CORRELATION OF TRANSIENT ELASTOGRAPHY WITH LIVER IRON CONCENTRATION, AND SERUM FERRITIN LEVELS IN PATIENTS WITH TRANSFUSION-DEPENDENT THALASSEMIA MAJOR PATIENTS FROM OMAN
Main Article Content
Keywords
ferritin, Fibrosis, Beta-thalassemia major, Transient Elastography, Magnetic Resonance Imaging
Abstract
Aims: In a cross-sectional study we aimed to assess the correlation between ultrasound transient elastography (TE), serum ferritin (SF), liver iron content (LIC) by magnetic resonance imaging (MRI) T2* along with the fibrosis-4 (FIB-4) score as a screening tool to detect significant liver fibrosis among chronically transfusion-dependent beta-thalassemia (TDT) patients.
Methods: The study was conducted at a tertiary health center treating TDT patients. Transient elastography was performed within 3 months of Liver MRI T2* examinations at the radiology department. T-test for independent data or Mann-Whitney U test was used to analyze differences between groups and Spearman correlation with linear regression analysis were used to evaluate the correlation between TE liver stiffness measurements and Liver MRI T2* values along with SF levels.
Results: In this study on 91 patients, the median age (IQR) of the subjects was 33 (9) years and body mass index was 23.8 (6.1) kg/m2. Median (IQR) TE by fibroscan, MRI T2*(3T), Liver iron concentration (LIC) by MRI Liver T2* and SF levels were 6.38 (2.6) kPa, 32.4 (18) milliseconds, 7(9) g/dry wt., and 1881 (2969) ng/mL, respectively. TE measurements correlated with LIC g/dry wt. (rS =0.39, p=0.0001) and with SF level (rS =0.43, P=0.001) but not with MRI T2* values (rS =-0.24; P=0.98).
Conclusion: We observed that in transfusion dependent β thalassemia major patients there was a significant correlation with the TE measured by ultrasound transient elastography, and LIC by MRI as well as SF levels but not with the fibrosis-4 (FIB-4) score.
Key Words: Serum ferritin; Fibrosis-4; Transfusion-dependent beta-thalassemia; Transient elastography; Magnetic resonance imaging
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References
2010; 50:1144-55. doi: 10.1111/j.1537-2995.2009.02551.x.
2. Farmakis D, Porter J, Taher A, Cappellini MD, Angastiniotis M, and Eleftheriou A, for the 2021 TIF Guidelines Taskforce* 2021 Thalassaemia International Federation Guidelines for the Management of Transfusion-dependent Thalassemia, Hemasphere. 2022 Aug; 6(8): e732. doi: 10.1097/HS9.0000000000000732.
3. Ribeil, J.A.; Arlet, J.B.; Dussiot, M.; Moura, I.C.; Courtois, G.; Hermine, O. Ineffective erythropoiesis in beta-thalassemia. Sci. World J. 2013, 2013, 394295. doi: 10.1155/2013/394295.
4. Angelucci E, Brittenham GM, McLaren CE, et al. Hepatic iron concentration and total body iron stores in thalassemia major. N Engl J Med. 2000; 343:327-31. doi: 10.1056/NEJM200008033430503.
5. St. Pierre TG, El-Beshlawy A, Elalfy M, et al. Multicenter validation of spin-density projection-assisted R2-MRI for the noninvasive measurement of liver iron concentration:
multi-center validation of R2-MRI for LIC measurement. Magn Reson Med. 2014; 71:2215-23. doi: 10.1002/mrm.24854.
6. Papakonstantinou O, Kostaridou S, Maris T, et al. Quantification of liver iron overload by T2 quantitative magnetic resonance imaging in thalassemia: Impact of chronic hepatitis C on measurements. J Pediatr Hematol Oncol. 1999; 21:142-8. doi: 10.1097/00043426-199903000-00011.
7. Bedossa P, Dargere D, Paradise V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003; 38: 1449-57. doi: 10.1016/j.hep.2003.09.022.
8. Puliyel M, Sposto R, Berdoukas VA, et al. Ferritin trends do not predict changes in total body iron in patients with transfusional iron overload. Am J Hematol. 2014; 89:391-4. doi: 10.1002/ajh.23650.
