Concepts of MRI quantification of iron in the liver: present and future of modern multiparametric methods: a review

INTRODUCTION: Accumulation of excess iron in the body or systemic iron overload occurs for various reasons, mainly as a result of inherited disorders of iron regulatory pathways, long-term and/or regular blood transfusions, uncontrolled breakdown of hemoglobin in hemolytic anemias, hematological malignancies. Mild iron overload can be associated with chronic liver disease and metabolic syndrome (dysmetabolic iron overload).

Despite optimal control of chelation, iron is deposition in vital organs such as the liver, heart, endocrine glands and subsequently damaged. Liver Iron Concentration (LIC) is linearly related to total body iron stores and may contain about 70% of the iron in the body. The introduction of MRI into the examination algorithm for patients with storage diseases provides the opportunity for early diagnosis of iron overload and monitoring the effectiveness of therapy.

OBJECTIVE: To summarize the current state and prospects for the clinical use of MR methods for quantitative assessment of iron content in the liver.

MATERIALS AND METHODS: An analysis of the main publications of domestic and foreign literature on non-invasive assessment of the degree of liver iron overload over the past 10 years was carried out in the main medical databases: Medline/PubMed, RISC/Elibrary, CyberLeninka, Google Scholar.

RESULTS: It was revealed that the main methods of MRI noninvasive assessment of the iron content in the liver are SIR and R2* – relaxometry. The latter defines modern approaches to both qualitative and quantitative assessment of iron overload, providing a linear correlation with LIC. Information about diffuse changes in the parenchyma is important, since the presence of fat deposits in the liver can lead to an increase in R2*, therefore, a simultaneous quantitative determination of iron and fat deposits in the liver is completely rational.

CONCLUSION: Diagnosis of liver iron overload is necessary to control and adjust the optimal treatment to prevent side effects of chelation therapy. To this end, the use of MRI has an enormous role, since the simultaneous acquisition of quantitative data on R2* and PDFF allows a comprehensive assessment of fat content and the degree of iron overload, which is not available to other imaging methods. The introduction of multiparametric liver MRI protocols with adaptation to new software will allow us to reach a new level of diagnosis of liver diseases.

MRI is the main tool for visualization, quantification and identification of the risks of liver iron overload. Modern multiparametric MRI of the liver has promising clinical significance for the quantitative assessment of iron deficiency and the degree of steatosis in the complex diagnosis of diffuse liver diseases.

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