Daniel J Rawle
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andreas Suhrbier
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- GVN Centre of Excellence, Australian Infectious Disease Research Centre, Brisbane, QLD, Australia
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3
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Puttawibul P, Kritsaneepaiboon S, Chotsampancharoen T, Vichitkunakorn P. The relationship between liver stiffness by two-dimensional shear wave elastography and iron overload status in transfusion-dependent patients. Pediatr Hematol Oncol 2024; 41:409-421. [PMID: 38978478 DOI: 10.1080/08880018.2024.2353900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/21/2023] [Indexed: 07/10/2024]
Abstract
Increased liver stiffness (LS) can be result of increased liver iron concentration (LIC) which may not yet be reflected in the liver fibrotic status. The objective of our study was to examine relationship between hemochromatosis, LS, and serum ferritin level in transfusion-dependent patients. We recruited all 70 transfusion-dependent patients, whose median age was 15, referred for evaluating LIC status by magnetic resonance imaging (MRI) followed by two-dimensional ultrasonography shear wave elastography (2D-SWE). Thalassemia beta affected the majority of the patients. The optimal cut point for prediction of severe hemochromatosis using median SWE (kPa) and SWV (m/s) was ≥ 7.0 kPa and ≥ 1.54 m/s, respectively, with sensitivity of 0.76 (95% confidence interval [CI] 0.55, 0.91) and, specificity of 0.69 (95%CI 0.53, 0.82). When combing the optimal cut point of SWE (kPa) at ≥ 7.0 and serum ferritin ≥ 4123 ng/mL, the sensitivity increased to 0.84 (95%CI 0.64, 0.95) with specificity of 0.67 (95%CI 0.50, 0.80), positive predictive value (PPV) of 0.60 (95%CI 0.42, 0.76), and negative predictive value (NPV) of 0.88 (95%CI 0.71, 0.96). Simultaneous tests of 2D-SWE and serum ferritin for prediction of severe hemochromatosis showed the highest sensitivity of 84% (95%CI 0.64-0.95), as compared to 2D-SWE alone at 76% (95%CI 0.55, 0.91) or serum ferritin alone at 44% (95%CI 0.24-0.65). We recommend measuring both 2D-SWE and serum ferritin in short interval follow up patients. Adding 2D-SWE to management guideline will help in deciding for aggressive adjustment of iron chelating medication and increased awareness of patients having severe hemochromatosis.
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Affiliation(s)
- Pimporn Puttawibul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand
| | | | | | - Polathep Vichitkunakorn
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
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Chung M, Ton L, Lee AY. Forget Me Not: Incidental Findings on Breast MRI. JOURNAL OF BREAST IMAGING 2024:wbae023. [PMID: 38758984 DOI: 10.1093/jbi/wbae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Indexed: 05/19/2024]
Abstract
With the growing utilization and expanding role of breast MRI, breast imaging radiologists may encounter an increasing number of incidental findings beyond the breast and axilla. Breast MRI encompasses a large area of anatomic coverage extending from the lower neck to the upper abdomen. While most incidental findings on breast MRI are benign, identifying metastatic disease can have a substantial impact on staging, prognosis, and treatment. Breast imaging radiologists should be familiar with common sites, MRI features, and breast cancer subtypes associated with metastatic disease to assist in differentiating malignant from benign findings. Furthermore, detection of malignancies of nonbreast origin as well as nonmalignant, but clinically relevant, incidental findings can significantly impact clinical management and patient outcomes. Breast imaging radiologists should consistently follow a comprehensive search pattern and employ techniques to improve the detection of these important incidental findings.
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Affiliation(s)
- Maggie Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Lauren Ton
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Fujii H, Matsuki M, Hamakawa T, Toda Y, Fujii N, Masuoka S, Nakamata A, Chiba E, Ishii K, Mori H. Choroid plexus and pituitary gland hemochromatosis induced by transfusional iron overload: Two case reports. Radiol Case Rep 2024; 19:1666-1670. [PMID: 38384695 PMCID: PMC10876467 DOI: 10.1016/j.radcr.2024.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Hemochromatosis is a primary or secondary pathological condition characterized by the deposition of excess iron in the body tissues, which can eventually lead to cellular damage and organ dysfunction. Although excess iron deposition in the central nervous system is rare, involvement of the choroid plexus, pituitary gland, cortical surfaces, and basal ganglia has been reported to date. This case report describes 2 cases of transfusion-induced hemochromatosis involving the choroid plexus and pituitary gland, which were diagnosed by magnetic resonance imaging (MRI). In both cases, gradient echo (GRE) sequences, such as T2 star-weighted image and susceptibility-weighted imaging demonstrated markedly low signal intensity in the choroid plexus. Furthermore, the pituitary gland showed low signal intensity on T2-weighted images in Patient 2. Because these low signal intensities were not seen prior to red blood cell transfusion, they were diagnosed with transfusion-induced hemochromatosis. Brain MRI with GRE sequences was useful in detecting iron deposition in the choroid plexus. Considering that iron deposition in the body tissues can lead to irreversible organ damage, MRI with GRE sequences should be considered for patients with suspected iron overload.
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Affiliation(s)
- Hiroyuki Fujii
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Mitsuru Matsuki
- Department of Pediatric Radiology, Jichi Children's Medical Center Tochigi, Japan
| | - Takefumi Hamakawa
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Nana Fujii
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Sota Masuoka
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Akihiro Nakamata
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Emiko Chiba
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Kazunari Ishii
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University, Tochigi, Japan
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Li D, Li J, Zhang H, Zhu Q, Wang T, Zhao W, Zhao S, Li W. Hereditary hemochromatosis caused by a C282Y/H63D mutation in the HFE gene: A case report. Heliyon 2024; 10:e28046. [PMID: 38560130 PMCID: PMC10979142 DOI: 10.1016/j.heliyon.2024.e28046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Hereditary hemochromatosis (HH) is a disease characterized by disordered iron metabolism. It often involves mutations of the HFE gene, which encodes the homeostatic iron regulator protein (HFE), as well as mutations affecting hepcidin antimicrobial peptide, hemojuvelin, or transferrin receptor 2. Historically, HH has been observed primarily in European and European diaspora populations, while classical HH is rare in Asian populations, including in China. In this article, we report a rare case of HH in a Chinese man that could be attributed to a heterozygous C282Y/H63D HFE mutation. Based on clinical examination, liver biopsy, and genetic testing results, the patient was diagnosed with HH. Clinical signs and symptoms and serum iron-related test results were recorded for a period of two years after the patient began treatment. Over this observation period, the patient was subjected to 25 phlebotomies (accounting for a total blood loss of 10.2 L). His serum ferritin levels decreased from 1550 μg/L to 454 μg/L, his serum iron concentration decreased from 40 μmol/L to 24.6 μmol/L, and his transferrin saturation decreased from 97.5% to 55.1%. Early diagnosis is essential for patients with HH to obtain good outcomes. Regular phlebotomy after diagnosis can improve HH symptoms and delay HH disease progression.
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Affiliation(s)
- Dongdong Li
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Jinfeng Li
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Hongkun Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Qiuyu Zhu
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Teng Wang
- Yiwu Central Hospital, 322000 Yiwu, Zhejiang, China
| | - Wen Zhao
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Shousong Zhao
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Wei Li
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
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Ito K, Ohgi K, Kimura K, Ishitaki K, Yamashita A, Yokote H, Tsukuda S, Matsushita K, Naraoka Y, Fujioka A, Ono T. Kidney R2* Mapping for Noninvasive Evaluation of Iron Overload in Paroxysmal Nocturnal Hemoglobinuria. Magn Reson Med Sci 2024:mp.2023-0114. [PMID: 38369335 DOI: 10.2463/mrms.mp.2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
PURPOSE The kidney iron deposition can cause kidney damage and renal insufficiency in paroxysmal nocturnal hemoglobinuria (PNH) patients. Assessment of iron deposition in the kidney is essential for the early diagnosis of renal damage in PNH patients. The purpose of this study was to evaluate kidney R2* (T2* reciprocals) values in PNH patients using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ). METHODS Two radiologists measured the R2* values of the renal cortex in 14 PNH patients and 13 healthy volunteers using IDEAL-IQ. Lactate dehydrogenase (LDH), a reliable marker of intravascular hemolysis, was also measured in all participants. RESULTS The kidney R2* values were significantly higher in PNH patients compared with those in healthy volunteers (P < 0.001). High inter-operator reproducibility of the measurements was also acquired using IDEAL-IQ. LDH levels were also significantly higher in PNH patients compared with those in healthy volunteers (P < 0.001). Kidney R2* values strongly correlated with LDH levels in PNH patients. CONCLUSION IDEAL-IQ has a possibility of becoming a useful method for the noninvasive evaluation of renal iron overload in PNH patients.
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Affiliation(s)
- Koichi Ito
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazuyuki Ohgi
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Koichiro Kimura
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
- Department of Diagnostic Radiology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichi Ishitaki
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
- Department of Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kanagawa, Kawasaki, Japan
| | - Akiyoshi Yamashita
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroyuki Yokote
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunji Tsukuda
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Ko Matsushita
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuko Naraoka
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Amon Fujioka
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tatsuki Ono
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
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Choi M, Lee N. Case report: Ultrasonographic and computed tomographic imaging features of hemochromatosis in a dog. Front Vet Sci 2024; 10:1331392. [PMID: 38292128 PMCID: PMC10825960 DOI: 10.3389/fvets.2023.1331392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
A castrated male mixed-breed dog weighing 7 kg presented with elevated liver enzymes and anorexia. Abdominal radiography revealed hepatomegaly with heterogeneous hepatic opacification, and abdominal ultrasonography showed a fine echotexture and heterogeneous parenchyma concurrent with a suspected acquired portosystemic shunt. Pre-contrast computed tomography (CT) showed marked hepatomegaly with homogeneous increased liver density and multiple enlarged abdominal lymph nodes with markedly increased parenchymal density. Histopathology of the hepatic and lymph node biopsy revealed accumulated abundant hemosiderin, and the Prussian Blue stain confirmed marked iron accumulation within the hepatocytes. Based on our review of the literature, this is the first case report describing the imaging diagnosis of hemochromatosis in a dog.
