MRI-Based Assessment of Hepatic Iron Overload and Steatosis in Patients Undergoing Hemodialysis:Current Status,Challenges,and Perspectives

Hu LIU; Hongwei ZHAO

doi:10.3881/j.issn.1000-503X.16066

PDF(885 KB)

Acta Academiae Medicinae Sinicae ›› 2024, Vol. 46 ›› Issue (3) : 449-457. DOI: 10.3881/j.issn.1000-503X.16066

MRI-Based Assessment of Hepatic Iron Overload and Steatosis in Patients Undergoing Hemodialysis:Current Status,Challenges,and Perspectives

Hu LIU ,
Hongwei ZHAO

Author information +

History +

Abstract

Long-term treatment of anemia involving frequent blood transfusions and intravenous iron administration increases the risks of hepatic iron overload and steatosis in the patients undergoing hemodialysis.Pathological accumulation of iron damages hepatocytes,not only elevating the risks of progressive hepatic fibrosis and cirrhosis but also potentially accelerating the process of hepatic steatosis.iron overload and steatosis may interact with each other,exacerbating liver damage and ultimately leading to further deterioration of hepatic fibrosis and cirrhosis.MRI characterized by non-invasiveness and high repeatability,enables the simultaneous quantitative assessment of hepatic iron and fat content,providing crucial information for early diagnosis and intervention of liver diseases.in recent years,researchers have achieved significant advances in the application of MRI in the diagnosis and treatment of liver diseases.MRI can accurately reflect the extent of hepatic iron overload and steatosis in patients and predict the risk of liver diseases.This article reviews the latest advances,challenges,and perspectives in the application of MRI in assessing hepatic iron overload and steatosis in the patients undergoing hemodialysis,aiming to offer valuable references for clinical practice。

Key words

hemodialysis / hepatic iron overload / hepatic steatosis / MRI / quantitative assessment

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

Hu LIU , Hongwei ZHAO. MRI-Based Assessment of Hepatic Iron Overload and Steatosis in Patients Undergoing Hemodialysis:Current Status,Challenges,and Perspectives[J]. Acta Academiae Medicinae Sinicae. 2024, 46(3): 449-457 https://doi.org/10.3881/j.issn.1000-503X.16066

References

List( Publishing order | Descend order by publishing year | Descend order by cited within ) Chart analysis

[1]	GBD Chronic Kidney Disease Collaboration. and national burden of chronic kidney disease,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2020, 395(10225):709-733.DOI:10.1016/S0140-6736(20)30045-3. Cited in this article [1]

[2]	《中国围透析期慢性肾脏病管理规范》专家组. 中国围透析期慢性肾脏病管理规范[J]. 中华肾脏病杂志, 2021, 37(8):690-704.DOI:10.3760/cma.j.cn441217-20210322-00104. Cited in this article [1]

[3]	中国医师协会肾脏内科医师分会血液透析滤过质控指南工作组. 血液透析滤过质量控制临床实践指南[J]. 中华医学杂志, 2024, 104(8):571-593.DOI:10.3760/cma.j.cn112137-20231212-01361. Cited in this article [1]

[4]	中国医师协会肾脏内科医师分会肾性贫血指南工作组. 中国肾性贫血诊治临床实践指南[J]. 中华医学杂志, 2021, 101(20):1463-1502.DOI:10.3760/cma.j.cn112137-20210201-00309. Cited in this article [1]

[5]	Wong WK, Chan WK, Ganapathy SS, et al. Metabolic dysfunction-associated fatty liver disease (MAFLD) and advanced liver fibrosis among hemodialysis patients in a multiethnic urban population in Malaysia[J]. Semin Dial, 2023, 36(2):107-116.DOI:10.1111/sdi.13117. Cited in this article [1]

[6]	Rostoker G, Loridon C, Griuncelli M, et al. Liver iron load influences hepatic pat fraction in end-stage renal disease patients on dialysis:a proof of concept study[J]. EBioMedicine, 2019, 39:461-471.DOI:10.1016/j.ebiom.2018.11.020. Cited in this article [5]

[7]	Sargent JA, Acchiardo SR. Iron requirements in hemodialysis[J]. Blood Purif, 2004, 22(1):112-123.DOI:10.1159/000074931. Cited in this article [1]

