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Li D, Li J, Zhang H, Zhu Q, Wang T, Zhao W, Zhao S, Li W. Hereditary hemochromatosis caused by a C282Y/H63D mutation in the HFE gene: A case report. Heliyon 2024; 10:e28046. [PMID: 38560130 PMCID: PMC10979142 DOI: 10.1016/j.heliyon.2024.e28046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Hereditary hemochromatosis (HH) is a disease characterized by disordered iron metabolism. It often involves mutations of the HFE gene, which encodes the homeostatic iron regulator protein (HFE), as well as mutations affecting hepcidin antimicrobial peptide, hemojuvelin, or transferrin receptor 2. Historically, HH has been observed primarily in European and European diaspora populations, while classical HH is rare in Asian populations, including in China. In this article, we report a rare case of HH in a Chinese man that could be attributed to a heterozygous C282Y/H63D HFE mutation. Based on clinical examination, liver biopsy, and genetic testing results, the patient was diagnosed with HH. Clinical signs and symptoms and serum iron-related test results were recorded for a period of two years after the patient began treatment. Over this observation period, the patient was subjected to 25 phlebotomies (accounting for a total blood loss of 10.2 L). His serum ferritin levels decreased from 1550 μg/L to 454 μg/L, his serum iron concentration decreased from 40 μmol/L to 24.6 μmol/L, and his transferrin saturation decreased from 97.5% to 55.1%. Early diagnosis is essential for patients with HH to obtain good outcomes. Regular phlebotomy after diagnosis can improve HH symptoms and delay HH disease progression.
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Affiliation(s)
- Dongdong Li
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Jinfeng Li
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Hongkun Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Qiuyu Zhu
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Teng Wang
- Yiwu Central Hospital, 322000 Yiwu, Zhejiang, China
| | - Wen Zhao
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Shousong Zhao
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
| | - Wei Li
- Department of Infectious Diseases, First Affiliated Hospital of Bengbu Medical College, 233000 Bengbu, Anhui, China
- National Clinical Research Center for Infectious Diseases, China
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2
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Reeder SB, Yokoo T, França M, Hernando D, Alberich-Bayarri Á, Alústiza JM, Gandon Y, Henninger B, Hillenbrand C, Jhaveri K, Karçaaltıncaba M, Kühn JP, Mojtahed A, Serai SD, Ward R, Wood JC, Yamamura J, Martí-Bonmatí L. Quantification of Liver Iron Overload with MRI: Review and Guidelines from the ESGAR and SAR. Radiology 2023; 307:e221856. [PMID: 36809220 PMCID: PMC10068892 DOI: 10.1148/radiol.221856] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 02/23/2023]
Abstract
Accumulation of excess iron in the body, or systemic iron overload, results from a variety of causes. The concentration of iron in the liver is linearly related to the total body iron stores and, for this reason, quantification of liver iron concentration (LIC) is widely regarded as the best surrogate to assess total body iron. Historically assessed using biopsy, there is a clear need for noninvasive quantitative imaging biomarkers of LIC. MRI is highly sensitive to the presence of tissue iron and has been increasingly adopted as a noninvasive alternative to biopsy for detection, severity grading, and treatment monitoring in patients with known or suspected iron overload. Multiple MRI strategies have been developed in the past 2 decades, based on both gradient-echo and spin-echo imaging, including signal intensity ratio and relaxometry strategies. However, there is a general lack of consensus regarding the appropriate use of these methods. The overall goal of this article is to summarize the current state of the art in the clinical use of MRI to quantify liver iron content and to assess the overall level of evidence of these various methods. Based on this summary, expert consensus panel recommendations on best practices for MRI-based quantification of liver iron are provided.
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Affiliation(s)
- Scott B. Reeder
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Takeshi Yokoo
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Manuela França
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Diego Hernando
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Ángel Alberich-Bayarri
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - José María Alústiza
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Yves Gandon
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Benjamin Henninger
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Claudia Hillenbrand
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Kartik Jhaveri
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Musturay Karçaaltıncaba
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Jens-Peter Kühn
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Amirkasra Mojtahed
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Suraj D. Serai
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Richard Ward
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - John C. Wood
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Jin Yamamura
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
| | - Luis Martí-Bonmatí
- From the Departments of Radiology (S.B.R., D.H.), Medical Physics
(S.B.R., D.H.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and
Emergency Medicine (S.B.R.), University of Wisconsin, Room 2472, 1111 Highland
Ave, Madison, WI 53705; Department of Radiology and Advanced Imaging Research
Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.);
Department of Radiology, Centro Hospitalar Universitário do Porto,
Oporto, Portugal (M.F.); Biomedical Imaging Research Group (GIBI230-PREBI),
Instituto de Investigación Sanitaria La Fe, Valencia, Spain
(Á.A.B.); Quantitative Imaging Biomarkers in Medicine, Quibim SL,
Valencia, Spain (Á.A.B.); Osatek, Magnetic Resonance Unit, Donostia
University Hospital, San Sebastián, Spain (J.M.A.); Department of
Radiology, University Hospital and University of Rennes 1, Rennes, France
(Y.G.); Department of Radiology, Medical University of Innsbruck, Innsbruck,
Austria (B.H.); Research Imaging NSW, Division of Research & Enterprise,
University of New South Wales, Sydney, Australia (C.H.); Joint Department of
Medical Imaging (K.J.) and Department of Medicine (R.W.), University Health
Network, University of Toronto, Toronto, Canada; Liver Imaging Team, Department
of Radiology, Hacettepe University School of Medicine, Ankara, Turkey (M.K.);
Institute and Policlinic for Diagnostic and Interventional Radiology, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany (J.P.K.); Department of Radiology, Division of Abdominal Imaging,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.);
Department of Radiology, Children’s Hospital of Philadelphia, University
of Pennsylvania School of Medicine, Philadelphia, Pa (S.D.S.); Division of
Pediatric Cardiology, Children’s Hospital of Los Angeles, Los Angeles,
Calif (J.C.W.); Center of Radiology & Endoscopy, Department of Diagnostic
& Interventional Radiology, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany (J.Y.); and Medical Imaging Department and Biomedical Imaging
Research Group, Hospital Universitario y Politécnico La Fe and Health
Research Institute, Valencia, Spain (L.M.B.)
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3
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Computed Tomography Techniques, Protocols, Advancements, and Future Directions in Liver Diseases. Magn Reson Imaging Clin N Am 2021; 29:305-320. [PMID: 34243919 DOI: 10.1016/j.mric.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Computed tomography (CT) is often performed as the initial imaging study for the workup of patients with known or suspected liver disease. Our article reviews liver CT techniques and protocols in clinical practice along with updates on relevant CT advances, including wide-detector CT, radiation dose optimization, and multienergy scanning, that have already shown clinical impact. Particular emphasis is placed on optimizing the late arterial phase of enhancement, which is critical to evaluation of hepatocellular carcinoma. We also discuss emerging techniques that may soon influence clinical care.
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Wu LY, Song ZY, Li QH, Mou LJ, Yu YY, Shen SS, Song XX. Iron chelators reverse organ damage in type 4B hereditary hemochromatosis: Case reports. Medicine (Baltimore) 2021; 100:e25258. [PMID: 33787609 PMCID: PMC8021318 DOI: 10.1097/md.0000000000025258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/04/2021] [Indexed: 01/30/2023] Open
Abstract
RATIONALE Hereditary hemochromatosis (HH) is a hereditary disorder of iron metabolism. It is classified into 4 main types depending on the underlying genetic mutation: human hemochromatosis protein (HFE) (type 1), hemojuvelin (HJV) (type 2A), HAMP (type 2B), transferrin receptor-2 (TFER2) (type 3), and ferroportin (type 4). Type 4 HH is divided into 2 subtypes according to different mutations: type 4A (classical ferroportin disease) and type 4B (non-classical ferroportin disease). Type 4B HH is a rare autosomal dominant disease that results from mutations in the Solute Carrier Family 40 member 1 (SLC40A1) gene, which encodes the iron transport protein ferroportin. PATIENT CONCERNS Here we report 2 elderly Chinese Han men, who were brothers, presented with liver cirrhosis, diabetes mellitus, skin hyperpigmentation, hyperferritinaemia as well as high transferrin saturation. DIAGNOSIS Subsequent genetic analyses identified a heterozygous mutation (p. Cys326Tyr) in the SLC40A1 gene in both patients. INTERVENTIONS We treated the patient with iron chelator and followed up for 3 years. OUTCOMES Iron chelator helped to reduce the serum ferritin and improve the condition of target organs, including skin, pancreas, liver as well as pituitary. LESSONS Type 4B HH is rare but usually tends to cause multiple organ dysfunction and even death. For those patients who have difficulty tolerating phlebotomy, iron chelator might be a good alternative.