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Affiliation(s)
- Mihyun Choi
- BON Animal Medical Center, Suwon, Republic of Korea
| | - Namsoon Lee
- Section of Medical Imaging, Veterinary Medical Center, Chungbuk National University, Cheongju, Republic of Korea
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Tonna RF, Haddadin R, Iqbal H, Gemil H. A Rare Case of Heterozygous C282Y Mutation Causing Hereditary Hemochromatosis With Acute Pancreatitis. Cureus 2024; 16:e52584. [PMID: 38371159 PMCID: PMC10874645 DOI: 10.7759/cureus.52584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Hereditary hemochromatosis (HH) is the most common autosomal recessive genetic disorder globally for Caucasians. HH is known as an iron metabolism disorder where there is an increase in iron absorption in the body. HH is not localized but a systemic disease; the manifestations of HH include cirrhosis, diabetes mellitus, cardiomyopathy, and pancreatitis. This case is about a 53-year-old female with a past medical history of heterozygous hereditary hemochromatosis who presents to the emergency department with abdominal pain, nausea, and vomiting and was found to have acute pancreatitis. This case report helps signify the importance of identifying and treating symptomatic heterozygous carriers of the HH gene mutation.
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Affiliation(s)
- Roger F Tonna
- Internal Medicine, MountainView Hospital, Las Vegas, USA
| | | | - Humzah Iqbal
- Internal Medicine, University of California San Francisco, Fresno, Fresno, USA
| | - Hatim Gemil
- Internal Medicine, MountainView Hospital, Las Vegas, USA
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Chung R, Garratt J, Remer EM, Navin P, Blake MA, Taffel MT, Hackett CE, Sharbidre KG, Tu W, Low G, Bara M, Carney BW, Corwin MT, Campbell MJ, Lee JT, Lee CY, Dueber JC, Shehata MA, Caoili EM, Schieda N, Elsayes KM. Adrenal Neoplasms: Lessons from Adrenal Multidisciplinary Tumor Boards. Radiographics 2023; 43:e220191. [PMID: 37347698 DOI: 10.1148/rg.220191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The radiologic diagnosis of adrenal disease can be challenging in settings of atypical presentations, mimics of benign and malignant adrenal masses, and rare adrenal anomalies. Misdiagnosis may lead to suboptimal management and adverse outcomes. Adrenal adenoma is the most common benign adrenal tumor that arises from the cortex, whereas adrenocortical carcinoma (ACC) is a rare malignant tumor of the cortex. Adrenal cyst and myelolipoma are other benign adrenal lesions and are characterized by their fluid and fat content, respectively. Pheochromocytoma is a rare neuroendocrine tumor of the adrenal medulla. Metastases to the adrenal glands are the most common malignant adrenal tumors. While many of these masses have classic imaging appearances, considerable overlap exists between benign and malignant lesions and can pose a diagnostic challenge. Atypical adrenal adenomas include those that are lipid poor; contain macroscopic fat, hemorrhage, and/or iron; are heterogeneous and/or large; and demonstrate growth. Heterogeneous adrenal adenomas may mimic ACC, metastasis, or pheochromocytoma, particularly when they are 4 cm or larger, whereas smaller versions of ACC, metastasis, and pheochromocytoma and those with washout greater than 60% may mimic adenoma. Because of its nonenhanced CT attenuation of less than or equal to 10 HU, a lipid-rich adrenal adenoma may be mimicked by a benign adrenal cyst, or it may be mimicked by a tumor with central cystic and/or necrotic change such as ACC, pheochromocytoma, or metastasis. Rare adrenal tumors such as hemangioma, ganglioneuroma, and oncocytoma also may mimic adrenal adenoma, ACC, metastasis, and pheochromocytoma. The authors describe cases of adrenal neoplasms that they have encountered in clinical practice and presented to adrenal multidisciplinary tumor boards. Key lessons to aid in diagnosis and further guide appropriate management are provided. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Ryan Chung
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Joanie Garratt
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Erick M Remer
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Patrick Navin
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael A Blake
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Myles T Taffel
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Caitlin E Hackett
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Kedar G Sharbidre
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Wendy Tu
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Gavin Low
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Meredith Bara
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Benjamin W Carney
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael T Corwin
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael J Campbell
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - James T Lee
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Cortney Y Lee
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Julie C Dueber
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Mostafa A Shehata
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Elaine M Caoili
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Nicola Schieda
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Khaled M Elsayes
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
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Low G, Ferguson C, Locas S, Tu W, Manolea F, Sam M, Wilson MP. Multiparametric MR assessment of liver fat, iron, and fibrosis: a concise overview of the liver "Triple Screen". Abdom Radiol (NY) 2023; 48:2060-2073. [PMID: 37041393 DOI: 10.1007/s00261-023-03887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
Chronic liver disease (CLD) is a common source of morbidity and mortality worldwide. Non-alcoholic fatty liver disease (NAFLD) serves as a major cause of CLD with a rising annual prevalence. Additionally, iron overload can be both a cause and effect of CLD with a negative synergistic effect when combined with NAFLD. The development of state-of-the-art multiparametric MR solutions has led to a change in the diagnostic paradigm in CLD, shifting from traditional liver biopsy to innovative non-invasive methods for providing accurate and reliable detection and quantification of the disease burden. Novel imaging biomarkers such as MRI-PDFF for fat, R2 and R2* for iron, and liver stiffness for fibrosis provide important information for diagnosis, surveillance, risk stratification, and treatment. In this article, we provide a concise overview of the MR concepts and techniques involved in the detection and quantification of liver fat, iron, and fibrosis including their relative strengths and limitations and discuss a practical abbreviated MR protocol for clinical use that integrates these three MR biomarkers into a single simplified MR assessment. Multiparametric MR techniques provide accurate and reliable non-invasive detection and quantification of liver fat, iron, and fibrosis. These techniques can be combined in a single abbreviated MR "Triple Screen" assessment to offer a more complete metabolic imaging profile of CLD.
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Affiliation(s)
- Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Craig Ferguson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Stephanie Locas
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Wendy Tu
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Florin Manolea
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Medica Sam
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada.
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Akca T, Ozdemir GN, Aycicek A, Ozkaya G. Long-term Results of Splenectomy in Transfusion-dependent Thalassemia. J Pediatr Hematol Oncol 2023; 45:143-148. [PMID: 35446800 DOI: 10.1097/mph.0000000000002468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
Splenectomy is indicated in transfusion-dependent thalassemia (TDT) only in certain situations. This study aimed to present the effectiveness, complications, and long-term follow-up results of splenectomy in children with TDT. We performed a 30-year single-institution analysis of cases of splenectomy for TDT between 1987 and 2017 and their follow-up until 2021. A total of 39 children (female/male: 24/15) were included. The mean age at splenectomy was 11.2±3.2 years, and their mean follow-up duration after splenectomy was 21.5±6.4 years. Response was defined according to the patient's annual transfusion requirement in the first year postsplenectomy and on the last follow-up year. Complete response was not seen in any of the cases; partial response was observed in 32.3% and no response in 67.6%. Thrombocytosis was seen in 87% of the patients. The platelet counts of 7 (17.9%) patients were >1000 (10 9 /L), and aspirin prophylaxis was given to 22 (56.4%) patients. Complications were thrombosis in 2 (5.1%) patients, infections in 11 (28.2%) patients, and pulmonary hypertension in 4 (10.2%) patients. Our study showed that after splenectomy, the need for transfusion only partially decreased in a small number of TDT patients. We think splenectomy can be delayed with appropriate chelation therapy up to higher annual transfusion requirement values.
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Affiliation(s)
- Tugberk Akca
- Departments of Pediatrics
- Departments of Pediatric Cardiology
| | - Gul N Ozdemir
- Pediatric Hematology and Oncology, Kanuni Sultan Suleyman Training and Research Hospital
- Department of Pediatric Hematology and Oncology, Istinye University Faculty of Medicine, Istanbul
| | - Ali Aycicek
- Pediatric Hematology and Oncology, Kanuni Sultan Suleyman Training and Research Hospital
- Department of Hematology and Oncology, Basaksehir Cam Sakura City Hospital, University of Health Sciences
| | - Guven Ozkaya
- Biostatistics, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
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13
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Imaging of metabolic and overload disorders in tissues and organs. Jpn J Radiol 2023; 41:571-595. [PMID: 36680702 DOI: 10.1007/s11604-022-01379-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023]
Abstract
Metabolic and overload disorders are a heterogeneous group of relatively uncommon but important diseases. While imaging plays a key role in the early detection and accurate diagnosis in specific organs with a pivotal role in several metabolic pathways, most of these diseases affect different tissues as part of a systemic syndromes. Moreover, since the symptoms are often vague and phenotypes similar, imaging alterations can present as incidental findings, which must be recognized and interpreted in the light of further biochemical and histological investigations. Among imaging modalities, MRI allows, thanks to its multiparametric properties, to obtain numerous information on tissue composition, but many metabolic and accumulation alterations require a multimodal evaluation, possibly using advanced imaging techniques and sequences, not only for the detection but also for accurate characterization and quantification. The purpose of this review is to describe the different alterations resulting from metabolic and overload pathologies in organs and tissues throughout the body, with particular reference to imaging findings.
