Adrenal Glands in Beta-thalassemia Major: Magnetic Resonance (MR) Imaging Features and Correlation with Iron Stores

Overview

Journal Eur Radiol

Specialty Radiology

Date 2005 Aug 9

PMID 16086182

Citations 9

Authors

Eleni Drakonaki

Olympia Papakonstantinou

Thomas Maris

Artemis Vasiliadou

Alex Papadakis

Nicholas Gourtsoyiannis

Affiliations

Soon will be listed here.

Abstract

This study aimed at describing the magnetic resonance (MR) imaging features of the adrenal glands in beta-thalassemic patients and at investigating the relation between adrenal and hepatic siderosis. Adrenal signal intensity (SI) was retrospectively assessed on abdominal MR studies of 35 patients with beta-thalassemia major undergoing quantification of hepatic siderosis and 12 healthy controls, using T1-(120/4/90), intermediate-(120/4/20), and T2*-(120/15/20) weighted GRE sequences. Adrenal SI was graded as grade 0 (normal SI on all sequences), grade 1 (hypointensity on T2* alone), or grade 2 (hypointensity on at least T2*). Adrenal size was measured in the thalassemic patients and compared with normative data. Liver-to-muscle (L/M) SI ratios, expressing hepatic siderosis, were estimated on each sequence. Serum ferritin levels were recorded. Adrenal hypointensity (grades 1 and 2) was noted in 24/35 (68.6%) patients. L/M ratios correlated significantly with adrenal SI in all sequences. Patients with grade 1 and grade 2 adrenal SI had significantly decreased L/M ratios compared with grade 0. Serum ferritin correlated significantly with L/M values but not with adrenal SI. Adrenal size was within normal limits. Diffuse hypointensity in normal-sized adrenals is a common MR finding in beta-thalassemic patients and correlates with the degree of hepatic siderosis.

Citing Articles

Evaluation of Iron Deposition in the Adrenal Glands of β Thalassemia Major Patients Using 3-Tesla MRI.

Guzelbey T, Gurses B, Ozturk E, Ozveren O, Sarsilmaz A, Karasu E Iran J Radiol. 2016; 13(3):e36375.

PMID: 27853501 PMC: 5107262. DOI: 10.5812/iranjradiol.36375.

Evaluation of the glucocorticoid, mineralocorticoid, and adrenal androgen secretion dynamics in a large cohort of patients aged 6-18 years with transfusion-dependent β-thalassemia major, with an emphasis on the impact of cardiac iron load.

Ucar A, Oner N, Ozek G, Cetincakmak M, Abuhandan M, Yildirim A Endocrine. 2016; 53(1):240-8.

PMID: 26839091 DOI: 10.1007/s12020-016-0872-2.

The Frequency of Adrenal Insufficiency in Adolescents and Young Adults with Thalassemia Major versus Thalassemia Intermedia in Iran.

Matin S, Jahromi M, Karemizadeh Z, Haghpanah S, De Sanctis V, Soliman A Mediterr J Hematol Infect Dis. 2015; 7(1):e2015005.

PMID: 25574364 PMC: 4283918. DOI: 10.4084/MJHID.2015.005.

Parametric exploration of the liver by magnetic resonance methods.

Sijens P Eur Radiol. 2009; 19(11):2594-607.

PMID: 19504103 PMC: 2762052. DOI: 10.1007/s00330-009-1470-y.

Magnetic resonance imaging assessment of excess iron in thalassemia, sickle cell disease and other iron overload diseases.

Wood J, Ghugre N Hemoglobin. 2008; 32(1-2):85-96.

PMID: 18274986 PMC: 2884397. DOI: 10.1080/03630260701699912.

References

Allkemper T, Schwindt W, Maintz D, Heindel W, Tombach B . Sensitivity of T2-weighted FSE sequences towards physiological iron depositions in normal brains at 1.5 and 3.0 T. Eur Radiol. 2004; 14(6):1000-4. DOI: 10.1007/s00330-004-2241-4. View

Sklar C, Lew L, Yoon D, David R . Adrenal function in thalassemia major following long-term treatment with multiple transfusions and chelation therapy. Evidence for dissociation of cortisol and adrenal androgen secretion. Am J Dis Child. 1987; 141(3):327-30. DOI: 10.1001/archpedi.1987.04460030105036. View

Alustiza J, Artetxe J, Castiella A, Agirre C, Emparanza J, Otazua P . MR quantification of hepatic iron concentration. Radiology. 2003; 230(2):479-84. DOI: 10.1148/radiol.2302020820. View