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Affiliation(s)
| | | | | | | | | | - Si-si Shen
- Department of Endocrinology, Second affiliated Hospital of Zhejiang University, HangZhou, Zhejiang Province, China
| | - Xiao-xiao Song
- Department of Endocrinology, Second affiliated Hospital of Zhejiang University, HangZhou, Zhejiang Province, China
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Alqanatish J, Alsowailmi B, Alfarhan H, Alhamzah A, Alharbi T. Juvenile Hemochromatosis: Rheumatic Manifestations of 2 Sisters Responding to Deferasirox Treatment. A Case Series and Literature Review. Open Access Rheumatol 2021; 13:15-21. [PMID: 33488128 PMCID: PMC7815067 DOI: 10.2147/oarrr.s276112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
Hereditary hemochromatosis (HH) is an inherited iron overload. The most common form of HH is type 1 hereditary hemochromatosis (HFE-related), which is associated with mutation of the HFE gene located on chromosome 6 and inherited in an autosomal recessive pattern. Type 2 hereditary hemochromatosis or juvenile hemochromatosis is less frequent autosomal recessive disease that results from mutations in the HJV gene on chromosome 1 (type2a) or the HAMP gene on chromosome19 (type2b). Mutation of type 2 transferrin receptor gene and mutation of the ferroportin gene result in hemochromatosis type 3 and hemochromatosis type 4, respectively. Juvenile hemochromatosis is characterized by an early onset of excess accumulation of iron in various organs. It could affect the liver, heart, pancreas and joints, resulting in arthropathy. Most juvenile hemochromatosis cases exhibit severe symptoms due to early onset. Cardiac and hypogonadism are the dominating features of the disease. Prevalence of arthropathy in juvenile hemochromatosis is higher than classic HH. Early diagnosis and intervention of juvenile hemochromatosis may prevent irreversible organ damage. The diagnosis can be made based on laboratory testing (of increased transferrin saturation, serum iron and ferritin levels), liver biopsy, imaging or genotype. According to international guidelines, treatment of HH is indicated when serum ferritin concentrations are above the upper limit of normal. We report two sisters who presented to the rheumatology clinic with arthralgia, which was subsequently found to have a homozygous mutation variant of unknown significance in the HFE2 gene: c.497A>G;p.(His166Arg) and has been treated with deferasirox (Exjade®). Musculoskeletal symptoms completely resolved in both patients in two months and remained so for one year on treatment.
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Affiliation(s)
- Jubran Alqanatish
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia.,Department of Pediatrics, King Abdullah Specialist Children's Hospital and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Banan Alsowailmi
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia
| | - Haneen Alfarhan
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia
| | - Albandari Alhamzah
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia
| | - Talal Alharbi
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14611, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia.,Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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6
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Ruan DD, Gan YM, Lu T, Yang X, Zhu YB, Yu QH, Liao LS, Lin N, Qian X, Luo JW, Tang FQ. Genetic diagnosis history and osteoarticular phenotype of a non-transfusion secondary hemochromatosis. World J Clin Cases 2020; 8:5962-5975. [PMID: 33344595 PMCID: PMC7723718 DOI: 10.12998/wjcc.v8.i23.5962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/23/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is not easy to identify the cause of various iron overload diseases because the phenotypes overlap. Therefore, it is important to perform genetic testing to determine the genetic background of patients.
AIM To investigate the genetic background of a patient with hemochromatosis complicated by psoriasis on both lower extremities.
METHODS Ten years ago, a 61-year-old male presented with iron overload, jaundice, hemolytic anemia and microcytic hypochromic anemia. Computed tomography of the left knee joint showed enlargement of the tibial medullary cavity and thinned bone cortices. Magnetic resonance imaging showed hepatic hemochromatosis, extensive abnormal signals from bone marrow cavities and nodular lesions in the lateral medullary cavity of the upper left lateral tibia. Single photon emission computed tomography showed radial dots of abnormal concentration in the upper end of the left tibia and radial symmetry of abnormal concentrations in joints of the extremities. The patient showed several hot spot mutations of the HFE and G6PD genes detected by next-generation sequencing, but no responsible gene mutation was found. The thalassemia gene was detected by gap-PCR.
RESULTS The patient was found to carry the -α4.2 and --SEA deletion mutations of the globin gene. These two mutations are common causes of Southeast Asian α-thalassemia, but rarely cause severe widespread non-transfusion secondary hemochromatosis osteoarthropathy. The simultaneous presence of an auxiliary superposition effect of a rare missense mutation of the PIEZO1 gene (NM_001142864, c.C4748T, p.A1583V) was considered. Moreover, several rare mutations of the IFIH1, KRT8, POFUT1, FLG, KRT2, and TGM5 genes may be involved in the pathogenesis of psoriasis.
CONCLUSION The selection of genetic detection methods for hemochromatosis still needs to be based on an in-depth study of the clinical manifestations of the disease.
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Affiliation(s)
- Dan-Dan Ruan
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Yu-Mian Gan
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Tao Lu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Xiao Yang
- Department of Management, Fujian Health College, Fuzhou 350101, Fujian Province, China
| | - Yao-Bin Zhu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Qing-Hua Yu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Li-Sheng Liao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Ning Lin
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Xin Qian
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Jie-Wei Luo
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Fa-Qiang Tang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Department of Orthopedics, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
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7
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Ruan DD, Gan YM, Lu T, Yang X, Zhu YB, Yu QH, Liao LS, Lin N, Qian X, Luo JW, Tang FQ. Genetic diagnosis history and osteoarticular phenotype of a non-transfusion secondary hemochromatosis. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Henninger B, Plaikner M, Zoller H, Viveiros A, Kannengiesser S, Jaschke W, Kremser C. Performance of different Dixon-based methods for MR liver iron assessment in comparison to a biopsy-validated R2* relaxometry method. Eur Radiol 2020; 31:2252-2262. [PMID: 32965571 PMCID: PMC7979591 DOI: 10.1007/s00330-020-07291-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 01/19/2023]
Abstract
Objectives To prospectively evaluate a 3D-multiecho-Dixon sequence with inline calculation of proton density fat fraction (PDFF) and R2* (qDixon), and an improved version of it (qDixon-WIP), for the MR-quantification of hepatic iron in a clinical setting. Methods Patients with increased serum ferritin underwent 1.5-T MRI of the liver for the evaluation of hepatic iron overload. The imaging protocol for R2* quantification included as follows: (1) a validated, 2D multigradient-echo sequence (initial TE 0.99 ms, R2*-ME-GRE), (2) a 3D-multiecho-Dixon sequence with inline calculation of PDFF and R2* (initial TE 2.38 ms, R2*-qDixon), and optionally (3) a prototype (works-in-progress, WIP) version of the latter (initial TE 1.04 ms, R2*-qDixon-WIP) with improved water/fat separation and noise-corrected parameter fitting. For all sequences, three manually co-registered regions of interest (ROIs) were placed in the liver. R2* values were compared and linear regression analysis and Bland-Altman plots calculated. Results Forty-six out of 415 patients showed fat-water (F/W) swap with qDixon and were excluded. A total of 369 patients (mean age 52 years) were included; in 203/369, the optional qDixon-WIP was acquired, which showed no F/W swaps. A strong correlation was found between R2*-ME-GRE and R2*-qDixon (r2 = 0.92, p < 0.001) with Bland-Altman revealing a mean difference of − 3.82 1/s (SD = 21.26 1/s). Correlation between R2*-GRE-ME and R2*-qDixon-WIP was r2 = 0.95 (p < 0.001) with Bland-Altman showing a mean difference of − 0.125 1/s (SD = 30.667 1/s). Conclusions The 3D-multiecho-Dixon sequence is a reliable tool to quantify hepatic iron. Results are comparable with established relaxometry methods. Improvements to the original implementation eliminate occasional F/W swaps and limitations regarding maximum R2* values. Key Points • The 3D-multiecho-Dixon sequence for 1.5 T is a reliable tool to quantify hepatic iron. • Results of the 3D-multiecho-Dixon sequence are comparable with established relaxometry methods. • An improved version of the 3D-multiecho-Dixon sequence eliminates minor drawbacks.
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Affiliation(s)
- Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michaela Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Heinz Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - André Viveiros
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Werner Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Complex confounder-corrected R2* mapping for liver iron quantification with MRI. Eur Radiol 2020; 31:264-275. [PMID: 32785766 DOI: 10.1007/s00330-020-07123-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/05/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES MRI-based R2* mapping may enable reliable and rapid quantification of liver iron concentration (LIC). However, the performance and reproducibility of R2* across acquisition protocols remain unknown. Therefore, the objective of this work was to evaluate the performance and reproducibility of complex confounder-corrected R2* across acquisition protocols, at both 1.5 T and 3.0 T. METHODS In this prospective study, 40 patients with suspected iron overload and 10 healthy controls were recruited with IRB approval and informed written consent and imaged at both 1.5 T and 3.0 T. For each subject, acquisitions included four different R2* mapping protocols at each field strength, and an FDA-approved R2-based method performed at 1.5 T as a reference for LIC. R2* maps were reconstructed from the complex data acquisitions including correction for noise effects and fat signal. For each subject, field strength, and R2* acquisition, R2* measurements were performed in each of the nine liver Couinaud segments and the spleen. R2* measurements were compared across protocols and field strength (1.5 T and 3.0 T), and R2* was calibrated to LIC for each acquisition and field strength. RESULTS R2* demonstrated high reproducibility across acquisition protocols (p > 0.05 for 96/108 pairwise comparisons across 2 field strengths and 9 liver segments, ICC > 0.91 for each field strength/segment combination) and high predictive ability (AUC > 0.95 for four clinically relevant LIC thresholds). Calibration of R2* to LIC was LIC = - 0.04 + 2.62 × 10-2 R2* at 1.5 T and LIC = 0.00 + 1.41 × 10-2 R2* at 3.0 T. CONCLUSIONS Complex confounder-corrected R2* mapping enables LIC quantification with high reproducibility across acquisition protocols, at both 1.5 T and 3.0 T. KEY POINTS • Confounder-corrected R2* of the liver provides reproducible R2* across acquisition protocols, including different spatial resolutions, echo times, and slice orientations, at both 1.5 T and 3.0 T. • For all acquisition protocols, high correlation with R2-based liver iron concentration (LIC) quantification was observed. • The calibration between confounder-corrected R2* and LIC, at both 1.5 T and 3.0 T, is determined in this study.