[8]	Canavese C, Bergamo D, Ciccone G, et al. Validation of serum ferritin values by magnetic susceptometry in predicting iron overload in dialysis patients[J]. Kidney Int, 2004, 65(3):1091-1098.DOI:10.1111/j.1523-1755.2004.00480.x. Cited in this article [1]

[9]	Ghoti H, Rachmilewitz EA, Simon-Lopez R, et al. Evidence for tissue iron overload in long-term hemodialysis patients and the impact of withdrawing parenteral iron[J]. Eur J Haematol, 2012, 89(1):87-93.DOI:10.1111/j.1600-0609.2012.01783.x. Cited in this article [1]

[10]	Delibas D, Evrimler S, Ercan K, et al. Iron overload in hemodialysis patients:comparison of serum iron parameters with T2* MRI sequence[J]. J Clin Ultrasound, 2023, 52(2):124-130.DOI:10.1002/jcu.23608. Cited in this article [1]

[11]	Rostoker G. When should iron supplementation in dialysis patients be avoided,minimized or withdrawn[J]. Semin Dial, 2019, 32(1):22-29.DOI:10.1111/sdi.12732. Cited in this article [1]

[12]	Del Vecchio L, Longhi S, Locatelli F. Safety concerns about intravenous iron therapy in patients with chronic kidney disease[J]. Clin Kidney J, 2016, 9(2):260-267.DOI:10.1093/ckj/sfv142. Cited in this article [1]

[13]	Li X, Cole SR, Kshirsagar AV, et al. Safety of dynamic intravenous iron administration strategies in hemodialysis patients[J]. Clin J Am Soc Nephrol, 2019, 14(5):728-737.DOI:10.2215/CJN.03970318. Cited in this article [1]

[14]	Low G, Ferguson C, Locas S, et al. Multiparametric MR assessment of liver fat,iron,and fibrosis:a concise overview of the liver “triple screen”[J]. Abdom Radiol (NY), 2023, 48(6):2060-2073.DOI:10.1007/s00261-023-03887-0. Cited in this article [1]

[15]	Mazé J, Vesselle G, Herpe G, et al. Evaluation of hepatic iron concentration heterogeneities using the MRI R2* mapping method[J]. Eur J Radiol, 2019, 116:47-54.DOI:10.1016/j.ejrad.2018.02.011. Cited in this article [1]

[16]	Rose C, Vandevenne P, Bourgeois E, et al. Liver iron content assessment by routine and simple magnetic resonance imaging procedure in highly transfused patients[J]. Eur J Haematol, 2006, 77(2):145-149.DOI:10.1111/j.0902-4441.2006.t01-1-EJH2571.x. Cited in this article [2]

[17]	Gandon Y, Olivie D, Guyader D, et al. Non-invasive assessment of hepatic iron stores by MRI[J]. Lancet, 2004, 363(9406):357-362.DOI:10.1016/S0140-6736(04)15436-6. Cited in this article [2]

[18]	Alustiza JM, Artetxe J, Castiella A, et al. MR quantification of hepatic iron concentration[J]. Radiology, 2004, 230(2):479-484.DOI:10.1148/radiol.2302020820. Cited in this article [2]

[19]	Reeder SB, Yokoo T, Franca M, et al. Quantification of liver iron overload with MRI:review and guidelines from the ESGAR and SAR[J]. Radiology, 2023, 307(1):e221856.DOI:10.1148/radiol.221856. Cited in this article [4]

[20]	St Pierre TG, Clark PR, Chua-anusorn W, et al. Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance[J]. Blood, 2005, 105(2):855-861.DOI:10.1182/blood-2004-01-0177. Cited in this article [1]

[21]	Craft ML, Edwards M, Jain TP, et al. R2 and R2* MRI assessment of liver iron content in an undifferentiated diagnostic population with hyperferritinaemia,and impact on clinical decision making[J]. Eur J Radiol, 2021, 135:109473.DOI:10.1016/j.ejrad.2020.109473. Cited in this article [2]

[22]	Hernando D, Levin YS, Sirlin CB, et al. Quantification of liver iron with MRI:state of the art and remaining challenges[J]. J Magn Reson Imaging, 2014, 40(5):1003-1021.DOI:10.1002/jmri.24584. Cited in this article [1]

