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Chavhan GB, Kamath BM, Siddiqui I, Tomlinson C. Magnetic resonance imaging of neonatal hemochromatosis. Pediatr Radiol 2022; 52:334-339. [PMID: 33710405 DOI: 10.1007/s00247-021-05008-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/15/2020] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Neonatal hemochromatosis is a rare condition that causes neonatal liver failure, frequently resulting in fetal loss or neonatal death. It is thought that most cases of neonatal hemochromatosis are caused by gestational alloimmune liver disease (GALD), with neonatal hemochromatosis being a phenotype of GALD rather than a disease process. Extrahepatic siderosis in the pancreas, myocardium, thyroid and minor salivary gland is a characteristic feature of neonatal hemochromatosis. There is also sparing of the reticuloendothelial system with no iron deposition in the spleen. Hepatic and extrahepatic siderosis seen in neonatal hemochromatosis is from iron dysregulation secondary to liver damage rather than iron deposition causing the liver damage. The presence of extrahepatic siderosis in the pancreas and thyroid is diagnostic of neonatal hemochromatosis and can be detected noninvasively by multi-echo gradient recalled echo (GRE) T2*-weighted sequence of MRI within hours of birth. This helps to expedite the treatment in the form of intravenous immunoglobulin and exchange transfusion, which improves the survival in these babies. The finding of hepatic siderosis is nonspecific and does not help in the diagnosis of neonatal hemochromatosis because it is seen with other causes of advanced liver disease.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,Medical Imaging Department, University of Toronto, Toronto, ON, Canada.
| | - Binita M Kamath
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Iram Siddiqui
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher Tomlinson
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
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Yokoyama R, Kanzaki Y, Watanabe T, Yamamura K, Komori T, Takeda Y, Nakajima O, Sohmiya K, Hoshiga M. Prevalence and Risk Factors of Silent Cerebral Microbleeds in Patients with Coronary Artery Disease. J Stroke Cerebrovasc Dis 2021; 31:106211. [PMID: 34823092 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/20/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cerebral microbleeds (CMBs), which can be detected by gradient-echo T2*-weighted magnetic resonance imaging (MRI), represent small chronic brain hemorrhages caused by structural abnormalities in cerebral small vessels. CMBs are known to be a potential predictor of future stroke, and are associated with age, various cardiovascular risk factors, cognitive impairment, and the use of antithrombotic drugs. Patients with coronary artery disease (CAD) are at potentially high risk of CMBs due to the presence of coexistent conditions. However, little is known about CMBs in patients with CAD. We aimed to identify the factors associated with the presence of CMBs among patients with CAD. METHODS We evaluated 356 consecutive patients [mean age, 72 ± 10 years; men = 276 (78%)] with angiographically proven CAD who underwent T2*-weighted brain MRI. The brain MRI was assessed by researchers blinded to the patients' clinical details. RESULTS CMBs were found in 128 (36%) patients. Among 356 patients, 119 (33%) had previously undergone percutaneous coronary intervention (PCI), and 26 (7%) coronary artery bypass grafting (CABG). There was no significant relationship between CMBs and sex, hypertension, dyslipidemia, diabetes mellitus, anticoagulation therapy, antiplatelet therapy, or prior PCI. CMBs were significantly associated with advanced age, previous CABG, eGFR, non-HDL cholesterol, carotid artery disease, long-term antiplatelet therapy, and long-term dual antiplatelet therapy (DAPT) using univariate logistic regression analysis. The multivariate logistic regression analysis showed that long-term antiplatelet therapy (odds ratio, 1.73; 95% CI, 1.06 - 2.84; P = 0.03) or long-term DAPT (odds ratio, 2.92; 95% CI, 1.39 - 6.17; P = 0.004) was significantly associated with CMBs after adjustment for confounding variables. CONCLUSIONS CMBs were frequently observed in patients with CAD and were significantly associated with long-term antiplatelet therapy, especially long-term DAPT.