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Evaluation of liver iron overload with R2* relaxometry with versus without fat suppression: both are clinically accurate but there are differences. Eur Radiol 2020; 30:5826-5833. [PMID: 32535737 DOI: 10.1007/s00330-020-07010-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/28/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess clinically relevant difference in hepatic iron quantification using R2* relaxometry with (FS) and without (non-FS) fat saturation for the evaluation of patients with suspected hepatic iron overload. METHODS We prospectively enrolled 134 patients who underwent 1.5-T MRI R2* relaxometry with FS and non-FS gradient echo sequences (12 echoes, initial TE = 0.99 ms). Proton density fat fraction for the quantification of steatosis was assessed. Linear regression analyses and Bland-Altman plots including Lin's concordance correlation coefficient were performed for correlation of FS R2* with non-FS R2*. Patients were grouped into 4 severity classes of iron overload (EASL based), and agreement was evaluated by contingency tables and the proportion of overall agreement. RESULTS A total of 41.8% of patients showed hepatic iron overload; 67.9% had concomitant steatosis; and 58.2% revealed no iron overload of whom 60.3% had steatosis. The mean R2* value for all FS data was 102.86 1/s, for non-FS 108.16 1/s. Linear regression resulted in an R-squared value of 0.99 (p < 0.001); Bland-Altman plot showed a mean R2* difference of 5.26 1/s (SD 17.82). The concordance correlation coefficient was only slightly lower for patients with steatosis compared with non-steatosis (0.988 vs. 0.993). The overall agreement between FS and non-FS R2* measurements was 94.8% using either method to classify patients according to severity of iron storage. No correlation between R2* and proton density fat fraction was found for both methods. CONCLUSION R2* relaxometry showed an excellent overall agreement between FS and non-FS acquisition. Both variants can therefore be used in daily routine. However, clinically relevant differences might result when switching between the two methods or during patient follow-up, when fat content changes over time. We therefore recommend choosing a method and keeping it straight in the context of follow-up examinations. KEY POINTS • Both variants of R2* relaxometry (FS and non-FS) may be used in daily routine. • Clinically relevant differences might result when switching between the two methods or during patient follow-up, when fat content changes over time. • It seems advisable choosing one method and keeping it straight in the context of follow-up examinations.
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Abstract
BACKGROUND Disorders of serum iron balance are frequently observed in chronic hepatitis C (CHC) patients. Iron overload as well as iron deficiency anemia are common clinical findings in these patients. Variceal bleeding is also a common complication. To date, no study has discussed the influence of esophageal bleeding on iron status in anemic CHC bleeders. OBJECTIVE Was to study reticulocyte hemoglobin content (CHr) and serum hepcidin levels in anemic CHC and to evaluate the influence of variceal bleeding on patients' iron status. METHODS Serum hepcidin levels and CHr were assessed in 65 early phase CHC patients (20 nonanemic, 23 anemic nonbleeders, and 22 anemic bleeders), and 20 healthy controls; and were compared with the conventional indices of iron deficiency including mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, serum iron, total iron binding capacity, transferrin saturation and ferritin. RESULTS Hepcidin levels were comparable in patients groups, but were significantly lower in patients than in controls (P = 0.01). Child-Pugh class B patients showed significantly lower hepcidin levels than class A patients. CHr levels were comparable in all groups as well as all iron deficiency indices. Patients with ferritin values or less 100 ng/ml and CHr or less 29 pg/cell or Tfsat or less 16% are more likely to have iron deficiency [odds ratio (OR = 3.93, 95% confidence interval (CI) = 2.54-6.08; OR = 10.50, 95% CI = 1.94-56.55, respectively). CONCLUSION Esophageal bleeding has an almost no influence on iron status in CHC patients. Serum hepcidin content is influenced by CHC disease rather than by anemia associated with or without esophageal bleeding and it could be used as a marker of early hepatic insufficiency. Assessing CHr content could add a potential utility in the detection of iron deficiency in CHC patients.
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Elsaid MI, John T, Li Y, Koduru S, Ali SZ, Catalano C, Narayanan N, Rustgi VK. Health Care Utilization and Economic Burdens of Hemochromatosis in the United States: A Population-Based Claims Study. J Manag Care Spec Pharm 2019; 25:1377-1386. [PMID: 31778618 PMCID: PMC10397675 DOI: 10.18553/jmcp.2019.25.12.1377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about the health care burden of hemochromatosis in the United States, despite its increased morbidity and mortality due to associated advanced liver diseases. OBJECTIVE To evaluate the health care utilization and economic burdens of hemochromatosis in the United States using real-world claims data. METHODS We performed a case-control analysis of adult participants in the Truven Health MarketScan Commercial Claims database from 2010 to 2015. 37,092 hemochromatosis cases were matched 1:1 by demographics and comorbidities to hemochromatosis-free controls with chronic liver disease using propensity scores. Total and service-specific health care parameters were quantified for the 12 months following versus the 12 months before the first date of hemochromatosis diagnosis and over the 12 months following a randomly selected date for controls. Incremental differences in health care burdens between cases and controls were examined using Wilcoxon signed rank tests and McNemar tests for continuous and dichotomous measures, respectively. Adjusted multivariable regression analyses using generalized linear models were used to compare the health care burdens for cases with controls. RESULTS In comparison with the year before, the 12 months following first hemochromatosis diagnoses had a higher total number of claims per patient (34.37 vs. 29.99; P < 0.0001) and an increase in the per-patient total health care costs ($20,023 vs. $16,905; P < 0.0001). After hemochromatosis diagnosis, health care costs were 2%, 8%, 23%, and 43% higher for inpatient admissions, emergency department visits, outpatient visits, and pharmaceutical prescriptions, compared respectively with the 12 months before diagnosis. In the 12 months following the index date, hemochromatosis cases incurred $2,732 more in total unadjusted costs compared with controls. Compared with controls, cases had adjusted incident rate ratio (IRR) 1.26 (95% CI = 1.30-1.77) times the total number of claims (IRR = 1.40, 95% CI = 1.38-1.43) more outpatient visits and IRR = 1.10 (95% CI = 1.08-1.11) excess pharmaceutical claims. Compared with controls, cases had significantly higher adjusted mean health care costs for inpatient services ($6,484 vs. $7,854), outpatient services ($7,032 vs. $11,005), and pharmaceutical claims ($2,520 vs. $2,822; all P values < 0.05). The annual health care costs among type 2 diabetes, hypertension, arthritis, and chronic kidney disease (CKD) patients with hemochromatosis were $6,968, $7,424, $2,967, and $43,847, respectively, higher than type 2 diabetes, hypertension, arthritis, and CKD patients without hemochromatosis (P < 0.0001). CONCLUSIONS Hemochromatosis in the United States is associated with significant health care utilization and economic burdens driven by outpatient visits, pharmaceutical claims, and a high number of comorbidities DISCLOSURES: No outside funding supported this study. The authors have no relevant financial or other relationships to disclose. An abstract containing some of the results from this study was accepted for the American Association for the Study of Liver Diseases Meeting; November 9-13, 2018; San Francisco, CA.
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Affiliation(s)
- Mohamed I. Elsaid
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Tina John
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - You Li
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sobha Koduru
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Saima Z. Ali
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Carolyn Catalano
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Navaneeth Narayanan
- Department of Pharmacy Practice, Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey, Piscataway, and Division of Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vinod K. Rustgi
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Abstract
Hereditary hemochromatosis (HH) is one of the most common genetic disorders among persons of northern European descent. There have been recent advances in the diagnosis, management, and treatment of HH. The availability of molecular diagnostic testing for HH has made possible confirmation of the diagnosis for most patients. Several genotype-phenotype correlation studies have clarified the differences in clinical features between patients with the C282Y homozygous genotypes and other HFE mutation patterns. The increasing use of noninvasive tests such as MRI T2* has made quantification of hepatic iron deposition easier and eliminated the need for liver biopsy in most patients. Serum ferritin of <1,000 ng/mL at diagnosis remains an important diagnostic test to identify patients with a low risk of advanced hepatic fibrosis and should be used routinely as part of the initial diagnostic evaluation. Genetic testing for other types of HH is available but is expensive and generally not useful in most clinical settings. Serum ferritin may be elevated among patients with nonalcoholic fatty liver disease and in those with alcoholic liver disease. These diagnoses are more common than HH among patients with elevated serum ferritin who are not C282Y homozygotes or C282Y/H63D compound heterozygotes. A secondary cause for liver disease should be excluded among patients with suspected iron overload who are not C282Y homozygotes. Phlebotomy remains the mainstay of therapy, but emerging novel therapies such as new chelating agents may have a role for selected patients.
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Czaja AJ. Review article: iron disturbances in chronic liver diseases other than haemochromatosis - pathogenic, prognostic, and therapeutic implications. Aliment Pharmacol Ther 2019; 49:681-701. [PMID: 30761559 DOI: 10.1111/apt.15173] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/08/2019] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Disturbances in iron regulation have been described in diverse chronic liver diseases other than hereditary haemochromatosis, and iron toxicity may worsen liver injury and outcome. AIMS To describe manifestations and consequences of iron dysregulation in chronic liver diseases apart from hereditary haemochromatosis and to encourage investigations that clarify pathogenic mechanisms, define risk thresholds for iron toxicity, and direct management METHODS: English abstracts were identified in PubMed by multiple search terms. Full length articles were selected for review, and secondary and tertiary bibliographies were developed. RESULTS Hyperferritinemia is present in 4%-65% of patients with non-alcoholic fatty liver disease, autoimmune hepatitis, chronic viral hepatitis, or alcoholic liver disease, and hepatic iron content is increased in 11%-52%. Heterozygosity for the C282Y mutation is present in 17%-48%, but this has not uniformly distinguished patients with adverse outcomes. An inappropriately low serum hepcidin level has characterised most chronic liver diseases with the exception of non-alcoholic fatty liver disease, and the finding has been associated mainly with suppression of transcriptional activity of the hepcidin gene. Iron overload has been associated with oxidative stress, advanced fibrosis and decreased survival, and promising therapies beyond phlebotomy and oral iron chelation have included hepcidin agonists. CONCLUSIONS Iron dysregulation is common in chronic liver diseases other than hereditary haemochromatosis, and has been associated with liver toxicity and poor prognosis. Further evaluation of iron overload as a co-morbid factor should identify the key pathogenic disturbances, establish the risk threshold for iron toxicity, and promote molecular interventions.
