Skip to main content
Erschienen in: Clinical Neuroradiology 3/2012

01.09.2012 | Original Article

Quantitative T2* Magnetic Resonance Imaging for Evaluation of Iron Deposition in the Brain of β-Thalassemia Patients

verfasst von: S. Akhlaghpoor, MD, A. Ghahari, MD, A. Morteza, MD, MPH, O. Khalilzadeh, MD, MPH, A. Shakourirad, MD, M. R. Alinaghizadeh, MSc

Erschienen in: Clinical Neuroradiology | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Iron overload is a common clinical problem in patients with β-thalassemia major. The purpose of this study was to assess the presence of excess iron in certain areas of the brain (thalamus, midbrain, adenohypophysis and basal ganglia) in patients with β-thalassemia major and evaluate the association with serum ferritin and liver iron content.

Materials and methods

A cross-sectional study on 53 patients with β-thalassemia major and 40 healthy controls was carried out. All patients and healthy controls underwent magnetic resonance imaging (MRI) examinations of the brain and liver. Multiecho fast gradient echo sequence was used and T2* values were calculated based on the Brompton protocol. Correlations between T2* values in the brain with T2* values in the liver as well as serum ferritin levels were investigated.

Results

There were no significant differences between patients and healthy controls with respect to age and sex. Patients had significantly lower T2* values in basal ganglia (striatum), thalamus and adenohypophysis compared to controls while there were no differences in the midbrain (red nucleus). There were no significant correlations between liver T2* values or serum ferritin with T2* values of basal ganglia (striatum), thalamus and adenohypophysis in patients or healthy controls. There were no significant correlations between T2* values of adenohypophysis and thalamus or basal ganglia (striatum) while these variables were significantly correlated in healthy controls.

