Iron Load Evaluation of Adrenal Glands and Kidneys by using MRI T2* In Iranian Thalassemia Patients

Abstract

Introduction: Multi-organ iron load is prevalent crucial side effect in thalassemic patients due to repeated transfusions, and high intestinal iron absorption. MRI T2* has demonstrated its potency as a non-invasive technique for the imaging of hemosiderosis in thalassemia. We aim to investigate the iron load of adrenal glands and kidneys using MRI T2* in adult thalassemia patients and evaluate the serum ferritin correlation of with kidneys, heart, liver, and adrenal glands’ iron load.Methods: Thirty-five thalassemia major (TM) and thalassemia intermediate (TI) patients (age range 18-50 years) from Zafar thalassemia Clinic, were recruited in this survey from September 2019 to October 2020. Magnetic Resonance Imaging (MRI) was used to map iron overload in several organs’ regions of interest (ROIs) using fast-gradient-echo multi echo T2*sequences protocol. T-test and chi-square analysis were done.Results: Nine (25.7%) patients had left Kidney T2* less than 36ms which could indicate abnormal renal iron load while this was 8 (22.9%) for the right kidney. In the left and right adrenal glands, these numbers were 31 (88.6%) and 29 (82.9%), respectively, below the normal threshold.Conclusion: Adrenal gland and renal iron overloads were detected in MRI images of thalassemic patients. Correlation for serum ferritin levels and kidney and adrenal glands T2* was found weakly negative. Non-invasive monitoring of the internal organs’ hemosiderosis using MRI T2* was found to be beneficial for iron-chelating optimization and preventing irreversible tissue damage.

Keywords

• magnetic resonance imaging
• iron overload
• thalassemia
• kidney
• adrenal glands