title: Comparison of Tissue Elastography With Magnetic Resonance Imaging T2* and Serum Ferritin Quantification in Detecting Liver Iron Overload in Patients With Thalassemia Major.
abstract: We investigated whether tissue elastography (TE) can be used as an alternative to magnetic resonance imaging (MRI) T2* analysis to determine the degree of iron overload in patients with thalassemia major.
  
  
  
  We conducted a prospective study of 154 patients (99 male; mean age, 12 ± 3.6 years) with thalassemia major requiring chronic blood transfusion and on iron chelator therapy. The study was performed at a tertiary hospital in India from January 2015 through June 2015. We performed routine blood sample analyses, measurements of serum levels of ferritin, and TE within 1 month of MRI T2* analysis of the liver. The Spearman correlation test and linear regression analysis were used to evaluate the correlation between TE liver stiffness measurements and R2* MRI results or serum ferritin levels.
  
  
  
  The subjects' mean total serum levels of bilirubin, alanine aminotransferase, aspartate aminotransferase, and albumin were 1.4 ± 0.6 mg/dL, 65.0 ± 51.8 IU/L, 62.9 ± 44 IU/L, and 4.2 ± 0.2 g/d, respectively. Mean liver stiffness measurement, MRI T2* (3 T), corresponding MRI R2* (3 T), and ferritin values were 8.2 ± 4.4 kPa, 3.18 ± 2.6 milliseconds, 617.3 ± 549 Hz, and 4712 ± 3301 ng/mL, respectively. On the basis of MRI analysis, 67 patients (43.5%) had mild iron overload, 49 patients (31.8%) had moderate iron overload, and 22 patients (14.3%) had severe iron overload. Fibroscan liver stiffness measurements correlated with MRI R2* values (r = 0.85; P < .001). TE results identified the patients with severe, moderate, and mild iron overload with area under the receiver operating characteristic curve values of 94.8%, 84.5%, and 84.7%, respectively. Liver stiffness measurements greater than 13.5, 7.8, and 5.5 kPa identified patients with severe, moderate, and mild iron overload, respectively; the sensitivity and specificity values were 92% and 93% for severe overload, 82% and 82% for moderate overload, and 73% and 75% for mild overload. No correlation was found between TE results and serum level of ferritin (r = 0.19; P = .11).
  
  
  
  Results of TE correlate with those from MRI T2* analysis. TE is cheaper and more available than MRI and might be used to estimate hepatic iron overload, especially moderate to severe overload in patients with thalassemia major who require chronic transfusion.
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India. Electronic address: niravpipalia@yahoo.com.
authors.forename: Nirav
authors.initials: N
authors.lastname: Pipaliya
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
authors.forename: Dattatray
authors.initials: D
authors.lastname: Solanke
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
authors.forename: Pathik
authors.initials: P
authors.lastname: Parikh
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
authors.forename: Meghraj
authors.initials: M
authors.lastname: Ingle
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
authors.forename: Ratna
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
authors.forename: Prabha
authors.initials: P
authors.lastname: Sawant
mesh_terms: D000293:Adolescent; D002648:Child; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007194:India; D019190:Iron Overload / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D044967:Serum / Q000737:chemistry*; D062606:Tertiary Care Centers; D017086:beta-Thalassemia / Q000150:complications*
chemical_list: D005293:Ferritins
keywords: Hemoglobinopathy; IO; LSM; Management; Monitor; Prognostic Factor