MR imaging of spleen in beta-thalassemia major.

PURPOSE: Splenomegaly and splenic siderosis are well-known findings in beta-thalassemia major. We explored the relation between splenic size, splenic and hepatic siderosis in transfusion-dependent beta-thalassemic patients, assessed by MR imaging. MATERIALS AND METHODS: Abdominal MR imaging studies of 47 consecutive thalassemic patients and 10 healthy subjects, used as controls, were retrospectively reviewed. The signal intensity ratios of spleen and liver to the right paraspinous muscle (S/M, L/M, respectively) were calculated on T1, intermediate, and T2*-weighted gradient-echo sequences, splenic volume was estimated on axial images and serum ferritin levels were recorded. RESULTS: Decreased S/M on all MR sequences was displayed in 36 patients. Six patients presented with normal S/M on all MR sequences and 5 patients displayed splenic hypointensity only on T2* sequence. No correlation between S/M and L/M was found whereas both L/M and S/M correlated with serum ferritin (P < 0.03). Splenic volume correlated to L/M (P < 0.05) but not to S/M values. CONCLUSION: In transfusion-dependent patients with beta-thalassemia, iron deposition in spleen cannot be predicted by the degree of hepatic siderosis, whereas splenomegaly relates to liver, but not splenic, iron overload. MR imaging can be a valuable tool in elucidating iron kinetics.

Adrenal glands in beta-thalassemia major: magnetic resonance (MR) imaging features and correlation with iron stores.

This study aimed at describing the magnetic resonance (MR) imaging features of the adrenal glands in beta-thalassemic patients and at investigating the relation between adrenal and hepatic siderosis. Adrenal signal intensity (SI) was retrospectively assessed on abdominal MR studies of 35 patients with beta-thalassemia major undergoing quantification of hepatic siderosis and 12 healthy controls, using T1-(120/4/90), intermediate-(120/4/20), and T2*-(120/15/20) weighted GRE sequences. Adrenal SI was graded as grade 0 (normal SI on all sequences), grade 1 (hypointensity on T2* alone), or grade 2 (hypointensity on at least T2*). Adrenal size was measured in the thalassemic patients and compared with normative data. Liver-to-muscle (L/M) SI ratios, expressing hepatic siderosis, were estimated on each sequence. Serum ferritin levels were recorded. Adrenal hypointensity (grades 1 and 2) was noted in 24/35 (68.6%) patients. L/M ratios correlated significantly with adrenal SI in all sequences. Patients with grade 1 and grade 2 adrenal SI had significantly decreased L/M ratios compared with grade 0. Serum ferritin correlated significantly with L/M values but not with adrenal SI. Adrenal size was within normal limits. Diffuse hypointensity in normal-sized adrenals is a common MR finding in beta-thalassemic patients and correlates with the degree of hepatic siderosis.

Abdominal lymphadenopathy in beta-thalassemia: MRI features and correlation with liver iron overload and posttransfusion chronic hepatitis C.

OBJECTIVE: The objective of our study was to describe the MRI features of abdominal lymphadenopathy in patients with beta-thalassemia major and investigate the relation of abdominal lymphadenopathy with the severity of iron overload and posttransfusion chronic hepatitis C. MATERIALS AND METHODS: Abdominal MRI studies of 60 consecutive patients with beta-thalassemia major, performed for quantification of liver iron overload at a single institution, were retrospectively studied for the presence of lymph nodes and their distribution, size, and number. The signal intensity ratios of liver, spleen, and the largest lymph node to the right paraspinous muscle (L/M, S/M, and LN/M, respectively) were calculated on T1-weighted gradient-echo images. MRI findings for the lymph nodes were compared with the histologically assigned activity level of chronic hepatitis C that was available in 17 patients who had undergone liver biopsy within 1 month of the MRI examination. RESULTS: Hypointense abdominal lymph nodes larger than 7 mm were seen in 19 (32%) of 60 thalassemic patients in perihepatic and paraortic distributions. Lymphadenopathy was related to both the severity of hepatic siderosis, as expressed by the L/M values, and the presence of chronic hepatitis C, given that 18 (95%) of the 19 thalassemic patients with lymphadenopathy had chronic hepatitis C. Moreover, thalassemic patients with a moderate or severe level of hepatic inflammation presented with abdominal lymphadenopathy more frequently than those with mild hepatic inflammation. CONCLUSION: The development of hypointense abdominal lymphadenopathy in patients with beta-thalassemia major who have received multiple transfusions depends both on the severity of liver iron overload and on the presence and the activity level of coexistent chronic hepatitis C.