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Affiliation(s)
- Albert J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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15
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Plaikner M, Kremser C, Zoller H, Steurer M, Glodny B, Jaschke W, Henninger B. Does gadoxetate disodium affect MRE measurements in the delayed hepatobiliary phase? Eur Radiol 2019; 29:829-837. [PMID: 30027410 PMCID: PMC6302879 DOI: 10.1007/s00330-018-5616-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/24/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess if the administration of gadoxetate disodium (Gd-EOB-DTPA) significantly affects hepatic magnetic resonance elastography (MRE) measurements in the delayed hepatobiliary phase (DHBP). METHODS A total of 47 patients (15 females, 32 males; age range 23-78 years, mean 54.28 years) were assigned to standard hepatic magnetic resonance imaging (MRI) with application of Gd-EOB-DTPA and hepatic MRE. MRE was performed before injection of Gd-EOB-DTPA and after 40-50 min in the DHBP. Liver stiffness values were obtained before and after contrast media application and differences between pre- and post-Gd-EOB-DTPA values were evaluated using a Bland-Altman plot and the Mann-Whitney-Wilcoxon test. In addition, the data were compared with regard to the resulting fibrosis classification. RESULTS Mean hepatic stiffness for pre-Gd-EOB-DTPA measurements was 4.01 kPa and post-Gd-EOB-DTPA measurements yielded 3.95 kPa. We found a highly significant individual correlation between pre- and post-Gd-EOB-DTPA stiffness values (Pearson correlation coefficient of r = 0.95 (p < 0.001) with no significant difference between the two measurements (p =0.49)). Bland-Altman plot did not show a systematic effect for the difference between pre- and post-stiffness measurements (mean difference: 0.06 kPa, SD 0.81). Regarding the classification of fibrosis stages, the overall agreement was 87.23% and the intraclass correlation coefficient was 96.4%, indicating excellent agreement. CONCLUSIONS Administration of Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver in the DHBP. Therefore, MRE can be performed in the DHBP. KEY POINTS • MRE of the liver can reliably be performed in the delayed hepatobiliary phase. • Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver. • MRE performed in the delayed hepatobiliary-phase is reasonable in patients with reduced liver function.
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Affiliation(s)
- M Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - H Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - M Steurer
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Glodny
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
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Opportunistic Screening for Hereditary Hemochromatosis With Unenhanced CT: Determination of an Optimal Liver Attenuation Threshold. AJR Am J Roentgenol 2018; 211:1206-1211. [PMID: 30300001 DOI: 10.2214/ajr.18.19690] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to assess whether a specific liver attenuation threshold for unenhanced CT allows both sensitive opportunistic detection of unsuspected hereditary hemochromatosis and low overall screening test-positive rates. MATERIALS AND METHODS We used a standard ROI placement method on unenhanced CT studies of 3357 consecutive adults (mean age, 57.0 years) with no symptoms of liver disease who underwent colorectal screening. Hepatic attenuation (in HU) was measured to assess test-positive rates at various liver attenuation thresholds. To assess sensitivity, unenhanced hepatic CT attenuation was also measured in 12 patients with hereditary hemochromatosis (mean age, 48.3 years), who were homozygous for the HFE C282Y mutation. All scans were obtained at 120 kV. Serum ferritin levels were recorded for the hereditary hemochromatosis cohort. RESULTS Mean liver attenuation ± SD among screened adults was 59.4 ± 12.7 HU, compared with 78.7 ± 13.1 HU (range, 59-105 HU) in the hereditary hemochromatosis cohort (p < 0.001). Screening test-positive rates were 30.6% (n = 1028) at 65 HU, 8.2% (n = 275) at 70 HU, 1.2% (n = 39) at 75 HU, and 0.2% (n = 7) at 80 HU. Corresponding sensitivities for hereditary hemochromatosis at these thresholds were 83.3% (10/12) at 65, 70, and 75 HU; and 50.0% (6/12) at 80 HU. Serum ferritin levels were elevated in all patients with hereditary hemochromatosis (mean, 1678 ng/mL; range, 477-3991 ng/mL). CONCLUSION An unenhanced CT liver attenuation threshold of 75 HU was sensitive (83.3%) for hereditary hemochromatosis while maintaining an acceptably low screening test-positive rate (1.2%). An unexplained liver attenuation of 75 HU or more on unenhanced CT should trigger appropriate laboratory investigation for iron overload; early intervention with phlebotomy can limit or prevent organ damage in patients with hemochromatosis.
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Lynch S, Pfeiffer CM, Georgieff MK, Brittenham G, Fairweather-Tait S, Hurrell RF, McArdle HJ, Raiten DJ. Biomarkers of Nutrition for Development (BOND)-Iron Review. J Nutr 2018; 148:1001S-1067S. [PMID: 29878148 PMCID: PMC6297556 DOI: 10.1093/jn/nxx036] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/27/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022] Open
Abstract
This is the fifth in the series of reviews developed as part of the Biomarkers of Nutrition for Development (BOND) program. The BOND Iron Expert Panel (I-EP) reviewed the extant knowledge regarding iron biology, public health implications, and the relative usefulness of currently available biomarkers of iron status from deficiency to overload. Approaches to assessing intake, including bioavailability, are also covered. The report also covers technical and laboratory considerations for the use of available biomarkers of iron status, and concludes with a description of research priorities along with a brief discussion of new biomarkers with potential for use across the spectrum of activities related to the study of iron in human health.The I-EP concluded that current iron biomarkers are reliable for accurately assessing many aspects of iron nutrition. However, a clear distinction is made between the relative strengths of biomarkers to assess hematological consequences of iron deficiency versus other putative functional outcomes, particularly the relationship between maternal and fetal iron status during pregnancy, birth outcomes, and infant cognitive, motor and emotional development. The I-EP also highlighted the importance of considering the confounding effects of inflammation and infection on the interpretation of iron biomarker results, as well as the impact of life stage. Finally, alternative approaches to the evaluation of the risk for nutritional iron overload at the population level are presented, because the currently designated upper limits for the biomarker generally employed (serum ferritin) may not differentiate between true iron overload and the effects of subclinical inflammation.
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Affiliation(s)
| | - Christine M Pfeiffer
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN
| | - Gary Brittenham
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Susan Fairweather-Tait
- Department of Nutrition, Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich NR4 7JT, UK
| | - Richard F Hurrell
- Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Harry J McArdle
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB21 9SB, UK
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
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18
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Pirasteh A, Yuan Q, Hernando D, Reeder SB, Pedrosa I, Yokoo T. Inter-method reproducibility of biexponential R 2 MR relaxometry for estimation of liver iron concentration. Magn Reson Med 2018; 80:2691-2701. [PMID: 29770484 DOI: 10.1002/mrm.27348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the reproducibility of biexponential R2 -relaxometry MRI for estimation of liver iron concentration (LIC) between proprietary and nonproprietary analysis methods. METHODS This single-center retrospective study, approved by investigational review board and compliant with the Health Insurance Portability and Accountability Act, included 40 liver MRI exams in 38 subjects with suspected or known iron overload. From spin-echo images of the liver, acquired at 5 different echo times (TE = 6-18 ms), biexponential R2 maps were calculated using 1 proprietary (FerriScan, Resonance Health Ltd., Claremont WA, Australia) and 3 nonproprietary (simulated annealing, nonlinear least squares, dictionary search) analysis methods. Each subject's average liver R2 value was converted to LIC using a previously validated calibration curve. Inter-method reproducibility for liver R2 and LIC were assessed for linearity using linear regression analysis and absolute agreement using intraclass correlation and Bland-Altman analysis. For point estimates, 95% confidence intervals were calculated; P values < 0.05 were considered statistically significant. RESULTS Linearity between the proprietary and nonproprietary methods was excellent across the observed range for R2 (20-312 s-1 ) and LIC (0.4-52.2 mg/g), with all coefficients of determination (R2 ) ≥ 0.95. No statistically significant bias was found (slope estimates ∼ 1; intercept estimates ∼ 0; P values > 0.05). Agreement between the 4 methods was excellent for both liver R2 and LIC (intraclass correlations ≥ 0.97). Bland-Altman 95% limits of agreement in % difference between the proprietary and nonproprietary methods were ≤ 9% and ≤ 16% for R2 and LIC, respectively. CONCLUSION Biexponential R2 -relaxometry MRI for LIC estimation is reproducible between proprietary and nonproprietary analysis methods.
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Affiliation(s)
- Ali Pirasteh
- Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qing Yuan
- Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Diego Hernando
- Radiology, Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Scott B Reeder
- Radiology, Medical Physics, Biomedical Engineering, Medicine, Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | - Ivan Pedrosa
- Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Takeshi Yokoo
- Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
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Radford-Smith DE, Powell EE, Powell LW. Haemochromatosis: a clinical update for the practising physician. Intern Med J 2018; 48:509-516. [DOI: 10.1111/imj.13784] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - Elizabeth E. Powell
- Centre for Liver Disease Research, Translational Research Institute, School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Department of Gastroenterology and Hepatology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Lawrie W. Powell
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- QIMR Berghofer Medical Research Institute; Brisbane Queensland Australia
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Scotet V, Saliou P, Uguen M, L'Hostis C, Merour MC, Triponey C, Chanu B, Nousbaum JB, Le Gac G, Ferec C. Do pregnancies reduce iron overload in HFE hemochromatosis women? results from an observational prospective study. BMC Pregnancy Childbirth 2018; 18:53. [PMID: 29454332 PMCID: PMC5816504 DOI: 10.1186/s12884-018-1684-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/06/2018] [Indexed: 12/17/2022] Open
Abstract
Background HFE hemochromatosis is an inborn error of iron metabolism linked to a defect in the regulation of hepcidin synthesis. This autosomal recessive disease typically manifests later in women than men. Although it is commonly stated that pregnancy is, with menses, one of the factors that offsets iron accumulation in women, no epidemiological study has yet supported this hypothesis. The aim of our study was to evaluate the influence of pregnancy on expression of the predominant HFE p.[Cys282Tyr];[Cys282Tyr] genotype. Methods One hundred and forty p.Cys282Tyr homozygous women enrolled in a phlebotomy program between 2004 and 2011 at a blood centre in western Brittany (France) were included in the study. After checking whether the disease expression was delayed in women than in men in our study, the association between pregnancy and iron overload was assessed using multivariable regression analysis. Results Our study confirms that women with HFE hemochromatosis were diagnosed later than men cared for during the same period (52.6 vs. 47.4 y., P < 0.001). Compared to no pregnancy, having at least one pregnancy was not associated with lower iron markers. In contrast, the amount of iron removed by phlebotomies appeared significantly higher in women who had at least one pregnancy (eβ = 1.50, P = 0.047). This relationship disappeared after adjustment for confounding factors (eβ = 1.35, P = 0.088). Conclusions Our study shows that pregnancy status has no impact on iron markers level, and is not in favour of pregnancy being a protective factor in progressive iron accumulation. Our results are consistent with recent experimental data suggesting that the difference in disease expression observed between men and women may be explained by other factors such as hormones.
