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J Hepatol. 2017 Sep;67(3):535-542. doi: 10.1016/j.jhep.2017.04.019. Epub 2017 May 5.

Sensitive and non-invasive assessment of hepatocellular iron using a novel room-temperature susceptometer.

Author information

1
Dept. of Medicine, Salem Medical Center and Center for Alcohol Research and Liver Disease, University of Heidelberg, Germany.
2
Dept. of Radiology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany.
3
Department of Pathology, University of Heidelberg, Germany.
4
Department of Pathology, University of Aachen, Germany.
5
Department of Pathology, Universities of Mainz and Heidelberg, Germany.
6
Dept. of Medicine, Salem Medical Center and Center for Alcohol Research and Liver Disease, University of Heidelberg, Germany. Electronic address: Sebastian.Mueller@urz.uni-heidelberg.de.

Abstract

BACKGROUND & AIMS:

Liver iron accumulates in various chronic liver diseases where it is an independent factor for survival and carcinogenesis. We tested a novel room-temperature susceptometer (RTS) to non-invasively assess liver iron concentration (LIC).

METHODS:

Two hundred and sixty-four patients with or without signs of iron overload or liver disease were prospectively enrolled. Thirty-five patients underwent liver biopsy with semiquantitative iron determination (Prussian Blue staining), atomic absorption spectroscopy (AAS, n=33), or magnetic resonance imaging (MRI, n=15).

RESULTS:

In vitro studies demonstrated a highly linear (r2=0.998) association between RTS-signal and iron concentration, with a detection limit of 0.3mM. Using an optimized algorithm, accounting for the skin-to-liver capsule distance, valid measurements could be obtained in 84% of cases. LIC-RTS showed a significant correlation with LIC-AAS (r=0.74, p<0.001), LIC-MRI (r=0.64, p<0.001) and hepatocellular iron (r=0.58, p<0.01), but not with macrophage iron (r=0.32, p=0.30). Normal LIC-RTS was 1.4mg/g dry weight. Besides hereditary and transfusional iron overload, LIC-RTS was also significantly elevated in patients with alcoholic liver disease. The areas under the receiver operating characteristic curve (AUROC) for grade 1, 2 and 3 hepatocellular iron overload were 0.72, 0.89 and 0.97, respectively, with cut-off values of 2.0, 4.0 and 5.0mg/g dry weight. Notably, the positive and negative predictive values, sensitivity, specificity and accuracy of severe hepatic iron overload (HIO) (grade ≥2) detection, were equal to AAS and superior to all serum iron markers. Depletion of hepatic iron could be efficiently monitored upon phlebotomy.

CONCLUSIONS:

RTS allows for the rapid and non-invasive measurement of LIC. In comparison to MRI, it could be a cost-effective bedside method for LIC screening. Lay summary: Novel room-temperature susceptometer (RTS) allows for the rapid, sensitive, and non-invasive measurement of liver iron concentration. In comparison to MRI, it could be a cost-effective bedside method for liver iron concentration screening.

KEYWORDS:

Alcoholic liver disease; Anemia; Atomic absorption spectroscopy; Cirrhosis; Hemochromatosis; Iron overload; Liver fibrosis; Liver iron; Liver stiffness; Magnetic susceptibility; Susceptometry

PMID:
28483679
DOI:
10.1016/j.jhep.2017.04.019
[Indexed for MEDLINE]

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