Histological Scores Validate the Accuracy of Hepatic Iron Load Measured by Signal Intensity Ratio and R2* Relaxometry MRI in Dialysis Patients

Guy Rostoker; Mireille Laroudie; Raphaël Blanc; Mireille Griuncelli; Christelle Loridon; Fanny Lepeytre; Clémentine Rabaté; Yves Cohen

doi:10.3390/jcm9010017

Histological Scores Validate the Accuracy of Hepatic Iron Load Measured by Signal Intensity Ratio and R2* Relaxometry MRI in Dialysis Patients

J Clin Med. 2019 Dec 19;9(1):17. doi: 10.3390/jcm9010017.

Authors

Guy Rostoker^{1

2}, Mireille Laroudie³, Raphaël Blanc⁴, Mireille Griuncelli¹, Christelle Loridon¹, Fanny Lepeytre¹, Clémentine Rabaté¹, Yves Cohen⁵

Affiliations

¹ Division of Nephrology and Dialysis (Service Néphrologie et de Dialyse), Ramsay-Santé, Hôpital Privé Claude Galien, 91480 Quincy-Sous-Sénart, France.
² Collège de Médecine des Hôpitaux de Paris, 75005 Paris, France.
³ Histopathology Laboratory ACP Bièvres (Laboratoire d'Anatomie et de Cytologie Pathologiques (ACP) Bièvres), Les Ulis-Praxea Diagnostics, 91300 Massy, France.
⁴ Division of Angiography (Service de Radiologie Interventionnelle), Ramsay-Santé, Hôpital Privé Claude Galien, 91480 Quincy-Sous-Sénart, France.
⁵ Division of Radiology (Service de Radiologie), Ramsay-Santé, Hôpital Privé Claude Galien, 91480 Quincy-Sous-Sénart, France.

Abstract

Almost all haemodialysis patients are treated with parenteral iron to compensate for blood loss and to allow the full therapeutic effect of erythropoiesis-stimulating agents. Iron overload is an increasingly recognised clinical situation diagnosed by quantitative magnetic resonance imaging (MRI). MRI methods have not been fully validated in dialysis patients. We compared Deugnier's and Turlin's histological scoring of iron overload and Scheuer's classification (with Perls' stain) with three quantitative MRI methods for measuring liver iron concentration (LIC)-signal intensity ratio (SIR), R2* relaxometry, and R2* multi-peak spectral modelling (Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation (IDEAL-IQ^®)) relaxometry-in 16 haemodialysis patients in whom a liver biopsy was formally indicated for medical follow-up. LIC MRI with these three different methods was highly correlated with Deugnier's and Turlin's histological scoring (SIR: r = 0.8329, p = 0.0002; R2* relaxometry: r = -0.9099, p < 0.0001; R2* relaxometry (IDEAL-IQ^®): r = -0.872, p = 0.0018). Scheuer's classification was also significantly correlated with these three MRI techniques. The positive likelihood ratio for the diagnosis of abnormal LIC by Deugnier's histological scoring was > 62 for the three MRI methods. This study supports the accuracy of quantitative MRI methods for the non-invasive diagnosis and follow-up of iron overload in haemodialysis patients.

Keywords: Deugnier’s and Turlin’s histological scoring; MRI; Perls’ stain; R2* relaxometry; Scheuer’s classification; dialysis; signal intensity ratio.