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Affiliation(s)
- Ryo Yokoyama
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan; Department of Cardiology, Hirakata City Hospital
| | - Yumiko Kanzaki
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan.
| | - Tomohiko Watanabe
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kenichiro Yamamura
- Departments of Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Tsuyoshi Komori
- Departments of Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Yoshihiro Takeda
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan; Department of Cardiology, Hirakata City Hospital
| | | | - Koichi Sohmiya
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan
| | - Masaaki Hoshiga
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan
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Lidén M, Adrian D, Widell J, Uggla B, Thunberg P. Quantitative T2* imaging of iron overload in a non-dedicated center - Normal variation, repeatability and reader variation. Eur J Radiol Open 2021; 8:100357. [PMID: 34095355 PMCID: PMC8167145 DOI: 10.1016/j.ejro.2021.100357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/03/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients with transfusion dependent anemia are at risk of complications from iron overload. Quantitative T2* magnetic resonance imaging (MRI) is the best non-invasive method to assess iron deposition in the liver and heart and to guide chelation therapy. Purpose To investigate the image quality and inter-observer variations in T2* measurements of the myocardium and the liver, and to obtain the lower limit of cardiac and hepatic quantitative T2* values in patients without suspicion of iron overload. Material and methods Thirty-eight patients referred for cardiac MRI were prospectively included in the study. Three patients were referred with, and 35 without suspicion of iron overload. Quantitative T2* parametric maps were obtained on a 1.5 T MRI system in the cardiac short axis and liver axial view. Two readers independently assessed the image quality and the representative and the lowest T2* value in the myocardium and the liver. Results The normal range of representative T2* values in the myocardium and liver was 24−45 ms and 14−37 ms, respectively. None of the 35 participants (0 %, 95 % confidence interval 0–11 %) in the normal reference group demonstrated representative T2* values below previously reported lower limits in the myocardium (20 ms) or the liver (8 ms). Focal myocardial areas with T2* values near the lower normal range, 19−20 ms, were seen in two patients. The readers generally reported good image quality. Conclusion T2* imaging for assessing iron overload can be performed in a non-dedicated center with sufficient image quality.
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Affiliation(s)
- Mats Lidén
- Department of Radiology, Faculty of Medicine and Health, Örebro University, S-701 82, Sweden
- Corresponding author.
| | - David Adrian
- Department of Radiology, Örebro University Hospital, Region Örebro County, Sweden
| | - Jonas Widell
- Department of Radiology, Örebro University Hospital, Region Örebro County, Sweden
| | - Bertil Uggla
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Thunberg
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Sweden
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Maeda K, Yamamoto Y, Akiyama K, Saotome T. T2 Star-weighted MRI of Beta-propeller Protein-associated Neurodegeneration. Intern Med 2021; 60:655. [PMID: 32963168 PMCID: PMC7946514 DOI: 10.2169/internalmedicine.5871-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kengo Maeda
- Department of Neurology, National Hospital Organization Higashi-ohmi General Medical Center, Japan
- Department of Internal Medicine, Vories Memorial Hospital, Japan
| | - Yutaka Yamamoto
- Department of Neurology, National Hospital Organization Higashi-ohmi General Medical Center, Japan
| | | | - Takao Saotome
- Department of Internal Medicine, Vories Memorial Hospital, Japan
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Abou Zahr R, Burkhardt BEU, Ehsan L, Potersnak A, Greil G, Dillenbeck J, Rogers Z, Hussain T. Real-World Experience Measurement of Liver Iron Concentration by R2 vs. R2 Star MRI in Hemoglobinopathies. Diagnostics (Basel) 2020; 10:E768. [PMID: 33003498 DOI: 10.3390/diagnostics10100768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background: Non-invasive determination of liver iron concentration (LIC) is a valuable tool that guides iron chelation therapy in transfusion-dependent patients. Multiple methods have been utilized to measure LIC by MRI. The purpose of this study was to compare free breathing R2* (1/T2*) to whole-liver Ferriscan R2 method for estimation of LIC in a pediatric and young adult population who predominantly have hemoglobinopathies. Methods: Clinical liver and cardiac MRI scans from April 2016 to May 2018 on a Phillips 1.5 T scanner were reviewed. Free breathing T2 and T2* weighted images were acquired on each patient. For T2, multi-slice spin echo sequences were obtained. For T2*, a single mid-liver slice fast gradient echo was performed starting at 0.6 ms with 1.2 ms increments with signal averaging. R2 measurements were performed by Ferriscan analysis. R2* measurements were performed by quantitative T2* map analysis. Results: 107 patients underwent liver scans with the following diagnoses: 76 sickle cell anemia, 20 Thalassemia, 9 malignancies and 2 Blackfan Diamond anemia. Mean age was 12.5 ± 4.5 years. Average scan time for R2 sequences was 10 min, while R2* sequence time was 20 s. R2* estimation of LIC correlated closely with R2 with a correlation coefficient of 0.94. Agreement was strongest for LIC < 15 mg Fe/g dry weight. Overall bias from Bland–Altman plot was 0.66 with a standard deviation of 2.8 and 95% limits of agreement −4.8 to 6.1. Conclusion: LIC estimation by R2* correlates well with R2-Ferriscan in the pediatric age group. Due to the very short scan time of R2*, it allows imaging without sedation or anesthesia. Cardiac involvement was uncommon in this cohort.
