Hassan M Ghoz1, Paul T Kröner1, Fernando F Stancampiano2, Andrew W Bowman3, Prakash Vishnu4, Michael G Heckman5, Nancy N Diehl5, Ethan McLeod6, Naveed Nikpour6, William C Palmer1. 1. Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA. 2. Department of Medicine, Mayo Clinic, Jacksonville, FL, USA. 3. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA. 4. Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA. 5. Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA. 6. Clinical Research Internship Study Program (CRISP), Mayo Clinic, Jacksonville, FL, USA.
Abstract
BACKGROUND: Magnetic resonance elastography (MRE) is a non-invasive test used to assess liver stiffness and fibrosis in chronic liver disease, which includes systemic iron overload. However, iron deposition by itself is associated with technical failure of MRE of the liver which necessitates the use of invasive liver biopsy as an alternative monitoring method for these patients. T2*-weighted magnetic resonance imaging (T2*) is a reliable modality to asses for hepatic as well as total body iron overload. Therefore, we aimed to determine a cutoff value on the T2* reading at which MRE would no longer provide accurate stiffness measurements in patients with iron overload. METHODS: Ninety-five patients with iron overload who underwent MRE at our institution, between 2010 and 2017 were reviewed retrospectively. We compared T2* values between patients with adequate elastography (N=63) versus those with non-diagnostic elastography (N=32). We additionally examined the ability of T2* to predict the likelihood of non-diagnostic elastography by estimating area under the ROC curve (AUC). RESULTS: T2* was significantly different between patients with and without an adequate elastography (P<0.0001) and predicted occurrence of non-diagnostic elastography with an AUC of 0.95. All patients with a non-diagnostic elastography had a T2* value below 20 milliseconds (ms), and correspondingly 55% of the patients with a T2* value below 20 ms had a non-diagnostic elastography. The subgroups of patients with a T2* value ≤10, ≤8, and ≤6 ms, had a higher likelihood of non-diagnostic elastography (87%, 92%, and 95%, respectively). CONCLUSIONS: T2* can be used to accurately predict which patients are most likely to have a non-diagnostic elastography reading. T2* of 20 ms or lower reflects a higher likelihood of non-diagnostic elastography.
BACKGROUND: Magnetic resonance elastography (MRE) is a non-invasive test used to assess liver stiffness and fibrosis in chronic liver disease, which includes systemic iron overload. However, iron deposition by itself is associated with technical failure of MRE of the liver which necessitates the use of invasive liver biopsy as an alternative monitoring method for these patients. T2*-weighted magnetic resonance imaging (T2*) is a reliable modality to asses for hepatic as well as total body iron overload. Therefore, we aimed to determine a cutoff value on the T2* reading at which MRE would no longer provide accurate stiffness measurements in patients with iron overload. METHODS: Ninety-five patients with iron overload who underwent MRE at our institution, between 2010 and 2017 were reviewed retrospectively. We compared T2* values between patients with adequate elastography (N=63) versus those with non-diagnostic elastography (N=32). We additionally examined the ability of T2* to predict the likelihood of non-diagnostic elastography by estimating area under the ROC curve (AUC). RESULTS: T2* was significantly different between patients with and without an adequate elastography (P<0.0001) and predicted occurrence of non-diagnostic elastography with an AUC of 0.95. All patients with a non-diagnostic elastography had a T2* value below 20 milliseconds (ms), and correspondingly 55% of the patients with a T2* value below 20 ms had a non-diagnostic elastography. The subgroups of patients with a T2* value ≤10, ≤8, and ≤6 ms, had a higher likelihood of non-diagnostic elastography (87%, 92%, and 95%, respectively). CONCLUSIONS: T2* can be used to accurately predict which patients are most likely to have a non-diagnostic elastography reading. T2* of 20 ms or lower reflects a higher likelihood of non-diagnostic elastography.
Entities:
Keywords:
Hemochromatosis; T2* cut-off value; magnetic resonance elastography (MRE)
Authors: E Angelucci; G M Brittenham; C E McLaren; M Ripalti; D Baronciani; C Giardini; M Galimberti; P Polchi; G Lucarelli Journal: N Engl J Med Date: 2000-08-03 Impact factor: 91.245
Authors: L J Anderson; S Holden; B Davis; E Prescott; C C Charrier; N H Bunce; D N Firmin; B Wonke; J Porter; J M Walker; D J Pennell Journal: Eur Heart J Date: 2001-12 Impact factor: 29.983
Authors: Timothy G St Pierre; Paul R Clark; Wanida Chua-anusorn; Adam J Fleming; Gary P Jeffrey; John K Olynyk; Pensri Pootrakul; Erin Robins; Robert Lindeman Journal: Blood Date: 2004-07-15 Impact factor: 22.113
Authors: John C Wood; Cathleen Enriquez; Nilesh Ghugre; J Michael Tyzka; Susan Carson; Marvin D Nelson; Thomas D Coates Journal: Blood Date: 2005-04-28 Impact factor: 22.113
Authors: Pippa Storey; Alexis A Thompson; Christine L Carqueville; John C Wood; R Andrew de Freitas; Cynthia K Rigsby Journal: J Magn Reson Imaging Date: 2007-03 Impact factor: 4.813
Authors: William C Palmer; Prakash Vishnu; William Sanchez; Bashar Aqel; Doug Riegert-Johnson; Leigh Ann Kenda Seaman; Andrew W Bowman; Candido E Rivera Journal: J Gen Intern Med Date: 2018-09-17 Impact factor: 6.473
Authors: Yi Zhou; Jin-Li Meng; Li Feng; Yong-Hong Huang; Jin Ye; Man Li; Zhong-You Xu; Xiang-Wei Li; Fang Yuan; Bin Song Journal: J Int Med Res Date: 2020-03 Impact factor: 1.671