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14
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Rafati Rahimzadeh M, Rafati Rahimzadeh M, Kazemi S, Moghadamnia AR, Ghaemi Amiri M, Moghadamnia AA. Iron; Benefits or threatens (with emphasis on mechanism and treatment of its poisoning). Hum Exp Toxicol 2023; 42:9603271231192361. [PMID: 37526177 DOI: 10.1177/09603271231192361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Iron is a necessary biological element and one of the richest in the human body, but it can cause changes in cell function and activity control. Iron is involved in a wide range of oxidation - reduction activities. Whenever iron exceeds the cellular metabolic needs, its excess causes changes in the products of cellular respiration, such as superoxide, hydrogen peroxide and hydroxyl. The formation of these compounds causes cellular toxicity. Lack of control over reactive oxygen species causes damages to DNA, proteins, and lipids. Conversely, superoxide, hydrogen peroxide and hydroxyl are reactive oxygen species, using antioxidants, restoring DNA function, and controlling iron stores lead to natural conditions. Iron poisoning causes clinical manifestations in the gastrointestinal tract, liver, heart, kidneys, and hematopoietic system. When serum iron is elevated, serum iron concentrations, total iron-binding capacity (TIBC) and ferritin will also increase. Supportive care is provided by whole bowel irrigation (WBI), esophagogastroduodenoscopy is required to evaluate mucosal injury and remove undissolved iron tablets. The use of chelator agents such as deferoxamine mesylate, deferasirox, deferiprone, deferitrin are very effective in removing excess iron. Of course, the combined treatment of these chelators plays an important role in increasing iron excretion, and reducing side effects.
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Affiliation(s)
| | | | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Maryam Ghaemi Amiri
- Faculty of Education Development Center (EDC), Babol University of Medical Sciences, Babol, Iran
| | - Ali Akbar Moghadamnia
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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15
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Raief Mosaad BM, Ibrahim AS, Mansour MG, ElAlfy MS, Ebeid FSE, Abdeldayem EH. The role of MRI-R2* in the detection of subclinical pancreatic iron loading among transfusion-dependent sickle cell disease patients and correlation with hepatic and cardiac iron loading. Insights Imaging 2022; 13:140. [PMID: 36057708 PMCID: PMC9440968 DOI: 10.1186/s13244-022-01280-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Pancreatic reserve could be preserved by early assessment of pancreatic iron overload among transfusion-dependent sickle cell disease (SCD) patients. This study aimed to measure pancreatic iron load and correlate its value with patients’ laboratory and radiological markers of iron overload. Materials and methods Sixty-six SCD children and young adults underwent MRI T2* relaxometry using a simple mathematical spreadsheet and laboratory assessment. Results The results indicated moderate-to-severe hepatic iron overload among 65.2% of studied cases. None had cardiac iron overload. Normal-to-mild iron overload was present in the pancreas in 86% of cases, and 50% had elevated serum ferritin > 2500 ug/L. There was no significant correlation between pancreatic R2* level, serum ferritin, and hepatic iron overload. Patients with higher levels of hemolysis markers and lower pre-transfusion hemoglobin levels showed moderate-to-severe pancreatic iron overload. Conclusion Chronically transfused patients with SCD have a high frequency of iron overload complications including pancreatic iron deposition, thereby necessitating proper monitoring of the body’s overall iron balance as well as detection of extrahepatic iron depositions.
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Affiliation(s)
| | - Ahmed Samir Ibrahim
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed G Mansour
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohsen Saleh ElAlfy
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Emad H Abdeldayem
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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16
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Greene CJ, Attwood K, Sharma NJ, Balderman B, Deng R, Muhitch JB, Smith GJ, Gross KW, Xu B, Kauffman EC. Iron accumulation typifies renal cell carcinoma tumorigenesis but abates with pathological progression, sarcomatoid dedifferentiation, and metastasis. Front Oncol 2022; 12:923043. [PMID: 35992801 PMCID: PMC9389085 DOI: 10.3389/fonc.2022.923043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Iron is a potent catalyst of oxidative stress and cellular proliferation implicated in renal cell carcinoma (RCC) tumorigenesis, yet it also drives ferroptosis that suppresses cancer progression and represents a novel therapeutic target for advanced RCC. The von Hippel Lindau (VHL)/hypoxia-inducible factor-α (HIF-α) axis is a major regulator of cellular iron, and its inactivation underlying most clear cell (cc) RCC tumors introduces both iron dependency and ferroptosis susceptibility. Despite the central role for iron in VHL/HIF-α signaling and ferroptosis, RCC iron levels and their dynamics during RCC initiation/progression are poorly defined. Here, we conducted a large-scale investigation into the incidence and prognostic significance of total tissue iron in ccRCC and non-ccRCC patient primary tumor cancer cells, tumor microenvironment (TME), metastases and non-neoplastic kidneys. Prussian Blue staining was performed to detect non-heme iron accumulation in over 1600 needle-core sections across multiple tissue microarrays. We found that RCC had significantly higher iron staining scores compared with other solid cancers and, on average, >40 times higher than adjacent renal epithelium. RCC cell iron levels correlated positively with TME iron levels and inversely with RCC levels of the main iron uptake protein, transferrin receptor 1 (TfR1/TFRC/CD71). Intriguingly, RCC iron levels, including in the TME, decreased significantly with pathologic (size/stage/grade) progression, sarcomatoid dedifferentiation, and metastasis, particularly among patients with ccRCC, despite increasing TfR1 levels, consistent with an increasingly iron-deficient tumor state. Opposite to tumor iron changes, adjacent renal epithelial iron increased significantly with RCC/ccRCC progression, sarcomatoid dedifferentiation, and metastasis. Lower tumor iron and higher renal epithelial iron each predicted significantly shorter ccRCC patient metastasis-free survival. In conclusion, iron accumulation typifies RCC tumors but declines toward a relative iron-deficient tumor state during progression to metastasis, despite precisely opposite dynamics in adjacent renal epithelium. These findings raise questions regarding the historically presumed selective advantage for high iron during all phases of cancer evolution, suggesting instead distinct tissue-specific roles during RCC carcinogenesis and early tumorigenesis versus later progression. Future study is warranted to determine how the relative iron deficiency of advanced RCC contributes to ferroptosis resistance and/or introduces a heightened susceptibility to iron deprivation that might be therapeutically exploitable.
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Affiliation(s)
- Christopher J. Greene
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Department of Biological Sciences, University at Buffalo, Buffalo, NY, United States
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Nitika J. Sharma
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Benjamin Balderman
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Rongia Deng
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Jason B. Muhitch
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Gary J. Smith
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Kenneth W. Gross
- Department of Molecular and Cellular Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Bo Xu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Eric C. Kauffman
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Department of Cancer Genetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- *Correspondence: Eric C. Kauffman,
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17
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Branisso PPF, de Oliveira CPMS, Filho HML, Lima FR, Santos AS, Mancini MC, de Melo ME, Carrilho FJ, Rocha MDS, Clark P, Branisso HJP, Cercato C. Non-invasive methods for iron overload evaluation in dysmetabolic patients. Ann Hepatol 2022; 27:100707. [PMID: 35477031 DOI: 10.1016/j.aohep.2022.100707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/04/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Although hyperferritinemia may reflect the inflammatory status of patients with non-alcoholic fatty liver disease (NAFLD), approximately 33% of hyperferritinemia cases reflect real hepatic iron overload. AIM To evaluate a non-invasive method for assessing mild iron overload in patients with NAFLD using 3T magnetic resonance imaging (MRI) relaxometry, serum hepcidin, and the expression of ferritin subunits. METHODS This cross-sectional study assessed patients with biopsy-proven NAFLD. MRI relaxometry was performed using a 3T scanner in all patients, and the results were compared with iron content determined by liver biopsy. Ferritin, hepcidin, and ferritin subunits were assessed and classified according to ferritin levels and to siderosis identified by liver biopsy. RESULTS A total of 67 patients with NAFLD were included in the study. MRI revealed mild iron overload in all patients (sensitivity, 73.5%; specificity, 70%). For mild (grade 1) siderosis, the transverse relaxation rate (R2*) threshold was 58.9 s-1 and the mean value was 72.5 s-1 (SD, 33.9), while for grades 2/3 it was 88.2 s-1 (SD, 31.9) (p < 0.001). The hepcidin threshold for siderosis was > 30.2 ng/mL (sensitivity, 87%; specificity, 82%). Ferritin H and ferritin L subunits were expressed similarly in patients with NAFLD, regardless of siderosis. There were no significant differences in laboratory test results between the groups, including glucose parameters and liver function tests. CONCLUSIONS MRI relaxometry and serum hepcidin accurately assessed mild iron overload in patients with dysmetabolic iron overload syndrome.
