title: Pancreatic iron and fat assessment by MRI-R2* in patients with iron overload diseases.
abstract: BACKGROUND
  To determine the pancreatic iron (R2*) and fat content (FC) in comparison to hepatic and cardiac R2* in patients with iron overload disorders like β-thalassemia major (TM), Diamond-Blackfan anemia (DBA) or hereditary hemochromatosis.
  
  
  METHODS
  R2* rates were assessed in the liver, heart and pancreas of 42 patients with TM, 29 subjects with other iron overload diseases, and 10 controls using an ECG-gated breathhold sequence (12 echo time [TE] = 1.3-25.7 ms, readout repetition time [TR] = 244 ms). Pancreatic R2* and FC were assessed from TE dependent region of interest based signal intensities performing water-fat chemical shift relaxometry and were compared with laboratory parameters (glucose, HbA1c, amylase and lipase).
  
  
  RESULTS
  A pancreatic iron gradient from tail (R2* = 122 s(-1) ) to head (R2* = 114 s(-1) , P < 10(-4) ) was found. The close association between cardiac and pancreatic R2* was also confirmed in patients with TM and other iron overload diseases (rs  = 0.64, P < 10(-4) ). Receiver operator characteristic analysis (area: 0.89, P < 10(-4) ) identified patients with elevated cardiac iron at a pancreatic R2* cut-off level of 131s(-1) (sensitivity = specificity at 81%). Highest pancreatic R2* (211s(-1) ) and FC (36%) were found in the tail region of diabetic patients with TM.
  
  
  CONCLUSIONS
  Pancreatic tail showed highest R2* rates and fat contents, especially in patients with thalassemia. Besides iron accumulation fatty degeneration might be an additional risk factor for the development of diabetes in β-thalassemia major, but this hypothesis needs further studies in prediabetic patients.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Charlotte D
authors.initials: CD
authors.lastname: Pfeifer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Bjoern P
authors.initials: BP
authors.lastname: Schoennagel
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Regine
authors.initials: R
authors.lastname: Grosse
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Zhiyue J
authors.initials: ZJ
authors.lastname: Wang
authors.affiliation: Siemens AG, Hamburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Graessner
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Nielsen
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Adam
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany.|UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Fischer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Jin
authors.initials: J
authors.lastname: Yamamura
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007501:Iron / Q000032:analysis*; D019190:Iron Overload / Q000378:metabolism* / Q000473:pathology; D008055:Lipids / Q000032:analysis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D057054:Molecular Imaging / Q000379:methods; D010179:Pancreas / Q000737:chemistry* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014018:Tissue Distribution
chemical_list: D008055:Lipids; D007501:Iron
keywords: R2*; fat infiltration; iron overload; pancreas; pancreatic tail; thalassemia