The Superiority of T2*MRI Over Serum Ferritin in the Evaluation of Secondary Iron Overload in a Chronic Kidney Disease Patient: A Case Report

Figures & data

Table 1 Summary of Relevant Data from 2016 to 2021 (Since the Detection of the Elevated Serum Ferritin)

Data	Reference Value	2016 (HD Initiated by the End of This Year)	2017(Before Renal Tx)	2018 (After Renal Tx)	2019	2020	2021 (When T2*MRI Done)
Hb level (range)	12–15 gm/dL	10.2–11	8.8–10.4	11.6–12.2	11.3–11.8	10.9–11.4	12.2–12.9
WBC	4–10 x10^3/uL	7.3	6.5	3.9	4.6	6.2	5.5
Serum ferritin	< 300 mcg/L	282	1150	1830	1650	1933	1219
TSAT	15–45%	39	49	52	46	48	38
Creatinine(range)	50–95 umol/L	168–205	320–380 (required HD 3 times /week)	75–118	105–115	100–120	105–123
Iron received	Total	None	Intravenous ferrous carboxymaltose (> 3 gm over 6 months)	None	None	None	None
Blood transfusion	Units/year	None	Two units of PRBC before renal Tx	None	None	None	None
ESA	Weekly	None	Received darbepoetin for six months before renal Tx	None	None	None	None
CRP level	< 6 mg/L	4	11.4	6.4	4.2	3.8	2.1

Abbreviations: CRP, C-reactive protein; Hb, hemoglobin; HD, hemodialysis; TSAT, transferrin saturation; TX, transplantation; WBC, white blood cells.

Table 2 Severity of Iron Overload Based on Hepatic and Myocardial T2*MRI and Our Patient Findings

Iron Load Severity	Normal	Mild	Moderate	Severe	Our Patient
Hepatic T2* by millisecond(ms), mg iron/ g of liver dry weight	>7.2ms,< 5 mg/g	3.3–7.2 ms, 5–10 mg/g	2.2–3.3 ms, 10–15 mg/g	< 2.2 ms, > 15 mg/g	T2*=7.4 ms, corresponding to < 5 mg iron/ g of liver dry weight (Normal)
Myocardial T2*by millisecond(ms), mg iron/ g of heart dry weight	> 20 ms,<1.2 mg/g	14–20 ms, 1.2–1.8 mg/g	10–14 ms, 1.8–2.7mg/g	< 10 ms, >2.7mg/g	T2* =29.4 ms, corresponding to <1.2 mg iron/ g of heart dry weight (Normal)

Figure 1 MRI 1.5 T (Siemens Avanto), using multi-TE gradient echo T2* MRI technique. Heart intensity is normal seen with the longest TE (14.68 msec). T2* =29.4 ms corresponding to <1.2 mg Iron/ g heart dry weight.

Figure 2 MRI 1.5 T (Siemens Avanto), using multi-TE gradient echo T2* MRI technique (using Garbowski method). Liver intensity is normal seen with the longest TE (14.68 msec). T2* =7.4 ms, corresponding to < 5 mg Iron/ g liver dry weight.