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Barrera CA, Otero HJ, Hartung HD, Biko DM, Serai SD. Protocol optimization for cardiac and liver iron content assessment using MRI: What sequence should I use? Clin Imaging 2019; 56:52-57. [PMID: 30889418 DOI: 10.1016/j.clinimag.2019.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/31/2019] [Accepted: 02/19/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine the optimal MRI protocol and sequences for liver and cardiac iron estimation in children. METHODS We evaluated patients ≤18 years with cardiac and liver MRIs for iron content estimation. Liver T2 was determined by a third-party company. Cardiac and Liver T2* values were measured by an observer. Liver T2* values were calculated using the available liver parenchyma in the cardiac MRI. Linear correlations and Bland-Altman plots were run between liver T2 and T2*, cardiac T2* values; and liver T2* on dedicated cardiac and liver MRIs. RESULTS 139 patients were included. Mean liver T2 and T2* values were 8.6 ± 5.4 ms and 4.5 ± 4.1 ms, respectively. A strong correlation between liver T2 and T2* values was observed (r = 0.96, p < 0.001) with a bias (+4.1 ms). Mean cardiac bright- and dark-blood T2* values were 26.5 ± 12.9 ms and 27.2 ± 11.9 ms, respectively. Cardiac T2* values showed a strong correlation (r = 0.81, p < 0.001) with a low bias (-1.0 ms). The mean liver T2* on liver and cardiac MRIs were 4.9 ± 4.7 ms and 4.6 ± 3.9 ms, respectively. A strong correlation between T2* values was observed (r = 0.96, p < 0.001) with a small bias (-0.2 ms). CONCLUSION MRI protocols for iron concentration in the liver and the heart can be simplified to avoid redundant information and reduce scan time. In most patients, a single breath-hold GRE sequence can be used to evaluate the iron concentration in both the liver and heart.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Hansel J Otero
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Helge D Hartung
- Department of Pediatrics, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Suraj D Serai
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
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Affiliation(s)
- Juan Lopez-Mattei
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
| | - Cezar Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jean Bernard Durand
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saamir Hassan
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Peter Kim
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lilia Sierra-Galan
- Department of Cardiology, American British Cowdray Medical Center, Mexico DF, Mexico
| | - Greg Gladish
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center; Houston, TX 77030, USA
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Tang MY, Chen TW, Huang XH, Li XH, Wang SY, Liu N, Zhang XM. Acute pancreatitis with gradient echo T2*-weighted magnetic resonance imaging. Quant Imaging Med Surg 2016; 6:157-67. [PMID: 27190768 DOI: 10.21037/qims.2016.04.03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND To study gradient recalled echo (GRE) T2*-weighted imaging (T2*WI) for normal pancreas and acute pancreatitis (AP). METHODS Fifty-one patients without any pancreatic disorders (control group) and 117 patients with AP were recruited. T2* values derived from T2*WI of the pancreas were measured for the two groups. The severity of AP was graded by the magnetic resonance severity index (MRSI) and the Acute Physiology and Chronic Healthy Evaluation II (APACHE II) scoring system. Logistic regression was used to analyze the relationship between the T2* values and AP severity. The usefulness of the T2* value for diagnosing AP and the relationship between the T2* values and the severity of AP were analyzed. RESULTS On GRE-T2*WI, the normal pancreas showed a well-marinated and consistently homogeneous isointensity. Edematous AP, as well as the non-necrotic area in necrotizing AP, showed ill-defined but homogeneous signal intensity. AP with pancreatic hemorrhage showed a decreased T2* value and a signal loss on the signal decay curve. The T2* value of pancreas in the AP group was higher than that of the control group (t=-8.20, P<0.05). The T2* value tended to increase along with the increase in MRSI scores but not with the APACHE II scores (P>0.05). AP was associated with a one standard deviation increment in the T2* value (OR =1.37; 95% CI: 1.216-1.532). CONCLUSIONS T2*WI demonstrates a few characteristics of the normal pancreas and AP, which could potentially be helpful for detecting hemorrhage, and contributes to diagnosing AP and its severity.
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Affiliation(s)
- Meng Yue Tang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, China
| | - Tian Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, China
| | - Xiao Hua Huang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, China
| | - Xing Hui Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, China
| | - Si Yue Wang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, China
| | - Nian Liu
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, China
| | - Xiao Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, China
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