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Affiliation(s)
- Virginie Scotet
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Inserm, EFS, Université de Brest, ISBAM, 22 avenue Camille Desmoulins, 29200, Brest, France.
| | - Philippe Saliou
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Inserm, EFS, Université de Brest, ISBAM, 22 avenue Camille Desmoulins, 29200, Brest, France.,Laboratoire d'Hygiene et de Sante Publique, Hopital Morvan, Brest, France
| | - Marianne Uguen
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Inserm, EFS, Université de Brest, ISBAM, 22 avenue Camille Desmoulins, 29200, Brest, France
| | - Carine L'Hostis
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Inserm, EFS, Université de Brest, ISBAM, 22 avenue Camille Desmoulins, 29200, Brest, France
| | | | - Céline Triponey
- Etablissement Français du Sang - Bretagne, Site de Brest, Brest, France
| | - Brigitte Chanu
- Etablissement Français du Sang - Bretagne, Site de Brest, Brest, France
| | - Jean-Baptiste Nousbaum
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Inserm, EFS, Université de Brest, ISBAM, 22 avenue Camille Desmoulins, 29200, Brest, France.,Service d'Hepato-Gastroenterologie, Hopital La Cavale Blanche, Brest, France
| | - Gerald Le Gac
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Inserm, EFS, Université de Brest, ISBAM, 22 avenue Camille Desmoulins, 29200, Brest, France.,Laboratoire de Genetique Moleculaire et d'Histocompatibilite, Hopital Morvan, Brest, France
| | - Claude Ferec
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Inserm, EFS, Université de Brest, ISBAM, 22 avenue Camille Desmoulins, 29200, Brest, France.,Etablissement Français du Sang - Bretagne, Site de Brest, Brest, France.,Laboratoire de Genetique Moleculaire et d'Histocompatibilite, Hopital Morvan, Brest, France
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21
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Laursen AH, Bjerrum OW, Friis-Hansen L, Hansen TO, Marott JL, Magnussen K. Causes of iron overload in blood donors - a clinical study. Vox Sang 2017; 113:110-119. [PMID: 29230833 DOI: 10.1111/vox.12619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the obligate iron loss from blood donation, some donors present with hyperferritinaemia that can result from a wide range of acute and chronic conditions including hereditary haemochromatosis (HH). The objective of our study was to investigate the causes of hyperferritinaemia in the blood donor population and explore the value of extensive HH mutational analyses. MATERIALS AND METHODS Forty-nine consecutive donors (f = 6, m = 43) were included prospectively from the Capital Regional Blood Center. Inclusion criteria were a single ferritin value >1000 μg/l or repeated hyperferritinaemia with at least one value >500 μg/l. All donors were questioned about their medical history and underwent a physical examination, biochemical investigations and next-generation sequencing of HH-related genes, including the HFE gene, the haemojuvelin gene (HFE2/HJV), the hepcidin gene (HAMP), the ferroportin 1 gene (SLC40A1) and the transferrin receptor 2 gene (TFR2). RESULTS Forty of 49 donors were mutation positive with a combined 69 mutations, 54 of which were located in the HFE gene. There were 11 mutations in the TFR2 gene, two mutations in the HFE2 gene and two mutations in the HAMP gene. Only four donors had apparent alternative causes of hyperferritinaemia. CONCLUSION HH-related mutations were the most frequent cause of hyperferritinaemia in a Danish blood donor population, and it appears that several different HH-genotypes can contribute to hyperferritinaemia. HH screening in blood donors with high ferritin levels could be warranted. HH-related iron overload should not in itself result in donor ineligibility.
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Affiliation(s)
- A H Laursen
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - O W Bjerrum
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - L Friis-Hansen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Biochemistry, Nordsjaellands Hospital, Hillerod, Denmark
| | - T O Hansen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen, Denmark
| | - J L Marott
- The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - K Magnussen
- Blood Centre Lab, Hvidovre Hospital, Hvidovre, Denmark.,Department of Immunology and Transfusion Medicine, Sorlandet hospital Kristiansand, Kristiansand, Norway
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22
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Taibbi A, Picone D, Midiri M, La Grutta L, Bartolotta TV. Diffuse Liver Diseases: Role of imaging. Semin Ultrasound CT MR 2017; 39:193-205. [PMID: 29571555 DOI: 10.1053/j.sult.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nowadays, the most common imaging techniques allow to study focal liver lesions with high diagnostic accuracy but a relatively recent emerging field of interest is represented by diffuse liver disease. They include a variegated series of storage and metabolic pathologies (ie, iron overload disorders and steatosis) requiring a precise diagnosis not always possible at imaging due to the overlapping of findings at conventional ultrasound, CT, or MR studies. In recent years, several imaging tecniques and specific softwares have been developed, especially for ultrasound and MR imaging, in order to identify different parameters useful in the noninvasive recognition and follow-up of these diffuse processes involving the liver. The aim of this article is to describe the most common and useful imaging findings of the most common and uncommon diffuse liver diseases illustrating the newest imaging technologies and developments at our disposal with corresponding advantages, limitations, and pitfalls.
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Affiliation(s)
- Adele Taibbi
- Department of Radiology, University Hospital, Palermo, Italy.
| | - Dario Picone
- Department of Radiology, University Hospital, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University Hospital, Palermo, Italy
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23
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de Graaff B, Neil A, Si L, Yee KC, Sanderson K, Gurrin L, Palmer AJ. Cost-Effectiveness of Different Population Screening Strategies for Hereditary Haemochromatosis in Australia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:521-534. [PMID: 28035629 DOI: 10.1007/s40258-016-0297-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Amongst populations of northern European ancestry, HFE-associated haemochromatosis is a common genetic disorder characterised by iron overload. In the absence of treatment, excess iron is stored in parenchymal tissues, causing morbidity and mortality. Population screening programmes may increase early diagnosis and reduce associated disease. No contemporary health economic evaluation has been published for Australia. The objective of this study was to identify cost-effective screening strategies for haemochromatosis in the Australian setting. METHODS A Markov model using probabilistic decision analysis was developed comparing four adult screening strategies: the status quo (cascade and incidental screening), genotyping with blood and buccal samples and transferrin saturation followed by genotyping (TfS). Target populations were males (30 years) and females (45 years) of northern European ancestry. Cost-effectiveness was estimated from the government perspective over a lifetime horizon. RESULTS All strategies for males were cost-effective compared to the status quo. The incremental costs (standard deviation) associated with genotyping (blood) were AUD7 (56), TfS AUD15 (45) and genotyping (buccal) AUD63 (56), producing ICERs of AUD1673, 4103 and 15,233/quality-adjusted life-year (QALY) gained, respectively. For females, only the TfS strategy was cost-effective, producing an ICER of AUD10,195/QALY gained. Approximately 3% of C282Y homozygotes were estimated to be identified with the status quo approach, compared with 40% with the proposed screening strategies. CONCLUSION This model estimated that genotyping and TfS strategies are likely to be more cost-effective screening strategies than the status quo.
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Affiliation(s)
- Barbara de Graaff
- Menzies Institute for Medical Research, Medical Science 2 Building, University of Tasmania, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, Medical Science 2 Building, University of Tasmania, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Lei Si
- Menzies Institute for Medical Research, Medical Science 2 Building, University of Tasmania, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Kwang Chien Yee
- School of Medicine, Medical Science 1 Building, University of Tasmania, 17 Liverpool St, Private Bag 68, Hobart, TAS, 7000, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, Medical Science 2 Building, University of Tasmania, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Lyle Gurrin
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, Medical Science 2 Building, University of Tasmania, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia.
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24
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de Graaff B, Si L, Neil AL, Yee KC, Sanderson K, Gurrin LC, Palmer AJ. Population Screening for Hereditary Haemochromatosis in Australia: Construction and Validation of a State-Transition Cost-Effectiveness Model. PHARMACOECONOMICS - OPEN 2017; 1:37-51. [PMID: 29442300 PMCID: PMC5691808 DOI: 10.1007/s41669-016-0005-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION HFE-associated haemochromatosis, the most common monogenic disorder amongst populations of northern European ancestry, is characterised by iron overload. Excess iron is stored in parenchymal tissues, leading to morbidity and mortality. Population screening programmes are likely to improve early diagnosis, thereby decreasing associated disease. Our aim was to develop and validate a health economics model of screening using utilities and costs from a haemochromatosis cohort. METHODS A state-transition model was developed with Markov states based on disease severity. Australian males (aged 30 years) and females (aged 45 years) of northern European ancestry were the target populations. The screening strategy was the status quo approach in Australia; the model was run over a lifetime horizon. Costs were estimated from the government perspective and reported in 2015 Australian dollars ($A); costs and quality-adjusted life-years (QALYs) were discounted at 5% annually. Model validity was assessed using goodness-of-fit analyses. Second-order Monte-Carlo simulation was used to account for uncertainty in multiple parameters. RESULTS For validity, the model reproduced mortality, life expectancy (LE) and prevalence rates in line with published data. LE for C282Y homozygote males and females were 49.9 and 40.2 years, respectively, slightly lower than population rates. Mean (95% confidence interval) QALYS were 15.7 (7.7-23.7) for males and 14.4 (6.7-22.1) for females. Mean discounted lifetime costs for C282Y homozygotes were $A22,737 (3670-85,793) for males and $A13,840 (1335-67,377) for females. Sensitivity analyses revealed discount rates and prevalence had the greatest impacts on outcomes. CONCLUSION We have developed a transparent, validated health economics model of C282Y homozygote haemochromatosis. The model will be useful to decision makers to identify cost-effective screening strategies.