[23]	Sirlin CB, Reeder SB. Magnetic resonance imaging quantification of liver iron[J]. Magn Reson Imaging Clin N Am, 2010, 18(3):359-381, ix.DOI:10.1016/j.mric.2010.08.014. Cited in this article [3]

[24]	Hernando D, Kramer JH, Reeder SB. Multipeak fat-corrected complex R2* relaxometry:theory,optimization,and clinical validation[J]. Magn Reson Med, 2013, 70(5):1319-1331.DOI:10.1002/mrm.24593. Cited in this article [3]

[25]	Krafft AJ, Loeffler RB, Song R, et al. Quantitative ultrashort echo time imaging for assessment of massive iron overload at 1.5 and 3 Tesla[J]. Magn Reson Med, 2017, 78(5):1839-1851.DOI:10.1002/mrm.26592. Cited in this article [1]

[26]	Doyle EK, Toy K, Valdez B, et al. Ultra-short echo time images quantify high liver iron[J]. Magn Reson Med, 2018, 79(3):1579-1585.DOI:10.1002/mrm.26791. Cited in this article [1]

[27]	Hernando D, Kuhn JP, Mensel B, et al. R2* estimation using “in-phase” echoes in the presence of fat:the effects of complex spectrum of fat[J]. J Magn Reson Imaging, 2013, 37(3):717-726.DOI:10.1002/jmri.23851. Cited in this article [2]

[28]	Zhan C, Olsen S, Zhang HC, et al. Detection of hepatic steatosis and iron content at 3 Tesla:comparison of two-point Dixon,quantitative multi-echo Dixon,and MR spectroscopy[J]. Abdom Radiol (NY), 2019, 44(9):3040-3048.DOI:10.1007/s00261-019-02118-9. Cited in this article [1]

[29]	Henninger B, Zoller H, Kannengiesser S, et al. 3D multiecho Dixon for the evaluation of hepatic iron and fat in a clinical setting[J]. J Magn Reson Imaging, 2017, 46(3):793-800.DOI:10.1002/jmri.25630. Cited in this article [1]

[30]	Hernando D, Cook RJ, Qazi N, et al. Complex confounder-corrected R2* mapping for liver iron quantification with MRI[J]. Eur Radiol, 2021, 31(1):264-275.DOI:10.1007/s00330-020-07123-x. Cited in this article [2]

[31]	Wood JC, Enriquez C, Ghugre N, et al. MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients[J]. Blood, 2005, 106(4):1460-1465.DOI:10.1182/blood-2004-10-3982. Cited in this article [2]

[32]	d’Assignies G, Paisant A, Bardou-Jacquet E, et al. Non-invasive measurement of liver iron concentration using 3-Tesla magnetic resonance imaging:validation against biopsy[J]. Eur Radiol, 2018, 28(5):2022-2030.DOI:10.1007/s00330-017-5106-3. Cited in this article [1]

[33]	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]. J Cardiovasc Magn Reson, 2014, 16(1):40.DOI:10.1186/1532-429X-16-40. Cited in this article [1]

[34]	Sharma SD, Hernando D, Horng DE, et al. Quantitative susceptibility mapping in the abdomen as an imaging biomarker of hepatic iron overload[J]. Magn Reson Med, 2015, 74(3):673-683.DOI:10.1002/mrm.25448. Cited in this article [1]

[35]	Li J, Lin H, Liu T, et al. Quantitative susceptibility mapping (QSM) minimizes interference from cellular pathology in R2* estimation of liver iron concentration[J]. J Magn Reson Imaging, 2018, 48(4):1069-1079.DOI:10.1002/jmri.26019. Cited in this article [1]

[36]	Lin H, Wei H, He N, et al. Quantitative susceptibility mapping in combination with water-fat separation for simultaneous liver iron and fat fraction quantification[J]. Eur Radiol, 2018, 28(8):3494-3504.DOI:10.1007/s00330-017-5263-4. Cited in this article [1]

[37]	Madihi Y, Tavakoli R, Riahinezhad M, et al. Prevalence of nonalcoholic fatty liver disease in children with renal failure underwent treatment with dialysis[J]. Int J Prev Med, 2022, 13:35.DOI:10.4103/ijpvm.ijpvm_410_21. Cited in this article [1]