Conclusions

Serum ferritin and liver iron content may not be good indicators of brain iron deposition in patients with β thalassemia major. Nevertheless, the quantitative T2* MRI technique is useful for evaluation of brain iron overload in β thalassemia major patients.
Literatur
1.
Zurück zum Zitat Maggio A, Vitrano A, Capra M, Cuccia L, Gagliardotto F, Filosa A, et al. Improving survival with deferiprone treatment in patients with thalassemia major: a prospective multicenter randomised clinical trial under the auspices of the Italian Society for Thalassemia and Hemoglobinopathies. Blood Cells Mol Dis. 2009;42:247–51. Epub 2009 Feb 23.PubMedCrossRef Maggio A, Vitrano A, Capra M, Cuccia L, Gagliardotto F, Filosa A, et al. Improving survival with deferiprone treatment in patients with thalassemia major: a prospective multicenter randomised clinical trial under the auspices of the Italian Society for Thalassemia and Hemoglobinopathies. Blood Cells Mol Dis. 2009;42:247–51. Epub 2009 Feb 23.PubMedCrossRef
2.
Zurück zum Zitat Papadimas J, Mandala E, Pados G, Kokkas B, Georgiadis G, Tarlatzis B, et al. Pituitary-testicular axis in men with beta-thalassaemia major. Hum Reprod. 1996;11:1900–4.PubMedCrossRef Papadimas J, Mandala E, Pados G, Kokkas B, Georgiadis G, Tarlatzis B, et al. Pituitary-testicular axis in men with beta-thalassaemia major. Hum Reprod. 1996;11:1900–4.PubMedCrossRef
3.
Zurück zum Zitat Sparacia G, Iaia A, Banco A, D’Angelo P, Lagalla R. Transfusional hemochromatosis: quantitative relation of MR imaging pituitary signal intensity reduction to hypogonadotropic hypogonadism. Radiology. 2000;215:818–23.PubMed Sparacia G, Iaia A, Banco A, D’Angelo P, Lagalla R. Transfusional hemochromatosis: quantitative relation of MR imaging pituitary signal intensity reduction to hypogonadotropic hypogonadism. Radiology. 2000;215:818–23.PubMed
4.
Zurück zum Zitat Brittenham GM, Griffith PM, Nienhuis AW, McLaren CE, Young NS, Tucker EE, et al. Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med. 1994;331:567–73.PubMedCrossRef Brittenham GM, Griffith PM, Nienhuis AW, McLaren CE, Young NS, Tucker EE, et al. Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med. 1994;331:567–73.PubMedCrossRef
5.
Zurück zum Zitat Cappellini MD, Bejaoui M, Agaoglu L, Porter J, Coates T, Jeng M, et al. Prospective evaluation of patient-reported outcomes during treatment with deferasirox or deferoxamine for iron overload in patients with beta-thalassemia. Clin Ther. 2007;29:909–17.PubMedCrossRef Cappellini MD, Bejaoui M, Agaoglu L, Porter J, Coates T, Jeng M, et al. Prospective evaluation of patient-reported outcomes during treatment with deferasirox or deferoxamine for iron overload in patients with beta-thalassemia. Clin Ther. 2007;29:909–17.PubMedCrossRef
6.
Zurück zum Zitat Telfer PT, Prestcott E, Holden S, Walker M, Hoffbrand AV, Wonke B. Hepatic iron concentration combined with long-term monitoring of serum ferritin to predict complications of iron overload in thalassaemia major. Br J Haematol. 2000;110:971–7.PubMedCrossRef Telfer PT, Prestcott E, Holden S, Walker M, Hoffbrand AV, Wonke B. Hepatic iron concentration combined with long-term monitoring of serum ferritin to predict complications of iron overload in thalassaemia major. Br J Haematol. 2000;110:971–7.PubMedCrossRef
7.
Zurück zum Zitat Angelucci E, Brittenham GM, McLaren CE, Ripalti M, Baronciani D, Giardini C, et al. Hepatic iron concentration and total body iron stores in thalassemia major. N Engl J Med. 2000;343:327–31.PubMedCrossRef Angelucci E, Brittenham GM, McLaren CE, Ripalti M, Baronciani D, Giardini C, et al. Hepatic iron concentration and total body iron stores in thalassemia major. N Engl J Med. 2000;343:327–31.PubMedCrossRef
8.
Zurück zum Zitat Kovesdy CP, Estrada W, Ahmadzadeh S, Kalantar-Zadeh K. Association of markers of iron stores with outcomes in patients with nondialysis-dependent chronic kidney disease. Clin J Am Soc Nephrol. 2009;4:435–41.PubMedCrossRef Kovesdy CP, Estrada W, Ahmadzadeh S, Kalantar-Zadeh K. Association of markers of iron stores with outcomes in patients with nondialysis-dependent chronic kidney disease. Clin J Am Soc Nephrol. 2009;4:435–41.PubMedCrossRef
9.
Zurück zum Zitat Walker EM Jr, Walker SM. Effects of iron overload on the immune system. Ann Clin Lab Sci. 2000;30:354–65.PubMed Walker EM Jr, Walker SM. Effects of iron overload on the immune system. Ann Clin Lab Sci. 2000;30:354–65.PubMed