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Affiliation(s)
- Paula Pessin Fábrega Branisso
- Obesity and metabolic syndrome study group, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | | | - Hilton Muniz Leão Filho
- Radiology department, InRad, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Fabiana Roberto Lima
- Patology department, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Aritânia Sousa Santos
- Laboratory of Carbohydrates and Raioimmunoassay (LIM/18), Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Marcio Correa Mancini
- Obesity and metabolic syndrome study group, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Maria Edna de Melo
- Radiology department, InRad, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Flair José Carrilho
- Gastroenterology department, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Manoel de Souza Rocha
- Radiology department, InRad, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Paul Clark
- Magnepath digital health company, Perth, Australia
| | | | - Cintia Cercato
- Obesity and metabolic syndrome study group, Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
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18
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Bhimaniya S, Arora J, Sharma P, Zhang Z, Khanna G. Liver iron quantification in children and young adults: comparison of a volumetric multi-echo 3-D Dixon sequence with conventional 2-D T2* relaxometry. Pediatr Radiol 2022; 52:1476-1483. [PMID: 35384483 DOI: 10.1007/s00247-022-05352-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/02/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-based liver iron quantification is the standard of care to guide chelation therapy in children at risk of hemochromatosis. T2* relaxometry is the most widely used technique but requires third-party software for post-processing. Vendor-provided three-dimensional (3-D) multi-echo Dixon techniques are now available that allow inline/automated post-processing. OBJECTIVE The purpose of our study was to evaluate the diagnostic accuracy of a volumetric multi-echo Dixon technique using conventional T2* relaxometry as the reference standard in a pediatric and young adult population. MATERIALS AND METHODS In this retrospective study, we queried the radiology information system to identify all MRIs performed for liver iron quantification from July 2015 to January 2020. All patients had undergone T2* relaxometry on a 1.5-tesla (T) scanner for liver iron concentration (LIC) estimation. In addition, a 3-D multi-echo Dixon was performed using Siemens Healthineers LiverLab (Erlangen, Germany). Two readers independently estimated liver R2* and T2* on the multi-echo Dixon by drawing free-hand regions of interest on the scanner-generated R2* and T2* maps. Conventional T2*-relaxometry-based LIC was the reference standard. We estimated interobserver agreement by concordance correlation coefficient (CCC). We used Bland-Altman analysis and Pearson correlation coefficient (r) to compare LIC by the two methods. RESULTS Fifty-four MRIs on 38 patients (22 females) were available for analysis. Mean patient age was 11.8 years (standard deviation [SD] 5.3 years). Reference standard LIC ranged 1.1-21.1 (median 6.8) mg/g dry weight of liver. The concordance between readers for T2* estimation using 3-D multi-echo Dixon was substantial (CCC 0.99, confidence interval 0.99-1.00). Bland-Altman plot showed that all observations were clustered around the zero bias line if the LIC average was ≤8 mg/g, and r was very strong (reader 1 r=0.93, reader 2 r=0.92, both P-values <0.001). With increasing LIC, there was a pattern of poor agreement on the Bland-Altman plot, with observations crossing the lower limits of agreement, and r was very weak (reader 1 r=0.05, P-value 0.84; reader 2 r=0.17, P-value 0.44). CONCLUSION Vendor-based 3-D multi-echo Dixon allows for excellent interobserver correlation in liver T2* estimation. LIC estimated by this method has a very strong correlation with conventional T2* relaxometry if liver iron overload is mild-moderate (LIC ≤8 mg/g).
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Affiliation(s)
- Sudhir Bhimaniya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jyoti Arora
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Puneet Sharma
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhongwei Zhang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Geetika Khanna
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Pediatric Radiology, Egleston Hospital, Children's Healthcare of Atlanta, 1405 Clifton Road NE, Radiology Admin Office 1st Floor Tower 2, Atlanta, GA, 30322, USA.
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19
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Thomas J, Ludwig DR, Ballard DH, Mellnick VM, Siegel CL, Fraum TJ. Spilling the beans: an inside scoop on the imaging of renal parenchymal disease. Abdom Radiol (NY) 2022; 47:2420-2441. [PMID: 35562564 PMCID: PMC9273813 DOI: 10.1007/s00261-022-03540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Renal parenchymal disease is commonly encountered on imaging, and an understanding of the spectrum of pathology is vital to making correct diagnoses and recommendations for management. These conditions can be categorized based on the presence of calcifications, cysts, solid masses, patterns of enhancement, and other characteristic non-mass findings, as well as on their spatial distribution (i.e., medullary vs. cortical). Making an accurate diagnosis is often challenging, as there is overlap in the features of various diseases, and many benign entities may mimic pathology. OBJECTIVE This review broadly discusses imaging features of renal parenchymal disease and provides a systematic approach to characterize findings and appropriately guide further management.
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Affiliation(s)
- Joel Thomas
- Abdominal Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA.
| | - Daniel R Ludwig
- Abdominal Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - David H Ballard
- Abdominal Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Vincent M Mellnick
- Abdominal Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Cary L Siegel
- Abdominal Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Tyler J Fraum
- Abdominal Imaging & Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
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20
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Ali Mohamed Aboughonaim A, Naguib Ettaby A, Ibrahim El-Noueum K, Hassab H, Emara DM. Dual gradient echo in-phase and out of phase sequences in assessment of hepatic iron overload in patients with beta-thalassemia, would be better? Eur J Radiol 2022; 154:110412. [PMID: 35724580 DOI: 10.1016/j.ejrad.2022.110412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of the dual gradient-echo (GRE) in- and out-of-phase sequences as a quantitative tool for hepatic iron overload in comparison with MRI R2* relaxometry in paediatric patients with beta-thalassemia. METHOD Sixty-three patients with beta-thalassemia major (transfusion-dependent) or beta-thalassemia intermedia (transfusion- and non-transfusion-dependent) were referred from the paediatric department (haematology unit) to the radiology department at a university hospital. The paediatrician conducted a clinical examination for the studied group, assessed their laboratory data, conducted R2* relaxometry and dual gradient echo sequences to calculate R2* and relative signal intensity index at the axial mid-section of the liver, and studied their correlation. A 1.5 Tesla MR scanner was used (Achieva; Philips Medical Systems, the Netherlands). Data were fed to the computer and analysed using the IBM SPSS software package version 20.0 (Armonk, NY: IBM Corp). The Kolmogorov-Smirnov test was used to verify the normality of distribution. The significance of the results was determined at the 5% level. The Chi-square, Fisher's exact correction, Pearson coefficient, and Bland-Altman tests were used. RESULTS Dual gradient-echo in- and out-of-phase sequences using visual assessment accurately assessed 93.65% of our patient group with hepatic iron overload. A significant correlation was found between the relative signal intensity index and hepatic MRI R2* relaxometry (p < 0.001, r = 0.861). CONCLUSIONS Dual gradient-echo in and out-of-phase sequences are good imaging tools for hepatic iron detection and quantification. These sequences showed good correlation with R2* relaxometry (r = 0.861, p < 0.001).
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Affiliation(s)
| | | | | | - Hoda Hassab
- Department of Pediatrics (hematology unit), Faculty of medicine, Alexandria University, Egypt
| | - Doaa M Emara
- Department of radiodiagnosis, Faculty of medicine, Alexandria University, Egypt
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21
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Boss A, Heeb L, Vats D, Starsich FHL, Balfourier A, Herrmann IK, Gupta A. Assessment of iron nanoparticle distribution in mouse models using ultrashort-echo-time MRI. NMR IN BIOMEDICINE 2022; 35:e4690. [PMID: 34994020 PMCID: PMC9286043 DOI: 10.1002/nbm.4690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
Microscopic magnetic field inhomogeneities caused by iron deposition or tissue-air interfaces may result in rapid decay of transverse magnetization in MRI. The aim of this study is to detect and quantify the distribution of iron-based nanoparticles in mouse models by applying ultrashort-echo-time (UTE) sequences in tissues exhibiting extremely fast transverse relaxation. In 24 C57BL/6 mice (two controls), suspensions containing either non-oxidic Fe or AuFeOx nanoparticles were injected into the tail vein at two doses (200 μg and 600 μg per mouse). Mice underwent MRI using a UTE sequence at 4.7 T field strength with five different echo times between 100 μs and 5000 μs. Transverse relaxation times T2 * were computed for the lung, liver, and spleen by mono-exponential fitting. In UTE imaging, the MRI signal could reliably be detected even in liver parenchyma exhibiting the highest deposition of nanoparticles. In animals treated with Fe nanoparticles (600 μg per mouse), the relaxation time substantially decreased in the liver (3418 ± 1534 μs (control) versus 228 ± 67 μs), the spleen (2170 ± 728 μs versus 299 ± 97 μs), and the lungs (663 ± 101 μs versus 413 ± 99 μs). The change in transverse relaxation was dependent on the number and composition of the nanoparticles. By pixel-wise curve fitting, T2 * maps were calculated showing nanoparticle distribution. In conclusion, UTE sequences may be used to assess and quantify nanoparticle distribution in tissues exhibiting ultrafast signal decay in MRI.
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Affiliation(s)
- Andreas Boss
- Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
| | - Laura Heeb
- Division of Visceral SurgeryUniversity Hospital ZurichZurichSwitzerland
| | | | - Fabian H. L. Starsich
- Laboratory for Particles‐Biology InteractionsSwiss Federal Laboratories for Materials Science and Technology (Empa)St. GallenSwitzerland
- Department of Mechanical and Process Engineering, ETH ZurichNanoparticle Systems Engineering LaboratoryZurichSwitzerland
| | - Alice Balfourier
- Laboratory for Particles‐Biology InteractionsSwiss Federal Laboratories for Materials Science and Technology (Empa)St. GallenSwitzerland
- Department of Mechanical and Process Engineering, ETH ZurichNanoparticle Systems Engineering LaboratoryZurichSwitzerland
| | - Inge K. Herrmann
- Laboratory for Particles‐Biology InteractionsSwiss Federal Laboratories for Materials Science and Technology (Empa)St. GallenSwitzerland
- Department of Mechanical and Process Engineering, ETH ZurichNanoparticle Systems Engineering LaboratoryZurichSwitzerland
| | - Anurag Gupta
- Division of Visceral SurgeryUniversity Hospital ZurichZurichSwitzerland
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22
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Cui MH, Billett HH, Suzuka SM, Ambadipudi K, Archarya S, Mowrey WB, Branch CA. Corrected cerebral blood flow and reduced cerebral inflammation in berk sickle mice with higher fetal hemoglobin. Transl Res 2022; 244:75-87. [PMID: 35091127 DOI: 10.1016/j.trsl.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
Fetal hemoglobin (HbF) is known to lessen the severity of sickle cell disease (SCD), through reductions in peripheral vaso-occlusive disease and reduced risk for cerebrovascular events. However, the influence of HbF on oxygen delivery to high metabolism tissues like the brain, or its influence on cerebral perfusion, metabolism, inflammation or function have not been widely studied. We employed a Berkley mouse model (BERK) of SCD with gamma transgenes q3 expressing exclusively human α- and βS-globins with varying levels of γ globin expression to investigate the effect of HbF expression on the brain using magnetic resonance imaging (MRI), MRI diffusion tensor imaging (DTI) and spectroscopy (MRS) and hematological parameters. Hematological parameters improved with increasing γ level expression, as did markers for brain metabolism, perfusion and inflammation. Brain microstructure assessed by DTI fractional anisotropy improved, while myo-inositol levels increased, suggesting improved microstructural integrity and reduced cell loss. Our results suggest that increasing γ levels not only improves sickle peripheral disease, but also improves brain perfusion and oxygen delivery while reducing brain inflammation while protecting brain microstructural integrity.
