Liver iron concentration in dysmetabolic hyperferritinemia: Results from a prospective cohort of 276 patients.

INTRODUCTION AND OBJECTIVES: We aimed to study the liver iron concentration in patients referred for hyperferritinemia to six hospitals in the Basque Country and to determine if there were differences between patients with or without metabolic syndrome. PATIENTS AND METHODS: Metabolic syndrome was defined by accepted criteria. Liver iron concentration was determined by magnetic resonance imaging. RESULTS: We obtained the data needed to diagnose metabolic syndrome in 276 patients; a total of 135 patients (49%), 115/240 men (48%), and 20/36 women (55.6%) presented metabolic syndrome. In all 276 patients, an MRI for the determination of liver iron concentration (mean±SD) was performed. The mean liver iron concentration was 30.83±19.38 for women with metabolic syndrome, 38.84±25.50 for men with metabolic syndrome, and 37.66±24.79 (CI 95%; 33.44-41.88) for the whole metabolic syndrome group. In 141 patients (51%), metabolic syndrome was not diagnosed: 125/240 were men (52%) and 16/36 were women (44.4%). The mean liver iron concentration was 34.88±16.18 for women without metabolic syndrome, 44.48±38.16 for men without metabolic syndrome, and 43.39±36.43 (CI 95%, 37.32-49.46) for the whole non-metabolic syndrome group. Comparison of the mean liver iron concentration from both groups (metabolic syndrome vs non-metabolic syndrome) revealed no significant differences (p=0.12). CONCLUSIONS: Patients with hyperferritinemia and metabolic syndrome presented a mildly increased mean liver iron concentration that was not significantly different to that of patients with hyperferritinemia and non-metabolic syndrome.

Liver iron concentration is not raised in patients with dysmetabolic hyperferritinemia.

Background & aims. Hyperferritinemia (HF) is frequently present in patients with metabolic syndrome (MS). MS associated with HF is named dysmetabolic hyperferritinemia (DH). There are some publications that propose that DH is associated with a raised liveriron concentration (LIC). We studied the LIC in patients referred for HF to a secondary hospital to determine if there are differences between patients with or without MS. MATERIAL AND METHODS: We conducted a prospective study of 132 consecutive patients with HF from January to December 2010. The MS was defined by the International Diabetes Federation criteria (2005). LIC was determined by Magnetic resonance imaging (MRI). RESULTS: The number of patients for which there was enough data to determine MS was 97, out of which 54 had MS and 43 had no MS (NMS). In 54/97 patients, MRI for LIC determination was performed. From the MS group, 44 were men (27 underwent MRI) and 10 women (9 MRI). The mean LIC was 27.83 ± 20.90 ?mol/g for the MS group. In the NMS group, 36 were men (13 MRI), and 7 women (5 MRI). In 18 patients from the NMS group, LIC was determined by MRI. The mean LIC was 33.16 ± 19.61 ?mol/g in the NMS group. We compared the mean values of LIC from both groups (MS vs. NMS) and no significant differences were found (p = 0.067). CONCLUSION: Patients with DH present a mean LIC within normal values and their values do not differ from those of patients with HF but without MS.

Non-invasive measurement of liver iron concentration by magnetic resonance imaging and its clinical usefulness.

Determination of liver iron concentration by magnetic resonance imaging (MRI) is becoming the new technique of choice for the diagnosis of iron overload in hereditary haemochromatosis and other liver iron surcharge diseases. Determination of hepatic iron concentration obtained by liver biopsy has been the gold standard for years. The development of MRI techniques, via signal intensity ratio methods or relaxometry, has provided a non-invasive and more accurate approach to the diagnosis of liver iron overload. This article reviews the available MRI methods for the determination of liver iron concentration and also evaluates the technique for the diagnosis and quantification of iron overload in different clinical practice scenarios.

Measurement of liver iron concentration by MRI is reproducible.

PURPOSE: The objectives were (i) construction of a phantom to reproduce the behavior of iron overload in the liver by MRI and (ii) assessment of the variability of a previously validated method to quantify liver iron concentration between different MRI devices using the phantom and patients. MATERIALS AND METHODS: A phantom reproducing the liver/muscle ratios of two patients with intermediate and high iron overload. Nine patients with different levels of iron overload were studied in 4 multivendor devices and 8 of them were studied twice in the machine where the model was developed. The phantom was analysed in the same equipment and 14 times in the reference machine. RESULTS: FeCl3 solutions containing 0.3, 0.5, 0.6, and 1.2 mg Fe/mL were chosen to generate the phantom. The average of the intramachine variability for patients was 10% and for the intermachines 8%. For the phantom the intramachine coefficient of variation was always below 0.1 and the average of intermachine variability was 10% for moderate and 5% for high iron overload. CONCLUSION: The phantom reproduces the behavior of patients with moderate or high iron overload. The proposed method of calculating liver iron concentration is reproducible in several different 1.5 T systems.