10.
Zurück zum Zitat van Gelder W, Huijskes-Heins MI, Cleton-Soeteman MI, van Dijk JP, van Eijk HG. Iron uptake in blood-brain barrier endothelial cells cultured in iron-depleted and iron-enriched media. J Neurochem. 1998;71:1134–40.PubMedCrossRef van Gelder W, Huijskes-Heins MI, Cleton-Soeteman MI, van Dijk JP, van Eijk HG. Iron uptake in blood-brain barrier endothelial cells cultured in iron-depleted and iron-enriched media. J Neurochem. 1998;71:1134–40.PubMedCrossRef
11.
Zurück zum Zitat Metafratzi Z, Argyropoulou MI, Kiortsis DN, Tsampoulas C, Chaliassos N, Efremidis SC. T(2) relaxation rate of basal ganglia and cortex in patients with beta-thalassaemia major. Br J Radiol. 2001;74:407–10.PubMed Metafratzi Z, Argyropoulou MI, Kiortsis DN, Tsampoulas C, Chaliassos N, Efremidis SC. T(2) relaxation rate of basal ganglia and cortex in patients with beta-thalassaemia major. Br J Radiol. 2001;74:407–10.PubMed
12.
Zurück zum Zitat Safarinejad MR. Evaluation of semen quality, endocrine profile and hypothalamus-pituitary-testis axis in male patients with homozygous beta-thalassemia major. J Urol. 2008;179:2327–32.PubMedCrossRef Safarinejad MR. Evaluation of semen quality, endocrine profile and hypothalamus-pituitary-testis axis in male patients with homozygous beta-thalassemia major. J Urol. 2008;179:2327–32.PubMedCrossRef
13.
Zurück zum Zitat Stark DD, Bass NM, Moss AA, Bacon BR, McKerrow JH, Cann CE, et al. Nuclear magnetic resonance imaging of experimentally induced liver disease. Radiology. 1983;148:743–51.PubMed Stark DD, Bass NM, Moss AA, Bacon BR, McKerrow JH, Cann CE, et al. Nuclear magnetic resonance imaging of experimentally induced liver disease. Radiology. 1983;148:743–51.PubMed
14.
Zurück zum Zitat Ghugre NR, Coates TD, Nelson MD, Wood JC. Mechanisms of tissue-iron relaxivity: nuclear magnetic resonance studies of human liver biopsy specimens. Magn Reson Med. 2005;54:1185–93.PubMedCrossRef Ghugre NR, Coates TD, Nelson MD, Wood JC. Mechanisms of tissue-iron relaxivity: nuclear magnetic resonance studies of human liver biopsy specimens. Magn Reson Med. 2005;54:1185–93.PubMedCrossRef
15.
Zurück zum Zitat Anderson LJ, Westwood MA, Holden S, Davis B, Prescott E, Wonke B, et al. Myocardial iron clearance during reversal of siderotic cardiomyopathy with intravenous desferrioxamine: a prospective study using T2* cardiovascular magnetic resonance. Br J Haematol. 2004;127:348–55.PubMedCrossRef Anderson LJ, Westwood MA, Holden S, Davis B, Prescott E, Wonke B, et al. Myocardial iron clearance during reversal of siderotic cardiomyopathy with intravenous desferrioxamine: a prospective study using T2* cardiovascular magnetic resonance. Br J Haematol. 2004;127:348–55.PubMedCrossRef
16.
Zurück zum Zitat Bizzi A, Brooks RA, Brunetti A, Hill JM, Alger JR, Miletich RS, et al. Role of iron and ferritin in MR imaging of the brain: a study in primates at different field strengths. Radiology. 1990;177:59–65.PubMed Bizzi A, Brooks RA, Brunetti A, Hill JM, Alger JR, Miletich RS, et al. Role of iron and ferritin in MR imaging of the brain: a study in primates at different field strengths. Radiology. 1990;177:59–65.PubMed
17.
Zurück zum Zitat Hirai T, Korogi Y, Sakamoto Y, Hamatake S, Ikushima I, Takahashi M. T2 shortening in the motor cortex: effect of aging and cerebrovascular diseases. Radiology. 1996;199:799–803.PubMed Hirai T, Korogi Y, Sakamoto Y, Hamatake S, Ikushima I, Takahashi M. T2 shortening in the motor cortex: effect of aging and cerebrovascular diseases. Radiology. 1996;199:799–803.PubMed
18.
Zurück zum Zitat Gandon Y, Olivie D, Guyader D, Aube C, Oberti F, Sebille V, et al. Non-invasive assessment of hepatic iron stores by MRI. Lancet. 2004;363:357–62. Gandon Y, Olivie D, Guyader D, Aube C, Oberti F, Sebille V, et al. Non-invasive assessment of hepatic iron stores by MRI. Lancet. 2004;363:357–62.
19.
Zurück zum Zitat Meloni A, Ramazzotti A, Positano V, Salvatori C, Mangione M, Marcheschi P, et al. Evaluation of a web-based network for reproducible T2* MRI assessment of iron overload in thalassemia. Int J Med Inform. 2009;78:503–12.PubMedCrossRef Meloni A, Ramazzotti A, Positano V, Salvatori C, Mangione M, Marcheschi P, et al. Evaluation of a web-based network for reproducible T2* MRI assessment of iron overload in thalassemia. Int J Med Inform. 2009;78:503–12.PubMedCrossRef