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Affiliation(s)
- Min-Hui Cui
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Henny H Billett
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Pathology, Albert Einstein College of Medicine, New York, New York
| | - Sandra M Suzuka
- Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Kamalakar Ambadipudi
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York
| | - Seetharama Archarya
- Department of Medicine, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York
| | - Wenzhu B Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, New York
| | - Craig A Branch
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, New York, New York; Department of Radiology, Albert Einstein College of Medicine, New York, New York; Department of Physiology & Biophysics, Albert Einstein College of Medicine, New York, New York.
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23
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Hepatic manifestations of systemic disease: an imaging-based review. Pediatr Radiol 2022; 52:852-864. [PMID: 34797394 DOI: 10.1007/s00247-021-05222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/28/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Abstract
The liver is responsible for many processes that maintain human metabolic homeostasis and can be affected by several pediatric systemic diseases. In this manuscript, we explore key pathological findings and imaging features across multiple modalities of a spectrum of congenital, metabolic and autoimmune disorders. Strengthening the radiologists' knowledge regarding potential hepatic manifestations of these systemic diseases will ultimately lead to improved care for pediatric patients.
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Pecorelli A, Franceschi P, Braccischi L, Izzo F, Renzulli M, Golfieri R. MRI Appearance of Focal Lesions in Liver Iron Overload. Diagnostics (Basel) 2022; 12:diagnostics12040891. [PMID: 35453939 PMCID: PMC9029711 DOI: 10.3390/diagnostics12040891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Liver iron overload is defined as an accumulation of the chemical element Fe in the hepatic parenchyma that exceeds the normal storage. When iron accumulates, it can be toxic for the liver by producing inflammation and cell damage. This can potentially lead to cirrhosis and hepatocellular carcinoma, as well as to other liver lesions depending on the underlying condition associated to liver iron overload. The correct assessment of liver iron storage is pivotal to drive the best treatment and prevent complication. Nowadays, magnetic resonance imaging (MRI) is the best non-invasive modality to detect and quantify liver iron overload. However, due to its superparamagnetic properties, iron provides a natural source of contrast enhancement that can make challenging the differential diagnosis between different focal liver lesions (FLLs). To date, a fully comprehensive description of MRI features of liver lesions commonly found in iron-overloaded liver is lacking in the literature. Through an extensive review of the published literature, we aim to summarize the MRI signal intensity and enhancement pattern of the most common FLLs that can occur in liver iron overload.
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Feng J, Feng Q, Chen Y, Yang T, Cheng S, Qiao Y, Shen J. MRI-Based Radiomic Signature Identifying Secondary Loss of Response to Infliximab in Crohn's Disease. Front Nutr 2022; 8:773040. [PMID: 35047543 PMCID: PMC8763017 DOI: 10.3389/fnut.2021.773040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Up to 50% of patients with Crohn's disease (CD) experience secondary loss of response (SLR) to infliximab. Patients with SLR may show clinical signs of iron deficiency as a result of inflammation despite being iron-replete. The magnetic resonance imaging (MRI)-based radiomic index, R2*, can detect changes in iron metabolism. Therefore, the R2* parameter has considerable potential for detection of SLR to infliximab. The aims of this study were to explore the correlation between R2* and inflammation and to develop a non-invasive nomogram based on R2* to identify SLR to infliximab in patients with CD. Three hundred and twenty-two infliximab-treated patients with CD who underwent magnetic resonance enterography within 2 weeks before or after 54 weeks of infliximab therapy were divided into training and validation datasets at a ratio of 8:2. Point-biserial analysis was conducted to confirm the relationship between R2* and inflammation. A multivariate logistic regression model was created using R2*, CRP and hemoglobin (OR, 1.10, 1.04 and 0.98; P < 0.05). Receiver-operating characteristic curves and the Hosmer-Lemeshow test were used to assess the performance of the model. A correlation between R2* and inflammation was identified. Different trends in R2* and iron status indices were observed between patients with responsive and non-responsive CD, which is worthy of further study. The model was converted to a visualized nomogram that had a good ability to discriminate the outcomes of infliximab therapy with an area under the curve of 0.723 (95% CI, 0.661-0.785) in the training dataset and 0.715 (95% CI, 0.587-0.843) in the validation dataset. We confirmed a correlation between R2* and inflammation in patients with CD. Based on the MRI-based radiomic signature, a novel nomogram was established and validated to facilitate individualized identification of SLR to infliximab in patients with CD.
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Affiliation(s)
- Jing Feng
- Key Laboratory of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Research Center, Ministry of Health, Shanghai, China.,Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Qi Feng
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yueying Chen
- Key Laboratory of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Research Center, Ministry of Health, Shanghai, China.,Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Tian Yang
- Key Laboratory of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Research Center, Ministry of Health, Shanghai, China.,Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Saiming Cheng
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Qiao
- Key Laboratory of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Research Center, Ministry of Health, Shanghai, China.,Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Jun Shen
- Key Laboratory of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Research Center, Ministry of Health, Shanghai, China.,Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Shanghai, China
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Qaseem Y, Cassidy F, Aganovic L, Purysko A, Mirza S, Vahdat N. Renovascular involvement of systemic vascular disease: a pictorial review. Abdom Radiol (NY) 2022; 47:3531-3545. [PMID: 35796773 PMCID: PMC9261205 DOI: 10.1007/s00261-022-03591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023]
Abstract
Like many solid organs, the kidneys are susceptible to a wide variety of systemic vascular diseases. Comprising a significant subset of these diseases are the vasculitides, broadly encompassing numerous inflammatory conditions of the blood vessels. However, many of these conditions are non-vasculitic and non-inflammatory, and differentiation of these entities is crucial to guide the initiation of proper therapy. These non-vasculitic diseases include coagulopathic conditions leading to vascular complications, hemolysis, and hematogenous processes that can affect multiple organ systems. These systemic diseases can result in both macrovascular and microvascular pathology, involving the arteries, veins, and smaller vessels, and management of these conditions can differ significantly depending upon the underlying pathophysiology. Because the clinical manifestations of these disease processes can be heterogeneous, ranging from renal dysfunction to life-threatening hemorrhage, proper recognition of these entities is essential to help guide clinicians to the correct diagnosis and prevent potentially disastrous complications. Many of these systemic vascular processes can be detected by non-invasive imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), and identification of their characteristic renal manifestations by radiologists is a critical component of patient care. This review covers a variety of these diseases and their imaging manifestations, to aid in their recognition and better equip radiologists to provide vital diagnostic information that can optimize patient care.
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Affiliation(s)
- Yousuf Qaseem
- grid.266100.30000 0001 2107 4242Department of Radiology, University of California San Diego Health, San Diego, CA USA
| | - Fiona Cassidy
- grid.266100.30000 0001 2107 4242Department of Radiology, University of California San Diego Health, San Diego, CA USA ,Department of Radiology, Veteran Administration Healthcare System, San Diego, CA USA
| | - Lejla Aganovic
- grid.266100.30000 0001 2107 4242Department of Radiology, University of California San Diego Health, San Diego, CA USA ,Department of Radiology, Veteran Administration Healthcare System, San Diego, CA USA
| | - Andrei Purysko
- grid.239578.20000 0001 0675 4725Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH USA
| | - Sara Mirza
- grid.266100.30000 0001 2107 4242Department of Radiology, University of California San Diego Health, San Diego, CA USA
| | - Noushin Vahdat
- grid.266100.30000 0001 2107 4242Department of Radiology, University of California San Diego Health, San Diego, CA USA ,Department of Radiology, Veteran Administration Healthcare System, San Diego, CA USA
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Kaban S, Damar Ç. Interrelationship between liver T2*-weighted magnetic resonance imaging and acoustic radiation force impulse elastography measurement results and plasma ferritin levels in children with β-thalassemia major. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:108-116. [PMID: 34716933 DOI: 10.1002/jcu.23095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate correlation and agreement between T2*-weighted magnetic resonance imaging (T2*-wMRI), acoustic radiation force impulse elastography (ARFI-e) measurement results of liver and plasma ferritin levels (PFLs) in children with β-thalassemia major (β-TM). METHODS The study included 40 pediatric patients (aged 64-216 months; 14 girls, 26 boys) receiving blood transfusion and chelation therapy. To detect the severity of liver iron overload (LIO) and concomitant parenchymal fibrosis, T2*-wMRI and ARFI-e measurements were performed from the right lobe segments. Student's t-test, Mann-Whitney U, ANOVA, Spearman's test and ICC were used for statistical analysis. RESULTS After the measurements of T2*-wMRI, patients were grouped as normal in 4 (10%), mild in 11 (27.5%), moderate in 21 (52.5%), and severe in 4 (10%) cases in terms of LIO. Combined moderate and severe groups had significantly higher ARFI-e and PFL values than the combination of other groups (p = .001, p = .040). The ARFI-e measurements of boys were found to be significantly higher than those of girls (p = .023). A strong negative correlation between T2*-wMRI and ARFI-e and a moderate negative correlation between T2*-wMRI and PFL were detected (p;r = 0.001;-0.606, p;r = 0.009; -0.407). A strong positive correlation was found between ARFI-e values and PFL (p;r = 0.001; 0.659). The optimal cut-off value of ARFI-e to predict liver fibrosis because of moderate&severe LIO was determined to be 1.29 M/s (80% sensitivity and 88% specificity). A moderate agreement was observed between the T2*-wMRI and ARFI-e methods [ICC: 0.680, 95% CI: (0.470 to 0.817)]. CONCLUSION Given the strong correlation and moderate agreement between ARFI-e and T2*-wMRI, ARFI -e could be used to monitor LIO in children with β-TM.