9. Parakh N, Chandra J, Correlation of transient elastography with MRI T2* and serum ferritin levels in children with Transfusion-dependent Thalasssaemia. Ind. Pediat. 2022; 59:929-932
10. Alavian SM, Sadeghian E. Association of fibro scan results with liver biopsy and sonography in major thalassemia patients with hepatitis C. International Journal Advances in Biotechnology Research. 2016; 7:532-7.
11. Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003; 29:1705-13. doi: 10.1016/j.ultrasmedbio.2003.07.001.
12. Garbowski MW, Carpenter JP, Smith G, et al. Biopsy-based calibration of T2* magnetic resonance for estimation of liver iron concentration and comparison with R2 ferriscan. J Cardiovasc Magn Reson. 2014; 16:40. doi: 10.1186/1532-429X-16-40.
13. Mirault T, Lucidarme D, Turlin B et al. Non-invasive assessment of liver fibrosis by transient elastography in post transfusional iron overload. Eur J Haematol. 2008; 80:337-40. doi: 10.1111/j.1600-0609.2007.01011.x.
14. Atmakusuma TD, Lubis AM. Correlation of serum ferritin and liver iron concentration with transient liver elastography in adult thalassemia intermedia patients with blood transfusion. J Blood Med. 2021; 12: 235-43. doi: 10.2147/JBM.S303703.
15. Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH, et al. Cardiovascular T2-star(T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J. 2001; 22:2171–9. doi: 10.1053/euhj.2001.2822.
16. Mokhtar GM, Gadallah M, El Sherif NHK, et al. Morbidities and mortality in transfusion-dependent beta-thalassemia patients (single-center experience). Pediatr Hematol Oncol 2013; 30:93–103. doi: 10.3109/08880018.2012.752054.
17. Toosi AEK, Karimzadeh Toosi AE. Liver fibrosis: causes and methods of assessment, a review. Rom J Intern Med 2015; 53:304–14. doi: 10.1515/rjim-2015-0039.
18. Deugnier Y, Turlin B, Ropert M, et al. Improvement in liver pathology of patients with β-thalassemia treated with deferasirox for at least 3 years. Gastroenterology 2011; 141:1202–11. doi: 10.1053/j.gastro.2011.06.065.
19. Elalfy MS, Esmat G, Matter RM, et al. Liver fibrosis in young Egyptian beta-thalassemia major patients: relation to hepatitis C virus and compliance with chelation. Ann Hepatol 2013; 12:54–61.
20. Sandrin L, Fourquet B, Hasquenoph J-M, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29:1705–13. doi: 10.1016/j.ultrasmedbio.2003.07.001.
21. Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut 2020; 69:1343–52. doi: 10.1136/gutjnl-2018-317593.
22. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006; 43:1317–25. doi: 10.1002/hep.21178
23. Hamidieh AA, Shazad B, Ostovaneh MR, Behfar M, Tayebi S, Malekzadeh R, et al, Noninvasive measurement of liver fibrosis using transient elastograpgy in pediatric patients with major thalassaemia who are candidates for hematopoietic sten cell transplantation, Biol. Blood Marrow Transplant. 2014; 20; 1912-1917. doi: 10.1016/j.bbmt.2014.07.025
24. Padeniya P, Ediriweera DS, De Silva AP, Niriella MA, Premawardhena A., Using FIB-4 score as a screening tool in the assessment of significant liver frirosis(F2) in patients with transfusion-dependent beta thalassaemia: a cross-sectional study,B
25. Fraquelli M, Cassinerio E, Roghi A, et al. Transient elastography in the assessment of liver fibrosis in adult thalassemia patients. Am J Hematol. 2010; 85:564-8. doi: 10.1002/ajh.21752.
26. Pipaliya N, Solanke D, Parikh P, et al. Comparison of tissue elastography with magnetic resonance imaging T2* and serum ferritin quantification in detecting liver iron overload in patients with thalassemia major. Clin Gastroenterol Hepatol.
2017; 15:292-98. doi: 10.1016/j.cgh.2016.08.046.