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Affiliation(s)
| | - Lei Si
- University of Tasmania, Hobart, TAS, Australia
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25
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Henninger B, Zoller H, Kannengiesser S, Zhong X, Jaschke W, Kremser C. 3D Multiecho Dixon for the Evaluation of Hepatic Iron and Fat in a Clinical Setting. J Magn Reson Imaging 2017; 46:793-800. [PMID: 28225576 DOI: 10.1002/jmri.25630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/22/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To prospectively evaluate a new 3D-multiecho-Dixon (3D-ME-Dixon) sequence for the quantification of hepatic iron and fat in a clinical setting. MATERIALS AND METHODS In all, 120 patients underwent 1.5T magnetic resonance imaging of the liver between December 2013 and June 2015 including the following three sequences: 3D-ME-Dixon with inline calculation of R2* and proton-density fat-fraction (PDFF) maps, single-voxel-spectroscopy (SVS), 2D multigradient-echo sequence (2D-ME-GRE). SVS and 2D-ME-GRE were used as reference for PDFF and R2*, respectively. R2*- and PDFF-values from 3D-ME-Dixon were compared with those of the reference. Linear regression analysis, Bland-Altman plots, and agreement parameters were calculated. RESULTS In total, 103 patients were finally included (87 men and 16 women; mean age, 50.51 years); 17/120 were excluded due to fat/water-swaps or R2*-values exceeding the constraint of 400 1/s for 3D-ME-Dixon. A strong correlation (r = 0.992, P < 0.001) between R2* of 3D-ME-Dixon and the reference 2D-ME-GRE was found. Bland-Altman analysis revealed systematically lower values for 3D-ME-Dixon (16.499%). Using an adapted threshold of 57 1/s, 3D-ME-Dixon obtained a positive/negative percentage agreement (PPA/NPA) of 84.4%/91.4% for detecting hepatic iron overload. For hepatic fat the correlation between 3D-ME-Dixon and the reference SVS was strong (r = 0.957, P < 0.001); PPA/NPA was 88.3%/91.4%. CONCLUSION The 3D-ME-Dixon sequence is a valuable tool for the evaluation of hepatic iron and fat in a clinical setting. Fat/water-swaps remain a drawback requiring improvements to the implementation and making it necessary to have proven conventional sequences at hand in case of an eventual occurrence. LEVEL OF EVIDENCE 1. Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:793-800.
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Affiliation(s)
- Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinz Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, Georgia, USA
| | - Werner Jaschke
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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İdilman İS, Akata D, Özmen MN, Karçaaltıncaba M. Different forms of iron accumulation in the liver on MRI. Diagn Interv Radiol 2017; 22:22-8. [PMID: 26712679 DOI: 10.5152/dir.2015.15094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Magnetic resonance imaging (MRI) is a well-established imaging modality to evaluate increased iron deposition in the liver. Both standard liver imaging series with in-phase and out-of-phase T1-weighted sequences for visual detection, as well as advanced T2- and T2*-weighted measurements may be used for mapping the iron concentration. In this article, we describe different forms of liver iron accumulation (diffuse, heterogeneous, multinodular, focal, segmental, intralesional, periportal, and lobar) and hepatic iron sparing (focal, geographic and nodular). Focal iron sparing is characterized by hypointense areas on R2* map and hyperintense areas on T2* map. We also illustrate MRI findings of simultaneous hepatic iron and fat accumulation. Coexistence of iron (siderosis) and fat (steatosis) can make interpretation of in- and out-of-phase T1-weighted images difficult; calculation of proton density fat fraction and R2* maps can characterize abnormal signal changes observed on in- and out-of-phase images. Knowledge of different forms of hepatic iron overload and iron sparing and evaluation of T2* and R2* maps would allow correct diagnosis of iron-associated liver disorders.
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Affiliation(s)
- İlkay S İdilman
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
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27
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de Graaff B, Neil A, Sanderson K, Yee KC, Palmer AJ. Costs associated with hereditary haemochromatosis in Australia: a cost-of-illness study. AUST HEALTH REV 2017; 41:254-267. [DOI: 10.1071/ah15188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to assess health sector, other sector and time-related (productivity) costs associated with hereditary haemochromatosis from societal, government and patient perspectives for the Australian setting. Methods A national web-based survey of people with haemochromatosis was conducted between November 2013 and February 2015. Participants completed a health survey and resource use diaries. Costs were calculated using a bottom-up approach and calculated in 2015 Australian dollars. Results Cost data were available for 157 participants. From a societal perspective, the estimated annual cost of haemochromatosis was A$274 million. The mean (95% confidence interval) cost for symptomatic patients was almost threefold greater than that of asymptomatic patients (A$10030 (7705–12670) vs A$3701 (2423–5296) respectively). Health sector and productivity-related time loss were the main cost drivers. When extrapolating costs to the Australian population level, asymptomatic haemochromatosis accounted for higher costs than symptomatic haemochromatosis (A$183 million vs A$91 million), reflecting the low clinical penetrance estimate used. Total costs increased when higher clinical penetrance estimates were used. Conclusion The present cost-of-illness study, the first to be published for haemochromatosis, found that although costs were substantial, they could be decreased by reducing clinical penetrance. Development of cost-effective strategies to increase early diagnosis is likely to result in better health outcomes for patients and lower total costs. What is known about the topic? To date, no cost-of-illness study has been conducted for haemochromatosis. Previous economic work in this area has relied on cost estimates based on expert opinion. What does the paper add? This paper provides the first cost estimates for haemochromatosis for the Australian population. These estimates, calculated using a bottom-up approach, were extrapolated to the population level based on the most robust epidemiological estimates available for the Australian population. What are the implications for practitioners? Population screening programs have been widely suggested as an approach to reduce clinical penetrance; however, the lack of high-quality economic analyses has been cited as a barrier to implementation. The present study provides the most robust cost estimates to date, which may be used to populate economic models. In addition, the present study illustrates that reducing clinical penetrance of haemochromatosis is likely to result in substantial reductions in cost.
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Abstract
A 39-year-old woman with end-stage renal disease, which was maintained on haemodialysis, developed secondary haemochromatosis after receiving blood transfusions and intravenous iron supplementation without sufficient serum ferritin concentration monitoring. The patient received intravenous deferoxamine three times a week, combined with high-dose recombinant human erythropoietin therapy and haemodialysis. After three months, improvements in biochemical indicators and iron overload were noted.
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Affiliation(s)
- Lu Cheng
- Division of Nephrology, West China Hospital, Sichuan University, Sichuan, China
| | - Xi Tang
- Division of Nephrology, West China Hospital, Sichuan University, Sichuan, China
| | - Ping Fu
- Division of Nephrology, West China Hospital, Sichuan University, Sichuan, China
| | - Fang Liu
- Division of Nephrology, West China Hospital, Sichuan University, Sichuan, China
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Sikorska K, Bernat A, Wroblewska A. Molecular pathogenesis and clinical consequences of iron overload in liver cirrhosis. Hepatobiliary Pancreat Dis Int 2016; 15:461-479. [PMID: 27733315 DOI: 10.1016/s1499-3872(16)60135-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The liver, as the main iron storage compartment and the place of hepcidin synthesis, is the central organ involved in maintaining iron homeostasis in the body. Excessive accumulation of iron is an important risk factor in liver disease progression to cirrhosis and hepatocellular carcinoma. Here, we review the literature on the molecular pathogenesis of iron overload and its clinical consequences in chronic liver diseases. DATA SOURCES PubMed was searched for English-language articles on molecular genesis of primary and secondary iron overload, as well as on their association with liver disease progression. We have also included literature on adjuvant therapeutic interventions aiming to alleviate detrimental effects of excessive body iron load in liver cirrhosis. RESULTS Excess of free, unbound iron induces oxidative stress, increases cell sensitivity to other detrimental factors, and can directly affect cellular signaling pathways, resulting in accelerated liver disease progression. Diagnosis of liver cirrhosis is, in turn, often associated with the identification of a pathological accumulation of iron, even in the absence of genetic background of hereditary hemochromatosis. Iron depletion and adjuvant therapy with antioxidants are shown to cause significant improvement of liver functions in patients with iron overload. Phlebotomy can have beneficial effects on liver histology in patients with excessive iron accumulation combined with compensated liver cirrhosis of different etiology. CONCLUSION Excessive accumulation of body iron in liver cirrhosis is an important predictor of liver failure and available data suggest that it can be considered as target for adjuvant therapy in this condition.
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Affiliation(s)
- Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology, Medical University of Gdansk, Powstania Styczniowego 9b, 81-519 Gdynia, Poland.