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Affiliation(s)
- Selami Kaban
- Faculty of Medicine, Department of Radiology, Gaziantep University, Gaziantep, Turkey
| | - Çağrı Damar
- Faculty of Medicine, Department of Radiology, Gaziantep University, Gaziantep, Turkey
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Roy A, Darapureddy A, Kumar Y. Noninvasive assessment of liver fibrosis by magnetic resonance elastography in patients with rheumatic disease on long-term methotrexate treatment. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_186_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kartamihardja AAP, Ariyani W, Hanaoka H, Taketomi-Takahashi A, Koibuchi N, Tsushima Y. The Role of Ferrous Ion in the Effect of the Gadolinium-Based Contrast Agents (GBCA) on the Purkinje Cells Arborization: An In Vitro Study. Diagnostics (Basel) 2021; 11:2310. [PMID: 34943547 PMCID: PMC8699861 DOI: 10.3390/diagnostics11122310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
Gadolinium deposition in the brain has been observed in areas rich in iron, such as the dentate nucleus of the cerebellum. We investigated the role of Fe2+ in the effect of gadolinium-based contrast agents (GBCA) on thyroid hormone-mediated Purkinje cell dendritogenesis in a cerebellar primary culture. The study comprises the control group, Fe2+ group, GBCA groups (gadopentetate group or gadobutrol group), and GBCA+Fe2+ groups. Immunocytochemistry was performed with an anti-calbindin-28K (anti-CaBP28k) antibody, and the nucleus was stained with 4',6-diamidino-2-phenylindole (DAPI). The number of Purkinje cells and their arborization were evaluated with an analysis of variance with a post-hoc test. The number of Purkinje cells was similar to the control groups among all treated groups. There were no significant differences in dendrite arborization between the Fe2+ group and the control groups. The dendrite arborization was augmented in the gadopentetate and the gadobutrol groups when compared to the control group (p < 0.01, respectively). Fe2+ significantly increased the effect of gadopentetate on dendrite arborization (p < 0.01) but did not increase the effect of gadobutrol. These findings suggested that the chelate thermodynamic stability and Fe2+ may play important roles in attenuating the effect of GBCAs on the thyroid hormone-mediated dendritogenesis of Purkinje cells in in vitro settings.
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Affiliation(s)
- Achmad Adhipatria Perayabangsa Kartamihardja
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (A.A.P.K.); (A.T.-T.)
- Department of Nuclear Medicine and Molecular Imaging, Universitas Padjajaran, Bandung 40161, Indonesia
| | - Winda Ariyani
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (W.A.); (N.K.)
| | - Hirofumi Hanaoka
- Department of Bioimaging and Information Analysis, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (A.A.P.K.); (A.T.-T.)
| | - Noriyuki Koibuchi
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (W.A.); (N.K.)
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan; (A.A.P.K.); (A.T.-T.)
- Division of Integrated Oncology Research, Gunma Initiative for Advanced Research, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
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Allam MFAB, Samra MFA, Rahman ASMA. The added value of chemical shift imaging in evaluation of bone marrow changes in sickle cell disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00384-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study was to assess the added value of chemical shift imaging when used with routine MRI study in evaluation of bone marrow changes in SCD. Forty-two patients with SCD and bone pain were included in the study; they underwent CSI and routine MRI study on the symptomatic anatomic part of the skeleton.
Results
Four patterns of diffuse bone marrow changes were recognized; they varied from persistent red marrow to diffuse hypointense patterns with abnormal signal loss percentage on CSI that suggest presence of iron overload (n = 28, 66.6%). Serum ferritin level was increasing in accordance to the degree of signal changes found on CSI with significant high negative correlation between the percentage of signal loss on CSI obtained from IP-OP/IP formula and serum ferritin level. In focal marrow lesions, all T1 hyperintense lesions demonstrated corresponding hyperintensity on IP and OP; the detection frequency on CSI was relatively higher on OP compared with IP images.
Conclusion
CSI has high diagnostic performance in detecting diffuse marrow changes and development of iron overload in SCD. In SCD-related focal marrow lesions, CSI could have a complementary role in detection of T1 hyperintensity and lesion conspicuity.
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Metra BM, Guglielmo FF, Halegoua-DeMarzio DL, Civan JM, Mitchell DG. Beyond the Liver Function Tests: A Radiologist's Guide to the Liver Blood Tests. Radiographics 2021; 42:125-142. [PMID: 34797734 DOI: 10.1148/rg.210137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver blood tests (often also known as liver chemistries, liver tests, or the common misnomer liver function tests) are routinely used in diagnosis and management of hepatobiliary disease. Abnormal liver blood test results are often the first indicator of hepatobiliary disease and a common indication for abdominal imaging with US, CT, or MRI. Most of the disease entities can be categorized into hepatocellular or cholestatic patterns, with characteristic traits on liver blood tests. Each pattern has a specific differential, which can help narrow the differential diagnosis when combined with the clinical history and imaging findings. This article reviews the major liver blood tests as well as a general approach to recognizing common patterns of hepatobiliary disease within these tests (hepatocellular, cholestatic, acute liver failure, isolated hyperbilirubinemia). Examples of hepatobiliary disease with hepatocellular or cholestatic patterns are presented with characteristic test abnormalities and imaging findings. The commonly encountered scenario of chronic hepatitis with possible fibrosis is also reviewed, with discussion of potential further imaging such as elastography. The role of liver blood tests and imaging in evaluating complications of hepatic transplant is also discussed. Overall, integrating liver blood test patterns with imaging findings can help the radiologist accurately diagnose hepatobiliary disease, especially in cases where imaging findings may not allow differentiation between different entities. ©RSNA, 2021.
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Affiliation(s)
- Brandon M Metra
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Flavius F Guglielmo
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Dina L Halegoua-DeMarzio
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Jesse M Civan
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Donald G Mitchell
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
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Kim E, Jean J, Kearns C, Ballard DH. Perivenous Hepatic Iron Deposition in Alcoholic Cirrhosis. Radiographics 2021; 41:1570-1571. [PMID: 34597224 DOI: 10.1148/rg.2021210190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esther Kim
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
| | - Jolie Jean
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
| | - Ciléin Kearns
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
| | - David H Ballard
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
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Marks RM, Fowler KJ, Bashir MR. MR Imaging of Diffuse Liver Disease. Magn Reson Imaging Clin N Am 2021; 29:347-358. [PMID: 34243922 DOI: 10.1016/j.mric.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The liver performs many vital functions for the human body. It stores essential vitamins and minerals, such as iron and vitamins A, D, K, and B12. It synthesizes proteins, such as blood clotting factors, albumin, and glycogen, as well as cholesterol, carbohydrates, and triglycerides. Additionally, it acts as a detoxifier, metabolizing and helping to clear alcohol, drugs, and ammonia. Typical MR imaging protocols for liver imaging include T2-weighted, chemical shift imaging, and precontrast and postcontrast T1-weighted sequences. This article discussed MR imaging of diffuse liver diseases and their typical imaging findings.
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Affiliation(s)
- Robert M Marks
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA 92134, USA; Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University, Box 3808, Durham, NC 27710, USA
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Morshid A, Szklaruk J, Yacoub JH, Elsayes KM. Errors and Misinterpretations in Imaging of Chronic Liver Diseases. Magn Reson Imaging Clin N Am 2021; 29:419-436. [PMID: 34243927 DOI: 10.1016/j.mric.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
MRI is an important problem-solving tool for accurate characterization of liver lesions. Chronic liver disease alters the typical imaging characteristics and complicates liver imaging. Awareness of imaging pitfalls and technical artifacts and ways to mitigate them allows for more accurate and timely diagnosis.
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Affiliation(s)
- Ali Morshid
- Department of Diagnostic Radiology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Joseph H Yacoub
- Department of Radiology, Medstar Georgetown University Hospital, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
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Richardson L, Gardner K, Eberhardt S, Thompson W. A case of hepatic splenosis in the setting of iron overload; multimodal and literature review. Radiol Case Rep 2021; 16:2499-2504. [PMID: 34257788 PMCID: PMC8259227 DOI: 10.1016/j.radcr.2021.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Hepatic splenosis, a rare entity, is the ectopic implantation of splenic tissue into the hepatic parenchyma, most often incidentally seen in patients with a history of splenic trauma and splenectomy. We present a unique case of hepatic splenosis in a patient with hemosiderosis and splenectomy following the incidental finding of hepatic masses on pretransplant imaging. Final diagnosis was made based on cross-sectional imaging characteristics matching that of the left upper quadrant splenules alone. We discuss common characteristics of hepatic splenosis on multiple modalities, the effect of iron deposition on the imaging characteristics of hepatic and splenic tissue and how that impacts the differential and diagnosis. This case highlights the unique imaging characteristics hepatic splenosis can have particularly in the setting of hemosiderosis. Hepatic splenosis imaging diagnosis has a significant advantage over tissue diagnosis in terms of decreased risk, time and cost.