Au W, Tam P, Ma S, Lam K . Giant myelolipoma in a patient with thalassemia intermedia. Am J Hematol. 2000; 65(3):265-6. DOI: 10.1002/1096-8652(200011)65:3<265::aid-ajh18>3.0.co;2-h. View

Ellis J, Schulman I, Smith C . Generalized siderosis with fibrosis of liver and pancreas in Cooley's (Mediterranean) anemia; with observations on the pathogenesis of the siderosis and fibrosis. Am J Pathol. 1954; 30(2):287-309. PMC: 1942465. View

Siegelman E, Mitchell D, Semelka R . Abdominal iron deposition: metabolism, MR findings, and clinical importance. Radiology. 1996; 199(1):13-22. DOI: 10.1148/radiology.199.1.8633135. View

Gandon Y, Guyader D, Heautot J, Reda M, Yaouanq J, Buhe T . Hemochromatosis: diagnosis and quantification of liver iron with gradient-echo MR imaging. Radiology. 1994; 193(2):533-8. DOI: 10.1148/radiology.193.2.7972774. View

Argyropoulou M, Metafratzi Z, Kiortsis D, Bitsis S, Tsatsoulis A, Efremidis S . T2 relaxation rate as an index of pituitary iron overload in patients with beta-thalassemia major. AJR Am J Roentgenol. 2000; 175(6):1567-9. DOI: 10.2214/ajr.175.6.1751567. View

Sparacia G, Iaia A, Banco A, DAngelo P, Lagalla R . Transfusional hemochromatosis: quantitative relation of MR imaging pituitary signal intensity reduction to hypogonadotropic hypogonadism. Radiology. 2000; 215(3):818-23. DOI: 10.1148/radiology.215.3.r00jn10818. View

10.

Barry M, Sherlock S . Measurement of liver-iron concentration in needle-biopsy specimens. Lancet. 1971; 1(7690):100-3. DOI: 10.1016/s0140-6736(71)90838-5. View

11.

Kelekis N, Alexopoulou E, Brountzos E, Ladis V, Boussiotou A, Kelekis D . Giant adrenal myelolipoma with minimal fat content in a patient with homozygous beta-thalassemia: appearance on MRI. J Magn Reson Imaging. 2003; 18(5):608-11. DOI: 10.1002/jmri.10401. View

12.

Mayo-Smith W, Boland G, Noto R, Lee M . State-of-the-art adrenal imaging. Radiographics. 2001; 21(4):995-1012. DOI: 10.1148/radiographics.21.4.g01jl21995. View

13.

McIntosh N . Endocrinopathy in thalassaemia major. Arch Dis Child. 1976; 51(3):195-201. PMC: 1545930. DOI: 10.1136/adc.51.3.195. View

14.

Macdonald R, Mallory G . Hemochromatosis and hemosiderosis. Study of 211 autopsied cases. Arch Intern Med. 1960; 105:686-700. View

15.

Masala A, Meloni T, Gallisai D, Alagna S, Rovasio P, Rassu S . Endocrine functioning in multitransfused prepubertal patients with homozygous beta-thalassemia. J Clin Endocrinol Metab. 1984; 58(4):667-70. DOI: 10.1210/jcem-58-4-667. View

16.

Gomori J, Horev G, Tamary H, Zandback J, Kornreich L, Zaizov R . Hepatic iron overload: quantitative MR imaging. Radiology. 1991; 179(2):367-9. DOI: 10.1148/radiology.179.2.2014276. View

17.

Hadjigeorgi C, Lafoyianni S, Pontikis Y . Asymptomatic myelolipoma of the adrenal. Pediatr Radiol. 1992; 22(6):465-6. DOI: 10.1007/BF02013515. View

18.

Gandon Y, Olivie D, Guyader D, Aube C, Oberti F, Sebille V . Non-invasive assessment of hepatic iron stores by MRI. Lancet. 2004; 363(9406):357-62. DOI: 10.1016/S0140-6736(04)15436-6. View

19.

Jacobs A . Iron overload--clinical and pathologic aspects. Semin Hematol. 1977; 14(1):89-113. View

20.

Papakonstantinou O, Maris T, Kostaridou V, Gouliamos A, Koutoulas G, Kalovidouris A . Assessment of liver iron overload by T2-quantitative magnetic resonance imaging: correlation of T2-QMRI measurements with serum ferritin concentration and histologic grading of siderosis. Magn Reson Imaging. 1995; 13(7):967-77. DOI: 10.1016/0730-725x(95)00041-e. View