R2 relaxometry based MR imaging for estimation of liver iron content: A comparison between two methods

Purpose: To compare the reproducibility and accuracy of R2-relaxometry MRI for estimation of liver iron concentration (LIC) between in-house analysis and FDA-approved commercially available third party results.

Methods: All MR studies were performed on a 1.5T scanner. Multi-echo spin-echo scans with a fixed TR and increasing TE values of 6 ms, 9 ms, 12 ms, 15 ms, and 18 ms (spaced at 3 ms intervals) were used. Post-processing of the images to calculate mean relaxivity, R2, included drawing of regions of interest to include the whole liver on mid-slice. The relationship between liver R2 values and estimated LIC calculated with in-house analysis and values reported by an external company (FerriScan^®, Resonance Health, Australia) were assessed with correlation coefficients and Bland-Altman difference plots. Continuous variables are presented as mean ± standard deviation. Significance was set at p value < 0.05.

Results: 474 studies from 175 patients were included in the study (mean age 10.4 ± 4.2 years (range 1-18 years); 254 studies from girls, 220 studies from boys). LIC ranged from 0.6 to 43 mg/g dry tissue, covering a broad range from normal levels to extremely high iron levels. Linearity between proprietary and in-house methods was excellent across the observed range for R2 (31.5 to 334.8 s^-1); showing a correlation coefficient of r = 0.87, p < 0.001. Bland-Altman R2 difference plot between the two methods shows a mean bias of + 21.5 s^-1 (range - 47.0 to + 90.0 s^-1 between two standard deviations). LIC reported by FerriScan^® compared with LIC estimated in-house with R2 as reported by FerriScan^® agreed strongly, (r = 1.0, p < 0.001).

Conclusion: R2 relaxometry MR imaging for liver iron concentration estimation is reproducible between proprietary FDA-approved commercial software and in-house analysis methods.