In a recent study, researchers determined that for detecting liver iron abundance in patients with myelodysplastic syndrome (MDS), magnetic resonance imaging (MRI) and dual-energy spectral computed tomography (DECT) each appeared to perform best at different adjusted serum ferritin (ASF) levels. The study was published in the journal Frontiers in Oncology.

Patients with MDS who receive red blood cell transfusions may experience iron overload, and the liver is the primary site of storage of excess iron. While ASF can give an approximation of iron storage, various factors can influence its reliability as an estimator of iron storage, according to the study researchers. Imaging techniques like MRI and DECT are sometimes used to aid in estimating iron storage, so the researchers sought to evaluate these imaging methods for this purpose.

In this retrospective study, patients with MDS were organized into subgroups for analysis based on ASF concentrations and evaluated for an estimation of iron content using MRI and/or DECT of the liver and cardiac tissue. For analysis, the researchers compared patients’ ASF categories with estimates of iron content derived from DECT or MRI signals. Assessments of accuracy were based on analyses of receiver operating characteristic (ROC) curves and correlations.

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A total of 141 patients were evaluated by MRI, and 63 were evaluated by DECT. In general, for patients with an ASF level ≥5000 ng/mL, DECT appeared to be the more accurate imaging method, while for patients with an ASF level <1000 ng/mL, MRI appeared to be the more accurate method.

Both methods of imaging performed similarly at estimating liver iron content when analyzing patients with ASF between 1000 and <2500 ng/mL. DECT seemed to enable better differentiation of patients into subgroups when the ASF level was ≥2500 ng/mL. Other patterns also emerged with different analyses.

MRI and DECT both performed less well in analyses of iron detection in heart tissue compared with liver tissue, with no significant correlations between ASF categories and iron content estimated by MRI or DECT. However, as the researchers explained in their report, there is typically much less iron deposition in the heart than in the liver.

The researchers considered MRI and DECT to be complementary techniques for the detection of iron in the liver, with MRI showing greater reliability for the lowest category of ASF levels and DECT seeming more reliable for the highest category of ASF.

“For the sake of more accurately evaluating iron content in MDS patients, the appropriate detection method can be selected according to the level of ASF in patients,” the researchers concluded in their report.


Zhang Y, Xiao C, Li J, et al. Comparative study on iron content detection by energy spectral CT and MRI in MDS patients. Front Oncol. 2021;11:646946. doi:10.3389/fonc.2021.646946