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Davidsen ES, Liseth K, Omvik P, Hervig T, Gerdts E. Reduced exercise capacity in genetic haemochromatosis. ACTA ACUST UNITED AC 2016; 14:470-5. [PMID: 17568251 DOI: 10.1097/hjr.0b013e3280ac151c] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many patients with genetic haemochromatosis complain about fatigue and reduced physical capacity. Exercise capacity, however, has not been evaluated in larger series of haemochromatosis patients treated with repeated phlebotomy. DESIGN AND METHODS We performed exercise echocardiography in 152 treated haemochromatosis patients (48+/-13 years, 26% women) and 50 healthy blood donors (49+/-13 years, 30% women), who served as controls. Echocardiography was performed at rest and during exercise in a semiupright position on a chair bicycle, starting from 20 W, increasing by 20 W/min. Transmitral early and atrial velocity and isovolumic relaxation time were measured at each step. Ventilatory gas exchange was measured by the breath-to-breath-technique. RESULTS Compared with healthy controls, haemochromatosis patients were more obese and less trained. More of them smoked, and 17% had a history of cardiovascular or pulmonary disease. Adjusted for training, the left ventricular function and dimensions at rest did not differ between the groups. During exercise the haemochromatosis patients obtained a significantly lower peak oxygen (O2) uptake (28.1 vs. 34.4 ml/kg per min, P<0.001). In a multiple regression analysis haemochromatosis predicted lower peak O2 uptake independently of significant contributions of sex, age, and height, as well as of systolic blood pressure and log-transformed isovolumic relaxation time at peak exercise, whereas no independent association was found with weight or physical activity (multiple R=0.74, P<0.001). Adding genotype, s-ferritin, prevalence of smoking, or history of cardiopulmonary disease among the covariates in subsequent models did not change the results. CONCLUSION Genetic haemochromatosis, even when treated with regular phlebotomy, is associated with lower exercise capacity independently of other covariates of exercise capacity.
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Abstract
Haemochromatosis is now known to be an iron-storage disease with genetic heterogeneity but with a final common metabolic pathway resulting in inappropriately low production of the hormone hepcidin. This leads to increase in intestinal absorption and deposition of excessive amounts of iron in parenchymal cells which in turn results in eventual tissue damage and organ failure. A clinical enigma has been the variable clinical expression with some patients presenting with hepatic cirrhosis at a young age and others almost asymptomatic for life. Research is unravelling this puzzle by identifying environmental factors-especially alcohol consumption-and associated modifying genes that modulate phenotypic expression. A high index of suspicion is required for early diagnosis but this can lead to presymptomatic therapy and a normal life expectancy. Venesection (phlebotomy) therapy remains the mainstay of therapy, but alternative therapies are the subject of current research.
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Affiliation(s)
- Lawrie W Powell
- Centre for the Advancement of Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, The University of Queensland, Brisbane, Australia.
| | - Rebecca C Seckington
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Yves Deugnier
- University Hospital and University of Rennes 1, Rennes, France
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Pelucchi S, Galimberti S, Greni F, Rametta R, Mariani R, Pelloni I, Girelli D, Busti F, Ravasi G, Valsecchi MG, Valenti L, Piperno A. Proprotein convertase 7 rs236918 associated with liver fibrosis in Italian patients with HFE-related hemochromatosis. J Gastroenterol Hepatol 2016; 31:1342-8. [PMID: 26868056 DOI: 10.1111/jgh.13315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/26/2016] [Accepted: 02/06/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM p.Cys282Tyr homozygosity is the prevalent genotype in (HFE)-related Hereditary Hemochromatosis with low penetrance and variable expression. However, liver cirrhosis and hepatocellular carcinoma remain the main causes of mortality in these patients. Detection of genetic modifiers identifying patients at risk for liver damage would be relevant for their clinical management. We evaluated proprotein convertase 7 (PCSK7) rs236918 as genetic marker of risk of liver fibrosis in an Italian cohort of p.Cys282Tyr homozygotes. METHODS Liver fibrosis was histologically assessed by Ishak score. We evaluated PCSK7 alleles and genotypes frequencies according to single or grouped staging scores: absent/mild fibrosis (stage: 0-2), moderate (stage: 3-4), and severe fibrosis/cirrhosis (stage: 5-6). Single nucleotide polymorphism genotyping was performed by restriction fragment length polymorphism or Taqman 5'-nuclease assays. RESULTS The rs236918 allele C frequency increased from stages 0-2 to 5-6 (7.1% vs 13.6%, vs 21.9%, P = 0.003). The wild-type genotype was significantly more frequent in the absent/mild fibrosis group (54.2%) compared with only 17% in patients with severe fibrosis/cirrhosis. At univariate proportional odds model, patients with GC + CC genotypes were 2.77 times (P = 0.0018) more likely to have worse liver staging scores than wild-type patients. In the adjusted analysis, odds ratio was 2.37 (P = 0.0218), and 2.56 (P = 0.0233) when the analysis was restricted to males. An exploratory mediation analysis suggested a direct effect of genotype on severe fibrosis/cirrhosis (odds ratio = 3.11, P = 0.0157), and a mild non-significant indirect effect mediated through iron accounting for 28%. CONCLUSIONS These findings confirm that PCSK7 rs236918 C allele is a risk factor for cirrhosis development in Italian patients with HFE-Hemochromatosis.
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Affiliation(s)
- Sara Pelucchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefania Galimberti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza, Italy
| | - Federico Greni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaela Rametta
- Department of Medicine, Second Division of Gastroenterology, IRCCS, Ospedale Maggiore Policlinico, University of Milano, Milano, Italy
| | - Raffaella Mariani
- Centre for disorder of iron metabolism, S.Gerardo Hospital, Monza, Italy
| | - Irene Pelloni
- Centre for disorder of iron metabolism, S.Gerardo Hospital, Monza, Italy
| | - Domenico Girelli
- Department of Medicine Policlinico GB Rossi, University of Verona, Verona, Italy
| | - Fabiana Busti
- Department of Medicine Policlinico GB Rossi, University of Verona, Verona, Italy
| | - Giulia Ravasi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza, Italy
| | - Luca Valenti
- Department of Medicine, Second Division of Gastroenterology, IRCCS, Ospedale Maggiore Policlinico, University of Milano, Milano, Italy
| | - Alberto Piperno
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Centre for disorder of iron metabolism, S.Gerardo Hospital, Monza, Italy.,Consortium of Human Molecular Genetics, Monza, Italy
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Affiliation(s)
- Tom Marjot
- Academic Clinical Fellow in Gastroenterology in the Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford
| | - Jane Collier
- Consultant Hepatologist in the Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford
| | - John D Ryan
- Academic Clinical Lecturer in Gastroenterology in the Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford OX3 9DU
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de Graaff B, Neil A, Sanderson K, Yee KC, Palmer AJ. Quality of life utility values for hereditary haemochromatosis in Australia. Health Qual Life Outcomes 2016; 14:31. [PMID: 26922941 PMCID: PMC4770680 DOI: 10.1186/s12955-016-0431-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 02/12/2016] [Indexed: 01/26/2023] Open
Abstract
Background Hereditary hemochromatosis (HH) is a common autosomal recessive disorder amongst persons of northern European heritage. If untreated, iron accumulates in parenchymal tissues causing morbidity and mortality. As diagnosis often follows irreversible organ damage, screening programs have been suggested to increase early diagnosis. A lack of economic evidence has been cited as a barrier to establishing such a program. Previous analyses used poorly estimated utility values. This study sought to measure utilities directly from people with HH in Australia. Methods Volunteers with HH were recruited to complete a web-based survey. Utility was assessed using the Assessment of Quality of Life 4D (AQOL-4D) instrument. Severity of HH was graded into four categories. Multivariable regression analysis was performed to identify parameters associated with HSUV. Results Between November 2013 and November 2014, 221 people completed the survey. Increasing severity of HH was negatively associated with utility. Mean (standard deviation) utilities were 0.76 (0.21), 0.81 (0.18), 0.60 (0.27), and 0.50 (0.27) for categories 1–4 HH respectively. Lower mean utility was found for symptomatic participants (categories 3 and 4) compared with asymptomatic participants (0.583 v. 0.796). Self-reported HH-related symptoms were negatively associated with HSUV (r = −0.685). Conclusions Symptomatic stages of HH and presence of multiple self-reported symptoms were associated with decreasing utility. Previous economic analyses have used higher utilities which likely resulted in underestimates of the cost effectiveness of HH interventions. The utilities reported in this paper are the most robust available, and will contribute to improving the validity of future economic models for HH.
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Affiliation(s)
- Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Kwang Chien Yee
- School of Medicine, University of Tasmania, Medical Sciences Building 2, 17 Liverpool St, Private Bag 68, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia.
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de Graaff B, Neil A, Sanderson K, Si L, Yee KC, Palmer AJ. A Systematic Review and Narrative Synthesis of Health Economic Studies Conducted for Hereditary Haemochromatosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:469-483. [PMID: 26255179 DOI: 10.1007/s40258-015-0189-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hereditary haemochromatosis (HH) is a common genetic condition amongst people of northern European heritage. HH is associated with increased iron absorption leading to parenchymal organ damage and multiple arthropathies. Early diagnosis and treatment prevents complications. Population screening may increase early diagnosis, but no programmes have been introduced internationally: a paucity of health economic data is often cited as a barrier. OBJECTIVE To conduct a systematic review of all health economic studies in HH. METHODS Studies were identified through electronic searching of economic/biomedical databases. Any study on HH with original economic component was included. Study quality was formally assessed. Health economic data were extracted and analysed through narrative synthesis. RESULTS Thirty-eight studies met the inclusion criteria. The majority of papers reported on costs or cost effectiveness of screening programmes. Whilst most concluded screening was cost effective compared with no screening, methodological flaws limit the quality of these findings. Assumptions regarding clinical penetrance, effectiveness of screening, health-state utility values (HSUVs), exclusion of early symptomatology (such as fatigue, lethargy and multiple arthropathies) and quantification of costs associated with HH were identified as key limitations. Treatment studies concluded therapeutic venepuncture was the most cost-effective intervention. CONCLUSIONS There is a paucity of high-quality health economic studies relating to HH. The development of a comprehensive HH cost-effectiveness model utilising HSUVs is required to determine whether screening is worthwhile.
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Affiliation(s)
- Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Kwang Chien Yee
- School of Medicine, University of Tasmania, Medical Science 1 Building, 17 Liverpool St, Private Bag 68, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia.
