Is serum ferritin level or T2-sequence magnetic resonance imaging more effective in predicting liver iron in transfusion-dependent thalassemia cases?

Abstract

Aim: Iron overload in transfusion-dependent thalassemia patients is a condition that requires continuous chelation therapy and monitoring. Determination of serum ferritin level is considered a simple method to monitor body iron load; however, it highlights that other methods of liver iron level determination, such as magnetic resonance imaging (MRI), are more precise. Materials and Methods: In order to contribute to understanding of liver iron load in thalassemia, liver iron level results of 14 transfusion-dependent thalassemia patients who underwent liver biopsy in preparation for stem cell transfusion were compared with liver T2 MRI and serum ferritin results. Results: The mean serum Ferritin value was 2488.43±1520.18 mg/L. When liver iron load was evaluated according to T2*MRI results, mild iron accumulation was found in eight patients, moderate level in five patients, and advanced iron accumulation in a patient. According to the modified Scheuer classification, iron level in biopsies was grade 1 in two patients; grade 2 in seven patients; It was grade 3 in three patients and grade 4 in two patients. As the ferritin level increased, the liver iron biopsy score also increased statistically significantly (r=0.544 and p=0.044). There was a statistically significant and inverse correlation between liver T2*MRI level and liver iron biopsy score (r=-0.724 and p=0.003). Ferritin level was not found statistically significant in differentiating iron level according to liver biopsy iron score (p=0.096). The area under the ROC curve for T2*MRI measurements was statistically significant (AUC=0.967; 95% CI: 0.880-1,000 and p=0.005). Conclusıon: In our study, we found that serum ferritin and T2 MRI results were correlated with liver biopsy iron levels. However, we found that the sensitivity and specificity of ferritin level in liver biopsy to show iron level was low, and the sensitivity and specificity of T2 MRI was high.