Carcinoma de endometrio: valor de la estadificación prequirúrgica por resonancia magnética / Endometrial carcinoma: merit of magnetic resonance in pre-surgical staging

Objetivo: Evaluar la capacidad de la RM para valorar la infiltración profunda del miometrio y cérvix en el carcinoma de endometrio. Pacientes y métodos: Se estudió una serie de 30 pacientes consecutivas diagnosticadas de cáncer de endometrio que fueron evaluadas prequirúrgicamente mediante resonancia magnética (RM). Se utilizaron secuencias TSE T2 con saturación de la grasa y secuencia dinámica FFE tras la administración de gadolinio. Se realizó una correlación con la estadificación posquirúrgica histológica. Se halló la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) para la infiltración profunda miometrial y la invasión del cérvix. Se analizaron los casos de sobrestimación e infraestimación. Resultados: Para el miometrio y cérvix se obtuvo una S del 67% y 63%, E del 89% y 91%, VPP del 80% y 71% y VPN del 80% y 87%, respectivamente. Se sobrevaloraron dos casos para la infiltración miometrial y dos para el cérvix e infravaloraron cuatro y tres casos, respectivamente. Conclusión: La estadificación por RM del carcinoma de endometrio es una técnica de alta fiabilidad diagnóstica pero presenta sus limitaciones (AU)

Aim: To evaluate MR capacity in assessing deep myometrial and cervical infiltrations in cases of endometrial carcinoma. Material and methods: A series of 30 consecutively diagnosed endometrial cancer patients was pre-surgically evaluated by means of magnetic resonance (MR). TSE-T2 sequences with fat saturation and dynamic FFE sequence were used after gadolinium administration. A correlation with post-surgical histological staging was made. There were then determined sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) for the deep myometrial infiltration and cervical invasion. Cases of overestimation and underestimation were analyzed. Results: Values obtained for myometrium and cervix were, respectively, S of 67% and 63%, SP of 89% and 91%, PPV of 80% and 71% and NPV of 80% and 87%. Two cases each were overvalued for myometrial infiltration and cervix; four cases and 3 cases, respectively, were undervalued. Conclusions: MR staging in cases of endometrial carcinoma is a highly reliable diagnostic technique, but it does present certain limitations (AU)

Rotura de menisco. Errores diagnósticos en RM / Meniscal tear. Diagnostic errors in MR imaging

Objetivo: Analizar las discrepancias diagnósticas encontradas entre la resonancia magnética (RM) y la artroscopia y determinar las causas de las mismas. Material y métodos: Se revisaron retrospectivamente las exploraciones de RM de 248 rodillas. Cuarenta mostraron discrepancias diagnósticas entre los resultados de RM y la artroscopia. Dos radiólogos reanalizaron independientemente las imágenes de 29 de los 40 estudios sin conocer el diagnóstico que previamente se había realizado en la RM y la artroscopia. Se correlacionaron sus interpretaciones con el diagnóstico de RM inicial, las imágenes de RM y los resultados de la artroscopia. Los errores diagnósticos originales de RM fueron clasificados como errores inevitables, errores de interpretación y errores secundarios a hallazgos equívocos. No se pudieron revisar 11 exámenes de RM ya que no se pudieron recuperar las imágenes correspondientes. Resultados: De 34 errores encontrados en los diagnósticos originales, 12 (35,5 por ciento) fueron clasificados como inevitables, 14 (41,2 por ciento) como errores de interpretación y 8 (23,5 por ciento) como secundarios a hallazgos equívocos. Conclusión: Se evitaron el 41,2 por ciento de los errores retrospectivamente, probablemente debido a una experiencia mayor en la interpretación de RM en nuestro departamento. El 35,5 por ciento fueron inevitables incluso en la revisión retrospectiva. Un porcentaje pequeño de errores diagnósticos fue debido a la presencia de hallazgos sutiles equívocos (AU)