20.
Zurück zum Zitat Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH, et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J. 2001;22:2171–9.PubMedCrossRef Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH, et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J. 2001;22:2171–9.PubMedCrossRef
21.
Zurück zum Zitat Argyropoulou MI, Metafratzi Z, Kiortsis DN, Bitsis S, Tsatsoulis A, Efremidis S. T2 relaxation rate as an index of pituitary iron overload in patients with beta-thalassemia major. AJR Am J Roentgenol. 2000;175:1567–9.PubMed Argyropoulou MI, Metafratzi Z, Kiortsis DN, Bitsis S, Tsatsoulis A, Efremidis S. T2 relaxation rate as an index of pituitary iron overload in patients with beta-thalassemia major. AJR Am J Roentgenol. 2000;175:1567–9.PubMed
22.
Zurück zum Zitat Xu X, Wang Q, Zhang M. Age, gender, and hemispheric differences in iron deposition in the human brain: an in vivo MRI study. Neuroimage. 2008;40:35–42.PubMedCrossRef Xu X, Wang Q, Zhang M. Age, gender, and hemispheric differences in iron deposition in the human brain: an in vivo MRI study. Neuroimage. 2008;40:35–42.PubMedCrossRef
23.
Zurück zum Zitat Hallgren B, Sourander P. The effect of age on the non-haemin iron in the human brain. J Neurochem. 1958;3:41–51.PubMedCrossRef Hallgren B, Sourander P. The effect of age on the non-haemin iron in the human brain. J Neurochem. 1958;3:41–51.PubMedCrossRef
24.
Zurück zum Zitat Westwood MA, Anderson LJ, Maceira AM, Shah FT, Prescott E, Porter JB, et al. Normalized left ventricular volumes and function in thalassemia major patients with normal myocardial iron. J Magn Reson Imaging. 2007;25:1147–51.PubMedCrossRef Westwood MA, Anderson LJ, Maceira AM, Shah FT, Prescott E, Porter JB, et al. Normalized left ventricular volumes and function in thalassemia major patients with normal myocardial iron. J Magn Reson Imaging. 2007;25:1147–51.PubMedCrossRef
25.
Zurück zum Zitat Positano V, Salani B, Pepe A, Santarelli MF, De Marchi D, Ramazzotti A, et al. Improved T2* assessment in liver iron overload by magnetic resonance imaging. Magn Reson Imaging. 2009;27:188–97.PubMedCrossRef Positano V, Salani B, Pepe A, Santarelli MF, De Marchi D, Ramazzotti A, et al. Improved T2* assessment in liver iron overload by magnetic resonance imaging. Magn Reson Imaging. 2009;27:188–97.PubMedCrossRef
26.
Zurück zum Zitat Tanner MA, He T, Westwood MA, Firmin DN, Pennell DJ. Multi-center validation of the transferability of the magnetic resonance T2* technique for the quantification of tissue iron. Haematologica. 2006;91:1388–91.PubMed Tanner MA, He T, Westwood MA, Firmin DN, Pennell DJ. Multi-center validation of the transferability of the magnetic resonance T2* technique for the quantification of tissue iron. Haematologica. 2006;91:1388–91.PubMed
27.
Zurück zum Zitat Gerlach M, Ben-Shachar D, Riederer P, Youdim MB. Altered brain metabolism of iron as a cause of neurodegenerative diseases? J Neurochem. 1994;63:793–807.PubMedCrossRef Gerlach M, Ben-Shachar D, Riederer P, Youdim MB. Altered brain metabolism of iron as a cause of neurodegenerative diseases? J Neurochem. 1994;63:793–807.PubMedCrossRef
28.
Zurück zum Zitat Schenker C, Meier D, Wichmann W, Boesiger P, Valavanis A. Age distribution and iron dependency of the T2 relaxation time in the globus pallidus and putamen. Neuroradiology. 1993;35:119–24.PubMedCrossRef Schenker C, Meier D, Wichmann W, Boesiger P, Valavanis A. Age distribution and iron dependency of the T2 relaxation time in the globus pallidus and putamen. Neuroradiology. 1993;35:119–24.PubMedCrossRef
29.
Zurück zum Zitat Wood JC, Fassler JD, Meade T. Mimicking liver iron overload using liposomal ferritin preparations. Magn Reson Med. 2004;51:607–11.PubMedCrossRef Wood JC, Fassler JD, Meade T. Mimicking liver iron overload using liposomal ferritin preparations. Magn Reson Med. 2004;51:607–11.PubMedCrossRef
30.
Zurück zum Zitat Wood JC, Tyszka JM, Carson S, Nelson MD, Coates TD. Myocardial iron loading in transfusion-dependent thalassemia and sickle cell disease. Blood. 2004;103:1934–6.PubMedCrossRef Wood JC, Tyszka JM, Carson S, Nelson MD, Coates TD. Myocardial iron loading in transfusion-dependent thalassemia and sickle cell disease. Blood. 2004;103:1934–6.PubMedCrossRef
31.
