The need for accurate and noninvasive evaluation of liver iron stores
prompted us to evaluate the reliability of high-field magnetic resonan
ce imaging equipment in liver patients with low or moderate siderosis,
given the poor results obtained using systems operating at low field
strength in such cases. Twenty patients with sporadic porphyria cutane
a tarda and 28 with comparable chronic liver diseases (chronic hepatit
is or cirrhosis) and moderate siderosis were compared with 10 patients
with idiopathic or secondary hemochromatosis and 10 healthy controls.
Plasma iron profile, ferritin concentration and liver iron concentrat
ion, determined with atomic absorption spectroscopy, were matched with
the magnetic resonance parameters-namely, transverse relaxation time
and the signal intensity for a given proton amount, obtained with equi
pment operating at a field strength of 1.5 T. Hemochromatosis patients
with mean liver iron concentrations of 550 mumol/gm dry wt (vs. 10 mu
mol of controls) exhibited an impressive reduction in the signal inten
sity with respect to the other three groups, and this reduction preven
ted any further comparison with the same porphyria cutanea tarda and c
hronic liver disease groups, whose liver iron level was twice that of
the controls. The signal intensity remained almost unchanged in the la
tter groups, whereas the transverse relaxation time was significantly
reduced. Moreover, correlation with liver iron was significantly inver
se in the case of the transverse relaxation time (n = 17, r = 0.62, p
= 0.008) and direct in the case of the transverse relaxation rate. The
transverse relaxation time values returned to normal in five patients
who had completed an iron-depletion program. No significant relations
hips between porphyrinuria (in porphyria cutanea tarda patients) or as
sociated histological lesions (steatosis or inflammation) and the sign
al intensity or the transverse relaxation time were observed. We concl
ude that a magnetic resonance imaging system operating at higher field
strength (with respect to previous studies) represents a useful, non-
invasive diagnostic tool for the evaluation of even modest liver iron
overload. Under these conditions, the decrease in the transverse relax
ation time is proportional to the decrease in iron. Hemochromatosis ca
nnot be investigated under the same conditions.