Purpose
The capability of MR imaging to document and quantify liver iron in number of pathologic conditions associated with liver iron overload, has been well documented. In our country, the major cause of iron overload is beta-thalassemia major. At our institution, MR imaging of the upper abdomen and myocardium has been added in the diagnostic follow up of the patients with beta-thalassemia for the estimation of iron status, and has eliminated the need for liver biopsies. There are scattered descriptions of abdominal lymphadenopathy in patients with...
Methods and Materials
PatientsThe MR imaging studies of 54 consecutive patients with beta-thalassemia major (aged 14-41 yrs, mean 266.3) were retrospectively reviewed. All patients received systematic red blood cell transfusions and subcutaneous chelation with desferroxamine. Thirty-seven of the 54 patients had post-transfusion chronic hepatitis, 33 of them chronic hepatitis C [HCV(+)] and4 chronic hepatitis B [HBc(+)] respectively. Total iron burden was assessed in all patients by means of serum ferritin levels, whereas liver iron concentration was determined in liver biopsy specimens, in 14 patients, with atomic absorption spectrophotometry.MR...
Results
Features of lymphadenopathyAbdominal lymph nodes > 5 mm in short axis were seen in 17 of the 54 patients with beta-thalassemia major (31%). Lymph nodes were located in periportal distribution in 12 patients, 9 in portocaval space, 7 in the gastrohepatic ligament, and finally 7 patients had visible paraaortic lymph nodes. The number of lymph nodes ranged from 5 mm to 22 mm long axis (mean 14.65.1) and 17 mm short axis (mean 103.4). All lymph nodes were hypointense on visual inspection, with signal intensities...
Conclusion
Mild enlargement of abdominal lymph nodes is common in patients with thalassemia and seems to associate with post-transfusion hepatitis. The degree of iron deposition in abdominal lymph nodes is similar to the degree of liver hemosiderosis. The possible predictive value of the size and number of lymph nodes as markers of hepatic inflammation and the contributory role of iron overload, in the development of lymphadenopathy, in patients with thalassemia, should be further explored.
References
1. Stark DD. Hepatic iron overload: paramagnetic pathology. Radiology 1991;179: 333-335.2. Gandon Y, Guyader D, Heautot JF, Reda MI, Yaouanq J, Buhe T, Brissot P, Carsin M, Deugnier Y. Hemochromatosis: diagnosis and quantification of liver iron with gradient-echo MR imaging. Radiology 1994; 193 (2): 533-538.3. Papakonstantinou O, Kostaridou S, Maris T, Gouliamos A, Premetis E, Kouloulias V, Nakopoulou L, Kattamis C. Quantification of liver iron overload by T2-quantitative MR imaging in thalassemia: impact of chronic hepatitis C on measurements. J Pediatr Hematol Oncol 1999; 21(2):...
Personal Information
O. Papakonstantinou 1(Iraklion/GR), Z. Spyridaki1(Iraklion/GR), T. G. Maris1(Iraklion/GR), V. Ladis2(Athens/GR), S. Kostaridou 2(Athens/GR), S. Karampekios1(Iraklion/GR), N. Gourtsoyiannis1(Iraklion/GR)1: Department of Radiology, University of Crete, Heraklion, Crete2: Thalassemia Unit, Aghia Sophia Childrens Hospital, 1st Department of Pediatrics, University of AthensE-mail:
[email protected]