MRI for Liver Iron Quantification: Concepts and Current Methods

Liver Iron content is best correlated to total body iron stores and is thus the organ of choice for evaluation in iron overload diseases. Liver biopsy was the historic standard for iron evaluation, but the evaluation is localized, comes with increased risks due to its invasiveness, and is costly. MRI is now widely used for liver iron evaluation. The superparamagnetic properties of iron cause a disturbance in magnetic resonance imaging, which can be evaluated with various techniques. These include signal intensity ratio (SIR), T2 relaxometry, T2* relaxometry, and Dixon-based solutions. Each of the methods has its own advantages and disadvantages, and factors such as availability, ease of use, accuracy, reproducibility, and cost can all play a role in the ultimate technique used for liver iron quantification. Quantitative susceptibility mapping, and ultrashort TE sequences are promising supplemental methods, but are primarily used as research sequences. These may become more clinically accepted in the near future. Dual energy CT is also being explored as an alternative but is still in the nascent stages. Overall, accurate liver iron concentration is feasible with the current tools available at most MR imaging centers and is highly valuable for evaluation of iron overload diseases.