Zurück zum Zitat Anderson LJ, Westwood MA, Prescott E, Walker JM, Pennell DJ, Wonke B. Development of thalassaemic iron overload cardiomyopathy despite low liver iron levels and meticulous compliance to desferrioxamine. Acta Haematol. 2006;115:106–8.PubMedCrossRef Anderson LJ, Westwood MA, Prescott E, Walker JM, Pennell DJ, Wonke B. Development of thalassaemic iron overload cardiomyopathy despite low liver iron levels and meticulous compliance to desferrioxamine. Acta Haematol. 2006;115:106–8.PubMedCrossRef
32.
Zurück zum Zitat Argyropoulou MI, Kiortsis DN, Efremidis SC. MRI of the liver and the pituitary gland in patients with beta-thalassemia major: does hepatic siderosis predict pituitary iron deposition? Eur Radiol. 2003;13:12–6.PubMedCrossRef Argyropoulou MI, Kiortsis DN, Efremidis SC. MRI of the liver and the pituitary gland in patients with beta-thalassemia major: does hepatic siderosis predict pituitary iron deposition? Eur Radiol. 2003;13:12–6.PubMedCrossRef
33.
Zurück zum Zitat Wood JC, Noetzl L, Hyderi A, Joukar M, Coates T, Mittelman S. Predicting pituitary iron and endocrine dysfunction. Ann N Y Acad Sci. 2010;1202:123–8. Wood JC, Noetzl L, Hyderi A, Joukar M, Coates T, Mittelman S. Predicting pituitary iron and endocrine dysfunction. Ann N Y Acad Sci. 2010;1202:123–8.
34.
Zurück zum Zitat Al-Rimawi HS, Jallad MF, Amarin ZO, Obeidat BR. Hypothalamic-pituitary-gonadal function in adolescent females with beta-thalassemia major. Int J Gynaecol Obstet. 2005;90:44–7.PubMedCrossRef Al-Rimawi HS, Jallad MF, Amarin ZO, Obeidat BR. Hypothalamic-pituitary-gonadal function in adolescent females with beta-thalassemia major. Int J Gynaecol Obstet. 2005;90:44–7.PubMedCrossRef
35.
Zurück zum Zitat De Sanctis V. Growth and puberty and its management in thalassaemia. Horm Res. 2002;1:72–9.CrossRef De Sanctis V. Growth and puberty and its management in thalassaemia. Horm Res. 2002;1:72–9.CrossRef
36.
Zurück zum Zitat Roth C, Pekrun A, Bartz M, Jarry H, Eber S, Lakomek M, Schroter W. Short stature and failure of pubertal development in thalassaemia major: evidence for hypothalamic neurosecretory dysfunction of growth hormone secretion and defective pituitary gonadotropin secretion. Eur J Pediatr. 1997;156:777–83.PubMedCrossRef Roth C, Pekrun A, Bartz M, Jarry H, Eber S, Lakomek M, Schroter W. Short stature and failure of pubertal development in thalassaemia major: evidence for hypothalamic neurosecretory dysfunction of growth hormone secretion and defective pituitary gonadotropin secretion. Eur J Pediatr. 1997;156:777–83.PubMedCrossRef
37.
Zurück zum Zitat Nielsen JE, Jensen LN, Krabbe K. Hereditary haemochromatosis: a case of iron accumulation in the basal ganglia associated with a parkinsonian syndrome. J Neurol Neurosurg Psychiatry. 1995;59:318–21.PubMedCrossRef Nielsen JE, Jensen LN, Krabbe K. Hereditary haemochromatosis: a case of iron accumulation in the basal ganglia associated with a parkinsonian syndrome. J Neurol Neurosurg Psychiatry. 1995;59:318–21.PubMedCrossRef
38.
Zurück zum Zitat Schroder J, Haan J. Extrapyramidal syndrome in idiopathic hemochromatosis. Significance of laboratory chemical, neurophysiologic and imaging procedures (CCT, MRT). Nervenarzt. 1987;58:577–8.PubMed Schroder J, Haan J. Extrapyramidal syndrome in idiopathic hemochromatosis. Significance of laboratory chemical, neurophysiologic and imaging procedures (CCT, MRT). Nervenarzt. 1987;58:577–8.PubMed
39.
Zurück zum Zitat Argyropoulou MI, Kiortsis DN, Astrakas L, Metafratzi Z, Chalissos N, Efremidis SC. Liver, bone marrow, pancreas and pituitary gland iron overload in young and adult thalassemic patients: a T2 relaxometry study. Eur Radiol. 2007;17:3025–30.PubMedCrossRef Argyropoulou MI, Kiortsis DN, Astrakas L, Metafratzi Z, Chalissos N, Efremidis SC. Liver, bone marrow, pancreas and pituitary gland iron overload in young and adult thalassemic patients: a T2 relaxometry study. Eur Radiol. 2007;17:3025–30.PubMedCrossRef
Metadaten
Titel
Quantitative T2* Magnetic Resonance Imaging for Evaluation of Iron Deposition in the Brain of β-Thalassemia Patients
verfasst von
S. Akhlaghpoor, MD
A. Ghahari, MD
A. Morteza, MD, MPH
O. Khalilzadeh, MD, MPH
A. Shakourirad, MD
M. R. Alinaghizadeh, MSc
Publikationsdatum
01.09.2012
Verlag
Springer-Verlag
Erschienen in
Clinical Neuroradiology / Ausgabe 3/2012
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-011-0108-z

Weitere Artikel der Ausgabe 3/2012

Clinical Neuroradiology 3/2012 Zur Ausgabe

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.