Zhang Qian, Hou Bo, Wang Lu, Du Yali, Han Bing, Feng Feng
Peking Union Medical Colleague Hospital, Beijing 100730, China.
Zhonghua Xue Ye Xue Za Zhi. 2015 Apr;36(4):302-6. doi: 10.3760/cma.j.issn.0253-2727.2015.04.009.
To use the technique of magnetic resonance imaging (MRI) T2* mapping to diagnose and follow-up of patients with iron overload.
107 patients who were suspected to have iron overload between 2011.7-2014.3 in Peking Union Medical Colleague Hospital were analyzed retrospectively. Patients had the document of MRI T2* value of liver, heart and pancreas, serum ferritin (SF), transferrin saturation (TS), transfusion amount and other related laboratory tests. T2* values were compared with SF and transfusion amount. T2* values in different organs and their relationship with SF were also evaluated. 10 patients who had been adequately chelated for more than half a year were followed up for their SF and T2* values.
There were 65 males and 42 females with the median age of 51(8-77)-year-old. They were 50 myelodysplastic syndromes (MDS), 36 aplastic anemia, 10 myelofibrosis, 7 hemachromatosis and 4 thalassemia carriers. Liver T2* value was significantly related to SF (r=0.120, P=0.001), but not related to transfusion amount (r=0.019, P=0.175), whereas cardiac MRI T2* was not related either to SF or to transfusion amount. No correlation of the T2* value was found between liver and heart (r=0.015, P=0.235). 70 patients was detected for liver, heart and pancreas T2* simultaneously. Pancreas T2* was compatible to SF (r=0.061，P=0.039) and cardiac T2* (r=0.110, P=0.005), but not correlated to heptic T2* (r=0.047, P= 0.071) or transfusion amount (r=0.000, P=0.960). For the 10 well-chelated patients, during the half year follow-up period, SF changed significantly from (2 566.5±1 152.2) μg/L before chelation to (1 473.4±803.0) μg/L after chelation(P=0.001), while liver T2* remained the same [(6.0±5.1) ms, (6.3±6.0) ms respectively, P=0.629].
MRI, although related to SF to some extent, was a valuable additional methods for quantifying iron overload. Iron deposition in different organs might be not related to each other and needed to be evaluated separately. Well-chelation therapy could change SF in half-year follow-up, but T2* change needed longer time to follow-up.
运用磁共振成像（MRI）T2* 成像技术对铁过载患者进行诊断及随访。
回顾性分析2011年7月至2014年3月在北京协和医院疑似铁过载的107例患者。患者有肝脏、心脏及胰腺的MRI T2* 值记录，以及血清铁蛋白（SF）、转铁蛋白饱和度（TS）、输血量及其他相关实验室检查结果。将T2* 值与SF及输血量进行比较。评估不同器官的T2* 值及其与SF的关系。对10例接受充分螯合治疗半年以上的患者进行SF及T2* 值随访。
共65例男性和42例女性，中位年龄51（8 - 77）岁。其中骨髓增生异常综合征（MDS）50例，再生障碍性贫血36例，骨髓纤维化10例，血色素沉着症7例，地中海贫血携带者4例。肝脏T2* 值与SF显著相关（r = 0.120，P = 0.001），但与输血量无关（r = 0.019，P = 0.175），而心脏MRI T2* 值与SF及输血量均无关。肝脏与心脏的T2* 值无相关性（r = 0.015，P = 0.235）。70例患者同时检测了肝脏、心脏及胰腺的T2* 值。胰腺T2* 值与SF（r = 0.061，P = 0.039）及心脏T2* 值（r = 0.110，P = 0.005）具有相关性，但与肝脏T2* 值（r = 0.047，P = 0.071）及输血量（r = 0.000，P = 0.960）无关。对于10例螯合良好的患者，在半年随访期内，SF从螯合前的（2 566.5±1 152.2）μg/L显著降至螯合后的（1 473.4±803.0）μg/L（P = 0.001），而肝脏T2* 值保持不变[分别为（6.0±5.1）ms和（6.3±6.0）ms，P = 0.629]。
MRI虽在一定程度上与SF相关，但仍是定量评估铁过载的有价值的辅助方法。不同器官的铁沉积可能互不相关，需分别评估。良好的螯合治疗可在半年随访期内使SF改变，但T2* 值变化需要更长时间的随访。