[38]	Choe AR, Ryu DR, Kim HY, et al. Noninvasive indices for predicting nonalcoholic fatty liver disease in patients with chronic kidney disease[J]. BMC Nephrol, 2020, 21(1):50.DOI:10.1186/s12882-020-01718-8. Cited in this article [1]

[39]	Behairy MA, Sherief AF, Hussein HA. Prevalence of non-alcoholic fatty liver disease among patients with non-diabetic chronic kidney disease detected by transient elastography[J]. Int Urol Nephrol, 2021, 53(12):2593-2601.DOI:10.1007/s11255-021-02815-9. Cited in this article [2]

[40]	Kanbay M, Bulbul MC, Copur S, et al. Therapeutic implications of shared mechanisms in non-alcoholic fatty liver disease and chronic kidney disease[J]. J Nephrol, 2021, 34(3):649-659.DOI:10.1007/s40620-020-00751-y. Cited in this article [1]

[41]	Singal AK, Hasanin M, Kaif M, et al. Nonalcoholic steatohepatitis is the most rapidly growing indication for simultaneous liver kidney transplantation in the United States[J]. Transplantation, 2016, 100(3):607-612.DOI:10.1097/TP.0000000000000945. Cited in this article [1]

[42]

European Association for the Study of the Liver EASL,European Association for the Study of Diabetes EASD, European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease[J]. J Hepatol, 2016, 64(6):1388-1402.DOI:10.1016/j.jhep.2015.11.004.

Cited in this article [1]

[43]

Chalasani

, Younossi

, Lavine

, et al. The diagnosis and management of non-alcoholic fatty liver disease:practice guideline by the American association for the study of liver diseases,American college of gastroenterology,and the American gastroenterological association[J]. Hepatology, 2012, 55(6):2005-2023.DOI:10.1002/hep.25762.

Cited in this article [1]

[44]	Reeder SB, Cruite I, Hamilton G, et al. Quantitative assessment of liver fat with magnetic resonance imaging and spectroscopy[J]. J Magn Reson Imaging, 2011, 34(4):729-749.DOI:10.1002/jmri.22775. Cited in this article [1]

[45]	Cassidy FH, Yokoo T, Aganovic L, et al. Fatty liver disease:MR imaging techniques for the detection and quantification of liver steatosis[J]. Radiographics, 2009, 29(1):231-260.DOI:10.1148/rg.291075123. Cited in this article [1]

[46]	Bohte AE, van Werven JR, Bipat S, et al. The diagnostic accuracy of US,CT,MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy:a meta-analysis[J]. Eur Radiol, 2011, 21(1):87-97.DOI:10.1007/s00330-010-1905-5. Cited in this article [1]

[47]	Meisamy S, Hines CD, Hamilton G, et al. Quantification of hepatic steatosis with T1-independent,T2-corrected MR imaging with spectral modeling of fat:blinded comparison with MR spectroscopy[J]. Radiology, 2011, 258(3):767-775.DOI:10.1148/radiol.10100708. Cited in this article [1]

[48]	Yokoo T, Serai SD, Pirasteh A, et al. Linearity,bias, and precision of hepatic proton density fat fraction measurements by using MR imaging:a meta-analysis[J]. Radiology, 2018, 286(2):486-498.DOI:10.1148/radiol.2017170550. Cited in this article [2]

[49]	Kuhn JP, Hernando D, Munoz del Rio A, et al. Effect of multipeak spectral modeling of fat for liver iron and fat quantification:correlation of biopsy with MR imaging results[J]. Radiology, 2012, 265(1):133-142.DOI:10.1148/radiol.12112520. Cited in this article [1]

[50]	Campo CA, Hernando D, Schubert T, et al. Standardized approach for ROI-based measurements of proton density fat fraction and R2* in the liver[J]. Am J Roentgenol, 2017, 209(3):592-603.DOI:10.2214/AJR.17.17812. Cited in this article [1]

[51]	Colgan TJ, Zhao R, Roberts NT, et al. Limits of fat quantification in the presence of iron overload[J]. J Magn Reson Imaging, 2021, 54(4):1166-1174.DOI:10.1002/jmri.27611. Cited in this article [1]

