磁共振成像在骨髓增生异常综合征患者铁过载诊断和评估中的应用价值

OBJECTIVE: To analyze the cardiac T2* value, liver iron concentration (LIC), and related laboratory parameters in myelodysplastic syndrome (MDS) with iron overload and evaluate the changes of organ functions after iron chelation therapy. To explore the value of magnetic resonance imaging (MRI) T2* in making early diagnosis and assessing organs iron overload. METHODS: Retrospective investigation was used to observe the cardiac T2* value, LIC, iron metabolism parameters and related laboratory parameters of 85 MDS patients from Nov 2014 to Jan 2018. Among them, 7 MDS patients with Low/Int-1 have received iron chelation therapy for 6 months during two MRI examinations. The above parameters were collected before and after iron chelation therapy for comparison. RESULTS: Correlations were found between heart T2* value and age (rs=−0.290, P=0.007) and left ventricular ejection fraction (LVEF) (rs=0.265, P=0.009). There was a significant negative correlation between heart T2* value and blood transfusion units (rs=−0.701, P<0.001). There was a significant positive correlation between LIC and serum ferritin (SF) (rs=0.577, P<0.001). There was also a correlation between LIC and ALT (rs=0.268, P=0.014) and blood transfusion units (rs=0.244, P=0.034). There was no correlation between heart T2* and pro-BNP, SF (all P>0.05), and no correlation between LIC and age (P>0.05). The increase of heart T2* between the normal and abnormal groups was statistically significant (P=0.005), but the iron overload ratio of the heart T2*<20 ms was not significant between the two groups. There was statistical significance in the proportion of severe liver iron overload (LIC>15 mg/g DW) (P=0.045). After iron chelation therapy, the values of SF, transferrin saturation, ALT, AST, pro-BNP and LIC of 7 patients were decreased compared with values before iron chelation therapy, and the peripheral blood cell level was increased. However, the changes of LVEF and T2* values after iron chelation were not obvious. CONCLUSION: MRI T2* may be a predictor of iron overload in patients with MDS in early stage, and may be more valuable compare with LVEF, SF and other laboratory indicators. The safety and repeatability of MRI cardiac T2* examination are recognized, and it can be used as an ideal detection for patients with iron overload.