title: Gradient-echo magnetic resonance imaging study of pancreatic iron overload in young Egyptian beta-thalassemia major patients and effect of splenectomy.
abstract: BACKGROUND
  Thalassemic patients suffer from diabetes mellitus secondary to hemosiderosis.
  
  
  OBJECTIVE
  The study aimed to evaluate pancreatic iron overload by T2*-weighted Gradient-echo magnetic resonance imaging (MRI) in young beta-thalassemia major patients and to correlate it with glucose disturbances, hepatic hemosiderosis, serum ferritin and splenectomy.
  
  
  METHODS
  Forty thalassemic patients (20 non diabetic, 10 diabetic, and 10 with impaired glucose tolerance) were recruited from Pediatric Hematology Clinic, in addition to 20 healthy controls. All patients underwent clinical assessment and laboratory investigations included complete blood count, liver function tests, serum ferritin and oral glucose tolerance test (OGTT). A T2*-weighted gradient-echo sequence MRI was performed with 1.5 T scanner and signal intensity ratio (SIR) of the liver and the pancreas to noise were calculated.
  
  
  RESULTS
  Significant reduction in signal intensity ratio (SIR) of the liver and the pancreas was shown in thalassemic patients compared to controls (P < 0.0001), Thalassemic patients with abnormal glucose tolerance; including diabetics and thalassemics with impaired glucose tolerance; displayed a higher degree of pancreatic and hepatic siderosis compared to thalassemics with normal glucose tolerance or controls (P < 0.001, P < 0.0001). Splenectomized thalassemic patients had significantly lower SIR of pancreas compared to non splenectomized patients (P < 0.05). A strong correlation was present between hepatic and pancreatic siderosis in studied patients (P < 0.001).
  
  
  CONCLUSIONS
  pancreatic siderosis can be detected by T2* gradient-echo MRI since childhood in thalassemic patients, and is more evident in patients with abnormal glucose tolerance. After splenectomy, iron deposition may be accelerated in the pancreas. Follow up of thalassemic patients using pancreatic MRI together with intensive chelation therapy may help to prevent the development of overt diabetes.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt. randa_matar@yahoo.com
authors.forename: Randa M
authors.initials: RM
authors.lastname: Matter
authors.forename: Khalid E
authors.initials: KE
authors.lastname: Allam
authors.forename: Amany M
authors.initials: AM
authors.lastname: Sadony
references.citation: Blood. 2009 Nov 5;114(19):4021-6
references.pmid: 19726718
references.citation: Eur Radiol. 2007 Dec;17(12):3025-30
references.pmid: 17549485
references.citation: Eur J Pediatr. 2003 Mar;162(3):139-146
references.pmid: 12655415
references.citation: AJR Am J Roentgenol. 1999 Jul;173(1):187-92
references.pmid: 10397124
references.citation: J Magn Reson Imaging. 2006 Feb;23(2):163-70
references.pmid: 16374880
references.citation: Br J Haematol. 2006 Aug;134(4):438-44
references.pmid: 16822284
references.citation: Curr Opin Hematol. 2007 May;14(3):183-90
references.pmid: 17414205
references.citation: Ann N Y Acad Sci. 1990;612:293-310
references.pmid: 2291557
references.citation: J Magn Reson Imaging. 2009 Apr;29(4):853-9
references.pmid: 19306409
references.citation: Lancet. 2004 Jan 31;363(9406):357-62
references.pmid: 15070565
references.citation: Hemoglobin. 2009;33(2):101-8
references.pmid: 19373585
references.citation: Med J Malaysia. 2008 Jun;63(2):109-12
references.pmid: 18942294
references.citation: Haematologica. 2008 Jan;93(1):116-9
references.pmid: 18166794
references.citation: J Magn Reson Imaging. 2003 May;17(5):589-92
references.pmid: 12720269
references.citation: Pancreas. 1993 Mar;8(2):176-80
references.pmid: 8460093
references.citation: Diabetes Metab. 2001 Apr;27(2 Pt 1):149-54
references.pmid: 11353881
references.citation: Br J Haematol. 2004 Feb;124(3):385-90
references.pmid: 14717788
references.citation: Eur Radiol. 2003 Jan;13(1):12-6
references.pmid: 12541105
references.citation: Eur J Haematol. 2009 May;82(5):388-92
references.pmid: 19141120
references.citation: J Pediatr Endocrinol Metab. 2000 Mar;13(3):303-6
references.pmid: 10714756
references.citation: Pediatr Endocrinol Rev. 2008 Oct;6 Suppl 1:158-69
references.pmid: 19337172
references.citation: Radiology. 1994 Nov;193(2):533-8
references.pmid: 7972774
references.citation: J Pediatr Hematol Oncol. 2006 May;28(5):311-5
references.pmid: 16772883
references.citation: AJR Am J Roentgenol. 1997 May;168(5):1205-8
references.pmid: 9129412
references.citation: Radiology. 1999 Jul;212(1):227-34
references.pmid: 10405746
references.citation: Pediatr Diabetes. 2004 Sep;5(3):126-32
references.pmid: 15450007
references.citation: Pediatr Blood Cancer. 2009 Dec;53(6):1054-9
references.pmid: 19618454
references.citation: Eur Radiol. 2007 Jun;17(6):1535-43
references.pmid: 17149622
references.citation: Diabetes Care. 2001 May;24(5):850-4
references.pmid: 11347742
references.citation: Pediatr Endocrinol Rev. 2004 Dec;2 Suppl 2:249-55
references.pmid: 16462705
references.citation: Haematologica. 2008 May;93(5):784-6
references.pmid: 18450735
references.citation: Pediatr Endocrinol Rev. 2004 Dec;2 Suppl 2:267-71
references.pmid: 16462709
references.citation: Hong Kong Med J. 2002 Aug;8(4):255-60
references.pmid: 12167729
references.citation: J Magn Reson Imaging. 2009 Feb;29(2):357-64
references.pmid: 19161188