Research Article| Volume 67, ISSUE 3, P535-542, September 2017

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Sensitive and non-invasive assessment of hepatocellular iron using a novel room-temperature susceptometer


      • Non-invasive and sensitive detection of hepatocellular iron overload.
      • Performance comparable to AAS and MRI.
      • Promising cost-effective tool for liver iron screening.
      • Follow-up of hepatic iron after phlebotomy.
      • Detection of hepatic iron overload in metabolic liver diseases.

      Background & Aims

      Liver iron accumulates in various chronic liver diseases where it is an independent factor for survival and carcinogenesis. We tested a novel room-temperature susceptometer (RTS) to non-invasively assess liver iron concentration (LIC).


      Two hundred and sixty-four patients with or without signs of iron overload or liver disease were prospectively enrolled. Thirty-five patients underwent liver biopsy with semiquantitative iron determination (Prussian Blue staining), atomic absorption spectroscopy (AAS, n = 33), or magnetic resonance imaging (MRI, n = 15).


      In vitro studies demonstrated a highly linear (r2 = 0.998) association between RTS-signal and iron concentration, with a detection limit of 0.3 mM. Using an optimized algorithm, accounting for the skin-to-liver capsule distance, valid measurements could be obtained in 84% of cases. LIC-RTS showed a significant correlation with LIC-AAS (r = 0.74, p <0.001), LIC-MRI (r = 0.64, p <0.001) and hepatocellular iron (r = 0.58, p <0.01), but not with macrophage iron (r = 0.32, p = 0.30). Normal LIC-RTS was 1.4 mg/g dry weight. Besides hereditary and transfusional iron overload, LIC-RTS was also significantly elevated in patients with alcoholic liver disease. The areas under the receiver operating characteristic curve (AUROC) for grade 1, 2 and 3 hepatocellular iron overload were 0.72, 0.89 and 0.97, respectively, with cut-off values of 2.0, 4.0 and 5.0 mg/g dry weight. Notably, the positive and negative predictive values, sensitivity, specificity and accuracy of severe hepatic iron overload (HIO) (grade ≥2) detection, were equal to AAS and superior to all serum iron markers. Depletion of hepatic iron could be efficiently monitored upon phlebotomy.


      RTS allows for the rapid and non-invasive measurement of LIC. In comparison to MRI, it could be a cost-effective bedside method for LIC screening.
      Lay summary: Novel room-temperature susceptometer (RTS) allows for the rapid, sensitive, and non-invasive measurement of liver iron concentration. In comparison to MRI, it could be a cost-effective bedside method for liver iron concentration screening.

      Graphical Abstract


      Linked Article

      • Is room temperature susceptometer really an accurate method to assess hepatocellular iron?
        Journal of HepatologyVol. 67Issue 6
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          We read with interest the study by Mueller et al. describing the use of room temperature susceptometer (RTS) to assess hepatic iron content (HIC).1 This is an interesting clinical application of the methods described by Avrin et al.2,3 This topic is relevant as there is still a need for a cost-effective and efficient iron quantification method in liver disease.
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      • Reply to: “Is room temperature susceptometry really an accurate method to assess hepatocellular iron?”
        Journal of HepatologyVol. 67Issue 6
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          We acknowledge the letter from Dr. Paisant et al. and thank them for their comments in response to our paper “Sensitive and noninvasive assessment of hepatocellular iron using a novel room temperature susceptometer”.1 However, we do not accept the idea of being more cautious with the interpretation. We not only performed a prospective study on a large and heterogeneous cohort that was carefully characterized for fibrosis stage and steatosis using transient elastography (TE) and controlled attenuation parameter (CAP), it also included a wide array of in vitro experiments.
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