Highlights
- •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).
Methods
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).
Results
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.
Conclusions
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
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 05, 2017
Accepted:
April 26,
2017
Received in revised form:
April 11,
2017
Received:
December 14,
2016
Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
