USEFULNESS OF DUAL-ENERGY CT FOR DETECTION OF LIVER IRON DEPOSITION IN TRANSFUSION-DEPENDENT PATIENTS
(Abstract release date: 05/21/15)
EHA Library. Kobayashi H. 06/12/15; 102653; PB2021
Disclosure(s): Niigata University Faculty of MedicineHematology, Endocrinology and Metabolism
Hironori Kobayashi
Contributions
Contributions
Abstract
Abstract: PB2021
Type: Publication Only
Background
Chronic red blood cell transfusions lead to iron overload, which has been implicated in the development of serious complications. Liver iron concentration (LIC) is considered an indicator of total body iron stores, and the measurement of T2* values by MRI represents a standard noninvasive technique to evaluate LIC. However, some limitations are associated with MRI, such as its high cost and the overestimation of LIC. Although the application of CT, which is easy to use and widely applied to measure LIC, needs to be considered, conventional single energy CT (SECT) also has limitations for the detection of LIC due to normal variations in CT attenuation, predominantly in patients with mild iron overload. Moreover, SECT fails to detect iron in fatty livers, which has an inverse effect on attenuation by lowering CT numbers. Dual-energy CT (DECT) is used to obtain additional information on tissue composition over that provided by SECT. This technique is based on substances showing different densities with two different energies, with each substance displaying its own energy-dependent change in CT attenuation. However, the role of DECT in the detection of LIC remains to be clarified.
Aims
The aim of this study was to examine whether DECT represented a novel and useful technique for the detection of LIC.
Methods
Eight transfusion-dependent patients underwent liver DECT using a dual-source 128-slice CT system, serum ferritin levels were measured, and liver MRI was performed. DECT images were acquired using a tube voltage pair of 140 kV and 80 kV or 140 kV and 100 kV, and the three-material decompositions of fat, soft tissue and iron. All patients provided informed consent. Patient 1 was a 54-year-old male with MDS (RCMD-RS). Patient 2 was a 66-year-old female with AML with MRC in 1st CR. Patient 3 was a 47-year-old female who had undergone renal transplantation for chronic renal failure. Patient 4 was a 65-year-old male with AML with MRC receiving iron chelation therapy. Patient 5 was a 47-year-old male with AML in 3rd CR. Patient 6 was a 52-year-old female with AA. Patient 7 was a 63-year-old male with AIHA. Patient 8 was a 56-year-old female with AML in 2nd CR. All patients had long transfusion histories and received red blood cell transfusions of at least more than 12 U.
Results
Serum ferritin levels in patients 1 to 8 were 961, 2168, 7875, 795, 1921, 5104, 2401, and 2916 ng/ml, respectively. Although patient 8 with fatty liver, which was confirmed by abdominal ultrasonography, showed hypodensity on SECT images, liver iron deposition was detected on DECT images. All patients showed diffuse severe hypointensity on MRI T2*-weighted images. Patients 1, 2, and 3 also showed severe diffuse iron deposition on DECT images. However, patients 4, 5, 6, and 8 showed mild focal iron deposition, while patient 7 did not show iron deposition on DECT images.
Summary
Our results suggest that DECT has the ability to detect liver iron deposition in transfusion-dependent patients more precisely than MRI. DECT may be a new tool that can overcome the limitations of MRI.
Keyword(s): Iron overload, Liver iron concentration, Transfusion
Session topic: Publication Only
Type: Publication Only
Background
Chronic red blood cell transfusions lead to iron overload, which has been implicated in the development of serious complications. Liver iron concentration (LIC) is considered an indicator of total body iron stores, and the measurement of T2* values by MRI represents a standard noninvasive technique to evaluate LIC. However, some limitations are associated with MRI, such as its high cost and the overestimation of LIC. Although the application of CT, which is easy to use and widely applied to measure LIC, needs to be considered, conventional single energy CT (SECT) also has limitations for the detection of LIC due to normal variations in CT attenuation, predominantly in patients with mild iron overload. Moreover, SECT fails to detect iron in fatty livers, which has an inverse effect on attenuation by lowering CT numbers. Dual-energy CT (DECT) is used to obtain additional information on tissue composition over that provided by SECT. This technique is based on substances showing different densities with two different energies, with each substance displaying its own energy-dependent change in CT attenuation. However, the role of DECT in the detection of LIC remains to be clarified.