[52]	Bashir MR, Wolfson T, Gamst AC, et al. Hepatic R2* is more strongly associated with proton density fat fraction than histologic liver iron scores in patients with nonalcoholic fatty liver disease[J]. J Magn Reson Imaging, 2019, 49(5):1456-1466.DOI:10.1002/jmri.26312. Cited in this article [1]

[53]	Jafari R, Hectors SJ, Koehne de González AK, et al. Integrated quantitative susceptibility and R2* mapping for evaluation of liver fibrosis:an ex vivo feasibility study[J]. NMR Biomed, 2021, 34(1):e4412.DOI:10.1002/nbm.4412. Cited in this article [1]

[54]	Hu F, Yang R, Huang Z, et al. 3D multi-echo dixon technique for simultaneous assessment of liver steatosis and iron overload in patients with chronic liver diseases:a feasibility study[J]. Quant Imaging Med Surg, 2019, 9(6):1014-1024.DOI:10.21037/qims.2019.05.20. Cited in this article [1]

[55]	Hong CW, Wolfson T, Sy EZ, et al. Optimization of region-of-interest sampling strategies for hepatic MRI proton density fat fraction quantification[J]. J Magn Reson Imaging, 2018, 47(4):988-994.DOI:10.1002/jmri.25843. Cited in this article [1]

[56]	Martí-Aguado D, Jiménez-Pastor A, Alberich-Bayarri Á, et al. Automated whole-liver MRI segmentation to assess steatosis and iron quantification in chronic liver disease[J]. Radiology, 2022, 302(2):345-354.DOI:10.1148/radiol.2021211027. Cited in this article [1]

[57]	Wang K, Mamidipalli A, Retson T, et al. Automated CT and MRI liver segmentation and biometry using a generalized convolutional neural network[J]. Radiol Artif Intell, 2019, 1(2):180022.DOI:10.1148/ryai.2019180022. Cited in this article [1]

[58]	Jimenez-Pastor A, Alberich-Bayarri A, Lopez-Gonzalez R, et al. Precise whole liver automatic segmentation and quantification of PDFF and R2* on MR images[J]. Eur Radiol, 2021, 31(10):7876-7887.DOI:10.1007/s00330-021-07838-5. Cited in this article [1]

[59]

Wang

, Cunha

, Hasenstab

, et al. Deep learning for inference of hepatic proton density fat fraction from T1-weighted in-phase and opposed-phase MRI:retrospective analysis of population-based trial data[J]. Am J Roentgenol, 2023, 221(5):620-631.DOI:10.2214/ajr.23.29607.

Cited in this article [1]

[60]	Meneses JP, Arrieta C, Della Maggiora G, et al. Liver PDFF estimation using a multi-decoder water-fat separation neural network with a reduced number of echoes[J]. Eur Radiol, 2023, 33(9):6557-6568.DOI:10.1007/s00330-023-09576-2. Cited in this article [1]

[61]

Gilligan

, Dillman

, Tkach

, et al. Comparison of navigator-gated and breath-held image acquisition techniques for multi-echo quantitative dixon imaging of the liver in children and young adults[J]. Abdom Radiol (NY), 2019, 44(6):2172-2181.DOI:10.1007/s00261-019-01960-1.

Cited in this article [1]

[62]	Armstrong T, Zhong X, Shih SF, et al. Free-breathing 3D stack-of-radial MRI quantification of liver fat and R2^* in adults with fatty liver disease[J]. Magn Reson Imaging, 2022, 85:141-152.DOI:10.1016/j.mri.2021.10.016. Cited in this article [1]

[63]	Eskreis-Winkler S, Corrias G, Monti S, et al. IDEAL-IQ in an oncologic population:meeting the challenge of concomitant liver fat and liver iron[J]. Cancer Imaging, 2018, 18(1):51.DOI:10.1186/s40644-018-0167-3. Cited in this article [1]

[64]

Roberts

, Hernando

, Panagiotopoulos

, et al. Addressing concomitant gradient phase errors in time-interleaved chemical shift-encoded MRI fat fraction and R2^* mapping with a pass-specific phase fitting method[J]. Magn Reson Med, 2022, 87(6):2826-2838.DOI:10.1002/mrm.29175.

Cited in this article [1]