Evaluation of Liver Iron Accumulation With Liver Elastography and Apparent Diffusion Coefficient in Children With Thalassaemia Major

Abstract

Background

Beta Thalassaemia Major is a hereditary disorder characterised by defective protein synthesis in the beta-globin chain, leading to chronic anaemia. As a consequence of repeated blood transfusions used to manage anaemia, excessive iron accumulation occurs, primarily in the liver and other vital organs, leading to organ damage.

Purpose

To determine the correlation between liver iron concentration and iron accumulation in the liver due to blood transfusions in paediatric patients diagnosed with Beta Thalassaemia Major, using shear wave elastography and liver magnetic resonance imaging apparent diffusion coefficient measurements.

Materials and Methods

A prospective study was conducted from January 2025 to April 2025 on 77 paediatric patients diagnosed with Beta Thalassaemia Major, utilising liver shear wave elastography, liver apparent diffusion coefficient, T2* values and serum ferritin levels.

Results

Descriptive statistics for the continuous variables of the patients: elasticity median (10.39 ± 4.39 kPa), velocity median (1.81 ± 0.36 m/s), liver ADC (0.52 ± 0.42), liver T2* (4.93 ± 5.15), LIC (9.45 ± 5.7). The median elasticity values differed significantly across the iron overload severity groups (p = 0.006). A post hoc analysis was performed to identify the groups responsible for this difference. The analysis revealed that the differences originated from comparisons between the mild (9.58 ± 3.62) and severe (14.44 ± 5.91) groups, the moderate (9.47 ± 3.24) and severe (14.44 ± 5.91) groups and the severe (14.44 ± 5.91) and normal (8.16 ± 2.44) groups (p^ac < 0.001; p^bc < 0.001; p^cd = 0.003).

Conclusion

We demonstrated a correlation between liver shear wave elastography and liver apparent diffusion coefficient values with MRI T2* and LIC in the group of paediatric patients diagnosed with Beta Thalassaemia Major who had a high liver iron burden.