Aims
The aim of this study was to examine whether DECT represented a novel and useful technique for the detection of LIC.
Methods
Eight transfusion-dependent patients underwent liver DECT using a dual-source 128-slice CT system, serum ferritin levels were measured, and liver MRI was performed. DECT images were acquired using a tube voltage pair of 140 kV and 80 kV or 140 kV and 100 kV, and the three-material decompositions of fat, soft tissue and iron. All patients provided informed consent. Patient 1 was a 54-year-old male with MDS (RCMD-RS). Patient 2 was a 66-year-old female with AML with MRC in 1st CR. Patient 3 was a 47-year-old female who had undergone renal transplantation for chronic renal failure. Patient 4 was a 65-year-old male with AML with MRC receiving iron chelation therapy. Patient 5 was a 47-year-old male with AML in 3rd CR. Patient 6 was a 52-year-old female with AA. Patient 7 was a 63-year-old male with AIHA. Patient 8 was a 56-year-old female with AML in 2nd CR. All patients had long transfusion histories and received red blood cell transfusions of at least more than 12 U.
Results
Serum ferritin levels in patients 1 to 8 were 961, 2168, 7875, 795, 1921, 5104, 2401, and 2916 ng/ml, respectively. Although patient 8 with fatty liver, which was confirmed by abdominal ultrasonography, showed hypodensity on SECT images, liver iron deposition was detected on DECT images. All patients showed diffuse severe hypointensity on MRI T2*-weighted images. Patients 1, 2, and 3 also showed severe diffuse iron deposition on DECT images. However, patients 4, 5, 6, and 8 showed mild focal iron deposition, while patient 7 did not show iron deposition on DECT images.
Summary
Our results suggest that DECT has the ability to detect liver iron deposition in transfusion-dependent patients more precisely than MRI. DECT may be a new tool that can overcome the limitations of MRI.
Keyword(s): Iron overload, Liver iron concentration, Transfusion
Session topic: Publication Only
Abstract: PB2021
Type: Publication Only
Background
Chronic red blood cell transfusions lead to iron overload, which has been implicated in the development of serious complications. Liver iron concentration (LIC) is considered an indicator of total body iron stores, and the measurement of T2* values by MRI represents a standard noninvasive technique to evaluate LIC. However, some limitations are associated with MRI, such as its high cost and the overestimation of LIC. Although the application of CT, which is easy to use and widely applied to measure LIC, needs to be considered, conventional single energy CT (SECT) also has limitations for the detection of LIC due to normal variations in CT attenuation, predominantly in patients with mild iron overload. Moreover, SECT fails to detect iron in fatty livers, which has an inverse effect on attenuation by lowering CT numbers. Dual-energy CT (DECT) is used to obtain additional information on tissue composition over that provided by SECT. This technique is based on substances showing different densities with two different energies, with each substance displaying its own energy-dependent change in CT attenuation. However, the role of DECT in the detection of LIC remains to be clarified.
Aims
The aim of this study was to examine whether DECT represented a novel and useful technique for the detection of LIC.
Methods
Eight transfusion-dependent patients underwent liver DECT using a dual-source 128-slice CT system, serum ferritin levels were measured, and liver MRI was performed. DECT images were acquired using a tube voltage pair of 140 kV and 80 kV or 140 kV and 100 kV, and the three-material decompositions of fat, soft tissue and iron. All patients provided informed consent. Patient 1 was a 54-year-old male with MDS (RCMD-RS). Patient 2 was a 66-year-old female with AML with MRC in 1st CR. Patient 3 was a 47-year-old female who had undergone renal transplantation for chronic renal failure. Patient 4 was a 65-year-old male with AML with MRC receiving iron chelation therapy. Patient 5 was a 47-year-old male with AML in 3rd CR. Patient 6 was a 52-year-old female with AA. Patient 7 was a 63-year-old male with AIHA. Patient 8 was a 56-year-old female with AML in 2nd CR. All patients had long transfusion histories and received red blood cell transfusions of at least more than 12 U.
