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Measurement of Hepatic Iron Concentration

Published:September 09, 2014DOI:https://doi.org/10.1016/j.cgh.2014.09.003
      Evaluation of hepatic iron concentration (HIC) continues to have an important role in assessing the potential for iron-mediated liver disease in patients with hereditary hemochromatosis (HH).
      • Bacon B.R.
      • Adams P.C.
      • Kowdley K.V.
      • et al.
      American Association for the Study of Liver Diseases. Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases.
      Furthermore, HIC monitoring in patients receiving iron chelation therapy is important for patients with hemoglobinopathies (eg, thalassemia, sickle cell disease) and myelodysplastic syndromes. Serum ferritin is a reliable indicator of body iron stores in HH, and still is considered suitable for monitoring response to phlebotomy therapy in HH, but is less reliable in non-HH iron overload.
      • Bacon B.R.
      • Adams P.C.
      • Kowdley K.V.
      • et al.
      American Association for the Study of Liver Diseases. Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases.
      Accordingly, there has been interest in the noninvasive measurement of HIC in non-HH iron overload for more than 30 years.
      • Brittenham G.M.
      • Farrel D.E.
      • Harris J.W.
      • et al.
      Magnetic-susceptibility measurement of human iron stores.
      Measurement of hepatic and cardiac iron concentration date back to the 1970s when the first magnetic susceptibility measurements were performed.
      • Brittenham G.M.
      • Farrel D.E.
      • Harris J.W.
      • et al.
      Magnetic-susceptibility measurement of human iron stores.
      Subsequently, with the development and proliferation of magnetic resonance imaging (MRI), this noninvasive methodology was deemed a better technology for assessing HIC and numerous methods and techniques for measuring HIC by MRI were developed and introduced into the medical literature. From the vantage point of a hepatologist, use of MRI for HIC is limited to a few centers with special interest. Further analysis seemed limited to determining if HIC was normal or whether there was severe iron overload. Correlations between HIC at several levels with an MRI value was lacking.
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