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Identifier

000362743

Title

Εναπόθεση σιδήρου σε ενδοκοιλιακά όργανα και μυελό οστών ασθενών με β-μεσογειακή αναιμία:Μελέτη με τεχνικές ποσοτικής απεικόνισης μαγνητικού συντονισμού

Alternative Title

Iron overload in abdominal organs and bone marrow of beta-thalassemic patients:a quantitative magnetic resonance imaging study.

Author

Δρακωνάκη, Ελένη

Thesis advisor

Καραντάνας, Απόστολος

Reviewer

Μαρής, Θωμάς
Αλεξανδράκης, Μιχαήλ
Μαργιωρής, Ανδρέας
Γραβάνης, Αχιλλέας
Καρκαβίτσας, Νικόλαος
Στειακάκη, Ευτυχία

Abstract

Purpose: To investigate the relation among bone marrow, liver and spleen siderosis in beta-thalassemia major, to describe the MR imaging patterns of reticuloendothelial system (RES) iron distribution and to assess the effectiveness of chelation protocols. Materials and Methods: Liver, spleen and spinal bone marrow iron stores were prospectively assessed on 106 abdominal MR studies of 72 transfused beta-thalassemic patients and 17 controls using T1-w, Pd, T2*-w Gradient Echo (GRE) and T1-w Turbo Spin Echo (TSE) sequences and T2 and T2* relaxometry. Signal intensity (SI) ratios of liver, spleen and bone marrow to paraspinous muscles (L/M, S/M, B/M respectively) and the respective T2 and T2* relaxation times were calculated. Serum ferritin levels and chelation protocols were recorded. In 34/72 patients two MR studies were performed within a mean period of 614,4 days. The changes in L/M, S/M and B/M and ferritin values were calculated στην Τ1-wΤSΕ sequence according to theformula:[D%=(2dvalue-1stvalue/1stvalue)x100%]. Results: L/M, B/M, S/M, Τ2 relaxation time of all three organs and Τ2* relaxation times of spleen and bone marrow correlated with ferritin values (Pearson’s r> 0,371, p~0). Significant correlation was found between a) B/M and L/M and b) S/M and L/M only in T1-w TSE sequence (r>0,434, p=0,05). B/M correlated with S/M in all sequences (p>0,01). No significant correlation was found between Τ2 and Τ2* relaxation times of liver, spleen and bone marrow. According to the SI of liver, spleen and bone marrow in T1-w TSE sequence, five patterns of RES iron distribution were discriminated. In 13,2% of patients the spleen exhibited normal SI in coexistence with a low SI liver. Patients on combined chelation therapy with deferiprone and deferrioxamine exhibited greater reduction of ferritin, liver, spleen and bone marrow iron stores than the patients on deferrioxamine alone (t-test, p<0,05). Conclusion: In transfused beta-thalassemic patients bone marrow siderosis correlates to splenic siderosis and ferritin levels but not to liver siderosis. Although spleen is usually hypointense, it may occasionally display normal signal intensity coexisting with liver hypointensity, a pattern typical of primary hemochromatosis. Combined therapy is found to be more effective than deferrioxamine alone.

Language

Greek

Subject

Iron

Magnetic resonance

Thalassemia

Μαγνητικός συντονισμός

Μεσογειακή αναιμία

Σίδηρος

Issue date

2009-04-07

Collection