França M, Martí-Bonmatí L, Porto G, Silva S, Guimarães S, Alberich-Bayarri Á, Vizcaíno J R, Pessegueiro Miranda H
Imaging Department - Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001 Porto, Portugal; i3S, Instituto de Investigação e Inovação em Saúde, IBMC, Institute for Molecular and Cell Biology, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal.
Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Av. Fernando Abril Martorell 106 Torre E, 46026 Valencia, Spain.
Clin Radiol. 2018 Feb;73(2):215.e1-215.e9. doi: 10.1016/j.crad.2017.07.022. Epub 2017 Aug 31.
To investigate iron loading within the liver, pancreas, spleen, and bone marrow using magnetic resonance imaging (MRI) transverse relaxation rate (R2*), in patients with diffuse liver diseases; to evaluate the relationships between iron accumulation in these tissue compartments; and to assess the association between tissue iron overload and the pattern of hepatic cellular iron distribution (hepatocytes versus Kupffer cells).
Fifty-six patients with diffuse liver diseases had MRI-derived R2* values, using a multi-echo chemical-shift encoded MRI sequence, of the liver, pancreas, spleen, and vertebral bone marrow. All patients had liver biopsy samples scored for hepatic iron grading (0-4) and iron cellular distribution (within hepatocytes only or within both hepatocytes and Kupffer cells).
Liver R2* increased with histological iron grade (R=0.58, p<0.001) and correlated with spleen (R=0.71, p<0.001) and bone marrow R2* (R=0.66, p<0.001), but not with pancreatic R2* (R=0.22, p=0.096). Splenic and bone marrow R2* values were also correlated (R=0.72, p<0.001). Patients with iron inside Kupffer cells had the highest R2* in liver, spleen and bone marrow.
Patients with chronic diffuse liver diseases have concomitant hepatic, splenic, and bone marrow iron loading. The highest hepatic iron scores and iron inside Kupffer cells were associated with the highest splenic and bone marrow deposits, suggesting systemic iron accumulation in the mononuclear phagocytic system.
利用磁共振成像（MRI）横向弛豫率（R2*）研究弥漫性肝病患者肝脏、胰腺、脾脏和骨髓中的铁负荷；评估这些组织中铁蓄积之间的关系；并评估组织铁过载与肝细胞铁分布模式（肝细胞与库普弗细胞）之间的关联。
56例弥漫性肝病患者采用多回波化学位移编码MRI序列测量肝脏、胰腺、脾脏和椎体骨髓的MRI衍生R2*值。所有患者均有肝活检样本，对肝铁分级（0-4级）和铁细胞分布（仅在肝细胞内或同时在肝细胞和库普弗细胞内）进行评分。
肝脏R2随组织学铁分级增加（R=0.58，p<0.001），并与脾脏（R=0.71，p<0.001）和骨髓R2相关（R=0.66，p<0.001），但与胰腺R2无关（R=0.22，p=0.096）。脾脏和骨髓的R2值也相关（R=0.72，p<0.001）。库普弗细胞内有铁的患者肝脏、脾脏和骨髓中的R2*最高。
慢性弥漫性肝病患者同时存在肝脏、脾脏和骨髓铁负荷。最高的肝铁评分和库普弗细胞内的铁与最高的脾脏和骨髓铁沉积相关，提示单核吞噬系统存在全身性铁蓄积。
