title: Signal-intensity-ratio MRI accurately estimates hepatic iron load in hemodialysis patients.
abstract: BACKGROUND
  Iron overload, diagnosed by means of magnetic resonance imaging (MRI), is an increasingly recognized disorder in hemodialysis patients. Specific MRI protocols have been shown to provide a reliable estimation of tissue iron content in non-renal patient populations but have not been validated in dialysis patients. Such validation studies require liver biopsy for histological comparison, but this invasive and risky procedure raises ethical concerns, especially regarding frail patients with end-stage renal disease.
  
  
  METHODS
  We compared in a pilot study Scheuer's histological classification and Deugnier and Turlin's histological classification of iron overload (Perls staining) with signal-intensity-ratio MRI values obtained with the Rennes University algorithm in 11 hemodialysis patients in whom liver biopsy was formally indicated for their medical follow-up.
  
  
  RESULTS
  For Scheuer's histological classification, the Wilcoxon non-parametric matched-pairs test showed no significant difference in the ranking of iron overload by the two methods eg histology and MRI (sum of ranks = 1.5; p = 1). The MRI and Scheuer's histological classifications were tightly correlated (rho = 0.866, p = 0.0035, Spearman's coefficient), as were the absolute liver iron concentrations (LIC) at MRI (rho = 0.860, p = 0.0013, Spearman's coefficient). The absolute liver iron concentrations at MRI were also highly correlated with Deugnier and Turlin's histological scoring (rho = 0.841, p = 0.0033, Spearman's coefficient).
  
  
  CONCLUSIONS
  This pilot study shows that liver iron determination based on signal-intensity-ratio MRI (Rennes University algorithm) very accurately identifies iron load in hemodialysis patients, by comparison with liver histology.
authors.affiliation: Division of Nephrology and Dialysis (Service Néphrologie et de Dialyse), Ramsay-Générale de Santé, Hôpital Privé Claude Galien, Quincy sous Sénart, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Rostoker
authors.affiliation: Histopathology laboratory ACP Bievres (Laboratoire d'Anatomie et de Cytologie Pathologiques (ACP) Bièvres), 7 avenue du Hoggar, 91940 les Ulis, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Laroudie
authors.affiliation: Division of Angiography (Service de radiologie interventionnelle), Ramsay Générale de Santé, Hôpital Privé Claude Galien, Quincy sous Sénart, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Blanc
authors.affiliation: Histopathology laboratory ACP Bievres (Laboratoire d'Anatomie et de Cytologie Pathologiques (ACP) Bièvres), 7 avenue du Hoggar, 91940 les Ulis, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Galet
authors.affiliation: Division of Nephrology and Dialysis (Service Néphrologie et de Dialyse), Ramsay-Générale de Santé, Hôpital Privé Claude Galien, Quincy sous Sénart, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Rabaté
authors.affiliation: Division of Nephrology and Dialysis (Service Néphrologie et de Dialyse), Ramsay-Générale de Santé, Hôpital Privé Claude Galien, Quincy sous Sénart, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Griuncelli
authors.affiliation: Division of Radiology (Service de Radiologie), Ramsay Générale de Santé, Hôpital Privé Claude Galien, Quincy sous Sénart, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
keywords: Internal medicine; Medical imaging; Medicine