Results
Serum ferritin levels in patients 1 to 8 were 961, 2168, 7875, 795, 1921, 5104, 2401, and 2916 ng/ml, respectively. Although patient 8 with fatty liver, which was confirmed by abdominal ultrasonography, showed hypodensity on SECT images, liver iron deposition was detected on DECT images. All patients showed diffuse severe hypointensity on MRI T2*-weighted images. Patients 1, 2, and 3 also showed severe diffuse iron deposition on DECT images. However, patients 4, 5, 6, and 8 showed mild focal iron deposition, while patient 7 did not show iron deposition on DECT images.
Summary
Our results suggest that DECT has the ability to detect liver iron deposition in transfusion-dependent patients more precisely than MRI. DECT may be a new tool that can overcome the limitations of MRI.
Keyword(s): Iron overload, Liver iron concentration, Transfusion
Session topic: Publication Only
Type: Publication Only
Background
Chronic red blood cell transfusions lead to iron overload, which has been implicated in the development of serious complications. Liver iron concentration (LIC) is considered an indicator of total body iron stores, and the measurement of T2* values by MRI represents a standard noninvasive technique to evaluate LIC. However, some limitations are associated with MRI, such as its high cost and the overestimation of LIC. Although the application of CT, which is easy to use and widely applied to measure LIC, needs to be considered, conventional single energy CT (SECT) also has limitations for the detection of LIC due to normal variations in CT attenuation, predominantly in patients with mild iron overload. Moreover, SECT fails to detect iron in fatty livers, which has an inverse effect on attenuation by lowering CT numbers. Dual-energy CT (DECT) is used to obtain additional information on tissue composition over that provided by SECT. This technique is based on substances showing different densities with two different energies, with each substance displaying its own energy-dependent change in CT attenuation. However, the role of DECT in the detection of LIC remains to be clarified.
Aims
The aim of this study was to examine whether DECT represented a novel and useful technique for the detection of LIC.
Methods
Eight transfusion-dependent patients underwent liver DECT using a dual-source 128-slice CT system, serum ferritin levels were measured, and liver MRI was performed. DECT images were acquired using a tube voltage pair of 140 kV and 80 kV or 140 kV and 100 kV, and the three-material decompositions of fat, soft tissue and iron. All patients provided informed consent. Patient 1 was a 54-year-old male with MDS (RCMD-RS). Patient 2 was a 66-year-old female with AML with MRC in 1st CR. Patient 3 was a 47-year-old female who had undergone renal transplantation for chronic renal failure. Patient 4 was a 65-year-old male with AML with MRC receiving iron chelation therapy. Patient 5 was a 47-year-old male with AML in 3rd CR. Patient 6 was a 52-year-old female with AA. Patient 7 was a 63-year-old male with AIHA. Patient 8 was a 56-year-old female with AML in 2nd CR. All patients had long transfusion histories and received red blood cell transfusions of at least more than 12 U.
Results
Serum ferritin levels in patients 1 to 8 were 961, 2168, 7875, 795, 1921, 5104, 2401, and 2916 ng/ml, respectively. Although patient 8 with fatty liver, which was confirmed by abdominal ultrasonography, showed hypodensity on SECT images, liver iron deposition was detected on DECT images. All patients showed diffuse severe hypointensity on MRI T2*-weighted images. Patients 1, 2, and 3 also showed severe diffuse iron deposition on DECT images. However, patients 4, 5, 6, and 8 showed mild focal iron deposition, while patient 7 did not show iron deposition on DECT images.
Summary
Our results suggest that DECT has the ability to detect liver iron deposition in transfusion-dependent patients more precisely than MRI. DECT may be a new tool that can overcome the limitations of MRI.
Keyword(s): Iron overload, Liver iron concentration, Transfusion
Session topic: Publication Only
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