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Katabathina VS, Buddha S, Rajebi H, Shah JN, Morani AC, Lubner MG, Dasyam A, Nazarullah A, Menias CO, Prasad SR. Pancreas in Hereditary Syndromes: Cross-sectional Imaging Spectrum. Radiographics 2021; 41:1082-1102. [PMID: 34143711 DOI: 10.1148/rg.2021200164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A wide spectrum of hereditary syndromes predispose patients to distinct pancreatic abnormalities, including cystic lesions, recurrent pancreatitis, ductal adenocarcinoma, nonductal neoplasms, and parenchymal iron deposition. While pancreatic exocrine insufficiency and recurrent pancreatitis are common manifestations in cystic fibrosis and hereditary pancreatitis, pancreatic cysts are seen in von Hippel-Lindau disease, cystic fibrosis, autosomal dominant polycystic kidney disease, and McCune-Albright syndrome. Ductal adenocarcinoma can be seen in many syndromes, including Peutz-Jeghers syndrome, familial atypical multiple mole melanoma syndrome, Lynch syndrome, hereditary breast and ovarian cancer syndrome, Li-Fraumeni syndrome, and familial pancreatic cancer syndrome. Neuroendocrine tumors are commonly seen in multiple endocrine neoplasia type 1 syndrome and von Hippel-Lindau disease. Pancreatoblastoma is an essential component of Beckwith-Wiedemann syndrome. Primary hemochromatosis is characterized by pancreatic iron deposition. Pancreatic pathologic conditions associated with genetic syndromes exhibit characteristic imaging findings. Imaging plays a pivotal role in early detection of these conditions and can positively affect the clinical outcomes of those at risk for pancreatic malignancies. Awareness of the characteristic imaging features, imaging-based screening protocols, and surveillance guidelines is crucial for radiologists to guide appropriate patient management. ©RSNA, 2021.
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Affiliation(s)
- Venkata S Katabathina
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Suryakala Buddha
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Hamid Rajebi
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Jignesh N Shah
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Ajay C Morani
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Meghan G Lubner
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Anil Dasyam
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Alia Nazarullah
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Srinivasa R Prasad
- From the Departments of Radiology (V.S.K., S.B., H.R.) and Pathology (A.N.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (J.N.S.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (A.C.M., S.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (M.G.L.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
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Consul N, Javed-Tayyab S, Morani AC, Menias CO, Lubner MG, Elsayes KM. Iron-containing pathologies of the spleen: magnetic resonance imaging features with pathologic correlation. Abdom Radiol (NY) 2021; 46:1016-1026. [PMID: 32915270 DOI: 10.1007/s00261-020-02709-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022]
Abstract
Systemic and non-systemic pathologies that involve iron deposition within the spleen have characteristic features on MRI due to the susceptibility properties of deposited iron, or hemosiderin. These lesions will have signal loss on longer echo sequences due to the T2* effect when evaluated with dual-echo gradient-echo sequences. The pathophysiology of systemic and localized iron sequestration disease processes can elucidate an underlying diagnosis based on these imaging features in conjunction with clinical information.
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Affiliation(s)
- Nikita Consul
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Sidra Javed-Tayyab
- Department of Radiology, Memorial-Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53726, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA.
- Department of Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Value of liver iron concentration in healthy volunteers assessed by MRI. Sci Rep 2020; 10:17887. [PMID: 33087836 PMCID: PMC7577999 DOI: 10.1038/s41598-020-74968-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 09/24/2020] [Indexed: 01/09/2023] Open
Abstract
Iron overload is a relatively common clinical condition resulting from disorders such as hereditary hemochromatosis, thalassemia, sickle cell disease, and myelodysplasia that can lead to progressive fibrosis and eventually cirrhosis of the liver. Therefore, it is essential to recognize the disease process at the earliest stage. Liver biopsy is the reference test for the assessment of liver fibrosis. It also allows for quantifying liver iron concentration (LIC) in patients. However, this is an invasive method with significant limitations and possible risks. Magnetic resonance imaging (MRI) and evaluation of the R2* relaxation rate can be an alternative to biopsy for assessing LIC. However, it causes a need for accurate R2* data corresponding to standard value for further comparison with examined patients. This study aimed to assess the normative values of liver R2* in healthy individuals. A total of 100 volunteers that met established criteria were enrolled in the study: 36 (36%) men and 64 (64%) women. The mean age was 22.9 years (range 20 to 32 years). R2* was estimated by an MRI exam with a 1.5 T clinical magnetic resonance scanner. Images for measuring the LIC and liver fat concentration were obtained using the IDEAL-IQ technique for liver imaging. The Mean (SD) liver R2* was 28.34 (2.25) s−1 (95% CI, 27.78–28.90, range 23.67–33.00 s−1) in females, 29.57 (3.20) s−1 (95% CI, 28.49–30.66, range 23.93–37.77 s−1) in males, and 28.72 (2.69) s−1 (range 23.67–37.77 s−1) in the whole group. R2* value in this particular population with a high proportion of young women did not exceed 38 s−1. In the absence of fibrosis or steatosis, liver stiffness and fat fraction did not show any relationship with R2*.
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Abstract
There are many different imaging features of cirrhosis, some of which are less commonly recognized. It is important that the radiologist is familiar with these features as cirrhosis can be first discovered on imaging performed for other indications, thus alerting the clinician for the need to screen for complications of cirrhosis and referral for potential treatment. This article reviews the various imaging findings of cirrhosis seen on cross-sectional imaging of the abdomen and pelvis.
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40
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Goyal A, Mohan B, Saggar K, Wander GS. Primary haemochromatosis resulting in dilated cardiomyopathy arising out of mutation in HJV gene in Indian patients: a rare scenario. BMJ Case Rep 2020; 13:13/9/e235650. [PMID: 32938653 DOI: 10.1136/bcr-2020-235650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary haemochromatosis (PH) is a genetic disorder of iron metabolism with multiorgan involvement due to mutations in HFE or more rarely haemojuvelin (HJV) gene. Cardiac involvement results in dilated cardiomyopathy with reduced ejection fraction and progressive heart failure. PH is rarely reported from India and cardiomyopathy due to PH from HJV mutations is thought to be uncommon. We report two families with cardiomyopathy resulting from PH. Diagnosis was suspected on the basis of skin pigmentation, markedly elevated serum ferritin and transferring saturation. Genetic testing revealed a rare mutation in HJV gene in one family. Being a treatable condition, PH should be suspected and investigated in cardiomyopathy patients in Indian subcontinent. If HFE is negative, analysis of non-HFE mutation should always be considered.
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Affiliation(s)
- Abhishek Goyal
- Cardiology, Hero DMC heart institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Bishav Mohan
- Cardiology, Hero DMC heart institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Radiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gurpreet Singh Wander
- Cardiology, Hero DMC heart institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Abstract
There are >1.5 billion people with chronic liver disease worldwide, causing liver diseases to be a significant global health issue. Diffuse parenchymal liver diseases, including hepatic steatosis, fibrosis, metabolic diseases, and hepatitis cause chronic liver injury and may progress to fibrosis and eventually hepatocellular carcinoma. As early diagnosis and treatment of these diseases impact the progression and outcome, the need for assessment of the liver parenchyma has increased. While the current gold standard for evaluation of the hepatic parenchymal tissue, biopsy has disadvantages and limitations. Consequently, noninvasive methods have been developed based on serum biomarkers and imaging techniques. Conventional imaging modalities such as ultrasound, computed tomography scan, and magnetic resonance imaging provide noninvasive options for assessment of liver tissue. However, several recent advances in liver imaging techniques have been introduced. This review article focuses on the current status of imaging methods for diffuse parenchymal liver diseases assessment including their diagnostic accuracy, advantages and disadvantages, and comparison between different techniques.
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42
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Homayounieh F, Saini S, Mostafavi L, Doda Khera R, Sühling M, Schmidt B, Singh R, Flohr T, Kalra MK. Accuracy of radiomics for differentiating diffuse liver diseases on non-contrast CT. Int J Comput Assist Radiol Surg 2020; 15:1727-1736. [DOI: 10.1007/s11548-020-02212-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
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Kinger NP, Moreno CC, Miller FH, Mittal PK. Abdominal Manifestations of Sickle Cell Disease. Curr Probl Diagn Radiol 2020; 50:241-251. [PMID: 32564896 DOI: 10.1067/j.cpradiol.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/24/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022]
Abstract
Sickle cell disease is a debilitating hematologic process that affects the entire body. Disease manifestations in the abdomen most commonly result from vaso-occlusion, hemolysis, or infection due to functional asplenia. Organ specific manifestations include those involving the liver (eg, hepatopathy, iron deposition), gallbladder (eg, stone formation), spleen (eg, infarction, abscess formation, sequestration), kidneys (eg, papillary necrosis, infarction), pancreas (eg, pancreatitis), gastrointestinal tract (eg, infarction), reproductive organs (eg, priapism, testicular atrophy), bone (eg, marrow changes, avascular necrosis), vasculature (eg, vasculopathy), and lung bases (eg, acute chest syndrome, infarction). Imaging provides an important clinical tool for evaluation of acute and chronic disease manifestations and complications. In summary, there are multifold abdominal manifestations of sickle cell disease. Recognition of these sequela helps guide management and improves outcomes. The purpose of this article is to review abdominal manifestations of sickle cell disease and discuss common and rare complications of the disease within the abdomen.
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Affiliation(s)
- Nikhar P Kinger
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA
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Ozaki K, Kozaka K, Kosaka Y, Kimura H, Gabata T. Morphometric changes and imaging findings of diffuse liver disease in relation to intrahepatic hemodynamics. Jpn J Radiol 2020; 38:833-852. [PMID: 32347423 DOI: 10.1007/s11604-020-00978-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/13/2020] [Indexed: 01/20/2023]
Abstract
Diffuse hepatic diseases have a variety of etiologies, with each showing characteristic morphometric changes. These changes are closely related to micro- and macro-level intrahepatic hemodynamics, in addition to the specific underlying pathophysiology. Short-term disorders in intrahepatic hemodynamics caused by each pathophysiological condition are compensated for by the balance of blood perfusion systems using potential trans-sinusoidal, transversal, and transplexal routes of communication (micro-hemodynamics), while long-term alterations to the intrahepatic hemodynamics result in an increase in total hepatic vascular resistance. Blood flow disorders induced by this increased vascular resistance elicit hepatic cellular necrosis and fibrosis. These changes should be uniformly widespread throughout the whole liver. However, morphometric changes do not occur uniformly, with shrinkage or enlargement not occurring homogeneously. Against this background, several macro-intrahepatic hemodynamic effects arise, such as asymmetrical and complicating morphometric structures of the liver, intricate anatomy of portal venous flow and hepatic venous drainage, and zonal differentiation between central and peripheral zones. These hemodynamic factors and pathophysiological changes are related to characteristic morphometric changes in a complicated manner, based on the combination of selective atrophy and compensatory hypertrophy (atrophy-hypertrophy complex). These changes can be clearly depicted on CT and MR imaging.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yasuo Kosaka
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Hitawala A, Alomari M, Khazaaleh S, Alomari A, Sanaka MR. Hemochromatosis As an Unusual Cause of Pancreatitis in an African-American Female of Child-bearing Age. Cureus 2020; 12:e7179. [PMID: 32257719 PMCID: PMC7123287 DOI: 10.7759/cureus.7179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hemochromatosis is a disorder of iron overload whereby there is toxic deposition of iron in various tissues and organs of the body. It can either be hereditary or secondary to some other underlying cause. Patients with mutations in the HFE gene are often predisposed to developing this disorder. It has a wide range of clinical presentation, from non-specific symptoms such as fatigue to overt development of cirrhosis, diabetes and skin pigmentation. We present an unusual case of hemochromatosis where an African-American female of child-bearing age presented to the emergency room with complaints of epigastric pain. She was found to have mildly elevated lipase and liver enzymes. Imaging studies were suggestive of acute-on-chronic pancreatitis with iron deposition in the spleen, pancreas and bone marrow. Her ferritin and transferrin saturation levels were elevated. She was diagnosed with acute-on-chronic pancreatitis secondary to alcoholism and hemochromatosis and treated with phlebotomy with good outcome. This case is one of the few reported cases of hemochromatosis in African-Americans, and emphasizes that even females in child-bearing age group can develop this condition. Elevated ferritin and transferrin saturation levels should prompt evaluation for this disorder.
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Affiliation(s)
- Asif Hitawala
- Internal Medicine, Cleveland Clinic-Fairview Hospital, Cleveland, USA
| | | | | | - Ahmed Alomari
- Internal Medicine, The Hashemite University, Zarqa, JOR
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46
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Uh J, Kadbi M, Hua CH. Effects of age-related breathing characteristics on the performance of four-dimensional magnetic resonance imaging reconstructed by prospective gating for radiation therapy planning. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 11:82-87. [PMID: 33458284 PMCID: PMC7807601 DOI: 10.1016/j.phro.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 11/04/2022]
Abstract
Background and purpose Four-dimensional magnetic resonance imaging (4D MRI) has advanced recently by incorporating prospective gating, but its performance on pediatric populations has not been investigated. This study aimed to determine the age-related performance of prospective gating, as compared with retrospective sorting. Materials and methods Prospectively gated 4D MRI scans were acquired on a motion phantom driven by real respiratory waveforms obtained from 23 pediatric and young adult patients (aged 5–24 years). The correlations between patient-specific breathing characteristics and the performance of 4D MRI were comparatively evaluated against retrospective sorting for the same scan time. For six patients who underwent both 4D MRI and 4D CT, the internal target volumes (ITVs) determined by the two modalities were compared. Results Longer scan time and greater sorting error were most highly correlated (P < 0.001) with breathing irregularity and extent of diaphragm motion, but age was not a strong covariate because of interindividual variation. Prospective gating was more accurate than retrospective sorting except for those patients with severe breathing irregularity (peak-to-peak coefficient of variation >30%). The ITVs of 4D MRI and 4D CT were comparable (Dice similarity: >90%) unless the breathing characteristics changed between the two imaging sessions. Conclusions For most patients analyzed in this study, prospective gating provided more accurate 4D MRI (95th percentile of deviation: <1.5 mm) than did retrospective sorting within a clinically feasible scan time (median: 5.9 min). The 4D MRI tended to take longer and to give larger sorting errors with deeper and irregular breathers.
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Affiliation(s)
- Jinsoo Uh
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mo Kadbi
- Philips Healthcare, Gainesville, FL, USA
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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47
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Henninger B, Alustiza J, Garbowski M, Gandon Y. Practical guide to quantification of hepatic iron with MRI. Eur Radiol 2019; 30:383-393. [PMID: 31392478 PMCID: PMC6890593 DOI: 10.1007/s00330-019-06380-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/03/2019] [Accepted: 07/19/2019] [Indexed: 01/19/2023]
Abstract
Abstract Our intention is to demystify the MR quantification of hepatic iron (i.e., the liver iron concentration) and give you a step-by-step approach by answering the most pertinent questions. The following article should be more of a manual or guide for every radiologist than a classic review article, which just summarizes the literature. Furthermore, we provide important background information for professional communication with clinicians. The information regarding the physical background is reduced to a minimum. After reading this article, you should be able to perform adequate MR measurements of the LIC with 1.5-T or 3.0-T scanners. Key Points • MRI is widely accepted as the primary approach to non-invasively determine liver iron concentration (LIC). • This article is a guide for every radiologist to perform adequate MR measurements of the LIC. • When using R2* relaxometry, some points have to be considered to obtain correct measurements—all explained in this article.
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Affiliation(s)
- Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Jose Alustiza
- Osatek, Donostia Universitary Hospital, P. Dr. Beguiristain 109, 20014, Donostia/San Sebastian, Spain
| | - Maciej Garbowski
- Department of Haematology, Cancer Institute, University College London, Paul O'Gorman Bld, 72 Huntley St, London, WC1E 6BT, UK
| | - Yves Gandon
- CHU Rennes, Inserm, LTSI - UMR_S 1099, University of Rennes, F-35000, Rennes, France
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48
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Abstract
Hereditary hemochromatosis (HH) is one of the most common genetic disorders among persons of northern European descent. There have been recent advances in the diagnosis, management, and treatment of HH. The availability of molecular diagnostic testing for HH has made possible confirmation of the diagnosis for most patients. Several genotype-phenotype correlation studies have clarified the differences in clinical features between patients with the C282Y homozygous genotypes and other HFE mutation patterns. The increasing use of noninvasive tests such as MRI T2* has made quantification of hepatic iron deposition easier and eliminated the need for liver biopsy in most patients. Serum ferritin of <1,000 ng/mL at diagnosis remains an important diagnostic test to identify patients with a low risk of advanced hepatic fibrosis and should be used routinely as part of the initial diagnostic evaluation. Genetic testing for other types of HH is available but is expensive and generally not useful in most clinical settings. Serum ferritin may be elevated among patients with nonalcoholic fatty liver disease and in those with alcoholic liver disease. These diagnoses are more common than HH among patients with elevated serum ferritin who are not C282Y homozygotes or C282Y/H63D compound heterozygotes. A secondary cause for liver disease should be excluded among patients with suspected iron overload who are not C282Y homozygotes. Phlebotomy remains the mainstay of therapy, but emerging novel therapies such as new chelating agents may have a role for selected patients.
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49
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Degnan AJ, Ho-Fung VM, Ahrens-Nicklas RC, Barrera CA, Serai SD, Wang DJ, Ficicioglu C. Imaging of non-neuronopathic Gaucher disease: recent advances in quantitative imaging and comprehensive assessment of disease involvement. Insights Imaging 2019; 10:70. [PMID: 31289964 PMCID: PMC6616606 DOI: 10.1186/s13244-019-0743-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022] Open
Abstract
Gaucher disease is an inherited metabolic disorder resulting in deficiency of lysosomal enzyme β-glucocerebrosidase causing the accumulation of abnormal macrophages (“Gaucher cells”) within multiple organs, most conspicuously affecting the liver, spleen, and bone marrow. As the most common glycolipid metabolism disorder, it is important for radiologists encountering these patients to be familiar with advances in imaging of organ and bone marrow involvement and understand the role of imaging in clinical decision-making. The recent advent of commercially available, reliable, and reproducible quantitative MRI acquisitions to measure fat fractions prompts revisiting the role of quantitative assessment of bone marrow involvement. This manuscript reviews the diverse imaging manifestations of Gaucher disease and discusses more optimal quantitative approaches to ascertain solid organ and bone marrow involvement with an emphasis on future applications of other quantitative methods including elastography.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Victor M Ho-Fung
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Rebecca C Ahrens-Nicklas
- Division of Human Genetics, The Children's Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Blvd, Floor 9, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Dah-Jyuu Wang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Can Ficicioglu
- Division of Human Genetics, The Children's Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Blvd, Floor 9, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
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50
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Hull NC, Schooler GR, Lee EY. Hepatobiliary MR Imaging in Children:. Magn Reson Imaging Clin N Am 2019; 27:263-278. [DOI: 10.1016/j.mric.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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