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Zaloumis SG, Allen KJ, Bertalli NA, Turkovic L, Delatycki MB, Nicoll AJ, McLaren CE, English DR, Hopper JL, Giles GG, Anderson GJ, Olynyk JK, Powell LW, Gurrin LC. Natural history of HFE simple heterozygosity for C282Y and H63D: a prospective 12-year study. J Gastroenterol Hepatol 2015; 30:719-25. [PMID: 25311314 PMCID: PMC4782752 DOI: 10.1111/jgh.12804] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The risk of hemochromatosis-related morbidity for HFE simple heterozygosity for either the C282Y or H63D substitutions in the HFE protein was assessed using a prospective community-based cohort study. METHODS HFE genotypes were measured for 31,192 persons of northern European descent, aged between 40 and 69 years when recruited to the Melbourne Collaborative Cohort Study, and subjects were followed for an average of 12 years. For a random sample of 1438 participants stratified according to HFE genotype, two sets of biochemical iron indices performed 12 years apart and, at follow-up only, the presence/absence of six disease features associated with hereditary hemochromatosis were obtained. Summary data for 257 (139 female) C282Y simple heterozygotes and 123 (74 female) H63D simple heterozygotes were compared with 330 (181 female) controls with neither HFE mutation. RESULTS At baseline, mean transferrin saturation (TS) (95% confidence interval) and prevalence of TS > 55% were 35.14% (33.25, 37.04) and 3/112 (3%), 33.03% (29.9, 36.15) and 0/39 (0%), and 29.67% (27.93, 31.4) and 3/135 (2%) for C282Y, H63D and wild-type male participants, respectively. At follow-up, mean TS levels remained similar to baseline levels for both men and women irrespective of simple heterozygosity for either mutation. No HFE C282Y or H63D simple heterozygotes had documented iron overload (based on hepatic iron measures or serum ferritin greater than 1000 mg/L at baseline with documented therapeutic venesection). CONCLUSION No documented iron overload was observed for HFE simple heterozygotes for either C282Y or H63D, and morbidity for both HFE simple heterozygote groups was similar to that of HFE wild-type participants.
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Affiliation(s)
- Sophie G. Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Katrina J. Allen
- Murdoch Childrens Research Institute, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Victoria, Australia,Department of Gastroenterology, Royal Children's Hospital, Victoria, Australia
| | | | - Lidija Turkovic
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Martin B. Delatycki
- Murdoch Childrens Research Institute, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Victoria, Australia,Austin Health, Heidelberg, Victoria, Australia
| | | | | | - Dallas R. English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Graham G. Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Greg J. Anderson
- QIMR Berghofer Medical Research Institute and The University of Queensland, Brisbane, Australia
| | - John K. Olynyk
- Department of Gastroenterology, Fremantle Hospital, Fremantle, Australia; School of Medicine and Pharmacology, University of Western Australia, Nedlands, Australia; Western Australian Institute of Medical Research, Perth, Australia
| | - Lawrie W. Powell
- QIMR Berghofer Medical Research Institute and The University of Queensland, Brisbane, Australia,The University of Queensland and the Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Lyle C. Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
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Makker J, Hanif A, Bajantri B, Chilimuri S. Dysmetabolic hyperferritinemia: all iron overload is not hemochromatosis. Case Rep Gastroenterol 2015; 9:7-14. [PMID: 25759633 PMCID: PMC4327557 DOI: 10.1159/000373883] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Disturbances in iron metabolism can be genetic or acquired and accordingly manifest as primary or secondary iron overload state. Organ damage may result from iron overload and manifest clinically as cirrhosis, diabetes mellitus, arthritis, endocrine abnormalities and cardiomyopathy. Hemochromatosis inherited as an autosomal recessive disorder is the most common genetic iron overload disorder. Expert societies recommend screening of asymptomatic and symptomatic individuals with hemochromatosis by obtaining transferrin saturation (calculated as serum iron/total iron binding capacity × 100). Further testing for the hemochromatosis gene is recommended if transferrin saturation is >45% with or without hyperferritinemia. However, management of individuals with low or normal transferrin saturation is not clear. In patients with features of iron overload and high serum ferritin levels, low or normal transferrin saturation should alert the physician to other – primary as well as secondary – causes of iron overload besides hemochromatosis. We present here a possible approach to patients with hyperferritinemia but normal transferrin saturation.
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Affiliation(s)
- Jasbir Makker
- Division of Gastroenterology, Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., USA ; Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., USA
| | - Ahmad Hanif
- Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., USA
| | - Bharat Bajantri
- Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., USA
| | - Sridhar Chilimuri
- Division of Gastroenterology, Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., USA ; Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., USA
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Luersen GF, Bhosale P, Szklaruk J. State-of-the-art cross-sectional liver imaging: beyond lesion detection and characterization. J Hepatocell Carcinoma 2015; 2:101-17. [PMID: 27508199 PMCID: PMC4918289 DOI: 10.2147/jhc.s85201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cross-sectional imaging with computed tomography or magnetic resonance imaging is routinely used to detect and diagnose liver lesions; however, these examinations can provide additional important information. The improvement of equipment and techniques has allowed outstanding evaluation of the vascular and biliary anatomy, which is practicable in most routine examinations. Anatomical variants may exclude patients from certain therapeutic options and may be the cause of morbidity or mortality after surgery or interventional procedures. Diffuse liver disease, such as steatosis, hemochromatosis, or fibrosis, must be diagnosed and quantified. Usually these conditions are silent until the late stages, and imaging plays an important role in detecting them early. Additionally, a background of diffuse disease may interfere in a focal lesion systematic reasoning. The diagnostic probability of a particular nodule varies according to the background liver disease. Nowadays, most diffuse liver diseases can be easily and accurately quantified by imaging, which has allowed better understanding of these diseases and improved patient management. Finally, cross-sectional imaging can calculate total and partial liver volumes and estimate the future liver remnant after hepatectomy. This information helps to select patients for portal vein embolization and reduces postoperative complications. Use of a specific hepatic contrast agent on magnetic resonance imaging, in addition to improving detection and characterization of focal lesions, provides functional global and segmental information about the liver parenchyma.
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Affiliation(s)
- Gustavo Felipe Luersen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Acton RT, Barton JC, Barton JC. Serum ferritin, insulin resistance, and metabolic syndrome: clinical and laboratory associations in 769 non-hispanic whites without diabetes mellitus in the HEIRS study. Metab Syndr Relat Disord 2014; 13:57-63. [PMID: 25423072 DOI: 10.1089/met.2014.0106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In some reports, serum ferritin (SF) has been associated with insulin resistance and metabolic syndrome. METHODS We studied non-Hispanic whites without diabetes mellitus in a postscreening examination. Participants included cases [HFE C282Y homozygosity; and transferrin saturation (TS) >50% and SF >300 μg/L (males) and TS >45% and SF >200 μg/dL (females), regardless of HFE genotype] and controls [HFE wild-type (wt/wt) and TS/SF 25th-75th percentiles]. We excluded participants with overnight fasts <8 hr, cirrhosis, hepatitis B or C, pregnancy, or missing data. Observations were age, sex, C282Y homozygosity, body mass index (BMI), systolic and diastolic blood pressures (SBP, DBP), lymphocytes, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), TS, SF, and glucose/insulin. Insulin resistance was defined as homeostasis model assessment of insulin resistance (HOMA-IR) 4th quartile (≥2.70). RESULTS A total of 407 women and 362 men (mean age 54 years) included 188 C282Y homozygotes and 371 wt/wt. Significant trends across HOMA-IR quartiles included age, male sex, BMI, SBP, DBP, lymphocytes, ALT, CRP >0.5 mg/dL (positive), and TS (negative). Multiple regression on HOMA-IR revealed significant associations with male sex, BMI, SBP, lymphocytes, ALT, CRP>0.5 mg/dL (positive), and DBP and SF (negative). Logistic regression on HOMA-IR 4th quartile revealed significant positive associations with age, male sex, BMI, and lymphocytes. Metabolic syndrome occurred in 53 participants (6.9%). Logistic regression on metabolic syndrome revealed these odds ratios: HOMA-IR 4th quartile [9.1 (4.8, 17.3)] and CRP >0.5 mg/dL [2.9 (1.6, 5.4)]. CONCLUSIONS Age, male sex, BMI, and lymphocytes were positively associated with HOMA-IR after correction for other factors. HOMA-IR 4th quartile and CRP >0.5 mg/dL predicted metabolic syndrome.
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Affiliation(s)
- Ronald T Acton
- 1 Department of Microbiology, University of Alabama at Birmingham , Birmingham, Alabama
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Wells SA. Quantification of Hepatic Fat and Iron with Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2014; 22:397-416. [PMID: 25086936 DOI: 10.1016/j.mric.2014.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Teixeira E, Borlido-Santos J, Brissot P, Butzeck B, Courtois F, Evans RW, Fernau J, Nunes JA, Mullett M, Paneque M, Pineau B, Porto G, Sorrill R, Sanchez M, Swinkels DW, Toska K, Varkonyi J. The importance of the general practitioner as an information source for patients with hereditary haemochromatosis. PATIENT EDUCATION AND COUNSELING 2014; 96:86-92. [PMID: 24857332 DOI: 10.1016/j.pec.2014.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/12/2014] [Accepted: 04/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore hereditary haemochromatosis (HH) patients' perspectives on genetic information, namely the types of sources used, preferred or trusted. METHODS A survey online was conducted by the European Federation of Associations of Patients with Haemochromatosis (EFAPH) and applied to members of nine National Associations. RESULTS From a total of 1019 validated questionnaires, 895 respondents had performed a genetic testing for HH. From these, 627 self-declared that they were sufficiently informed about the implications of the genetic test to their health. The majority (66%) obtained the information from a specialist doctor, but would like to obtain it from the family doctor. However, the specialist was still the one they trusted more (69%). Regarding the 298 respondents who did not feel sufficiently informed, the majority (78%) also would like to have information from the family doctor although they also trusted the specialist more (75%). A different perspective was reported when patients were asked about the implications of the genetic testing to their family members, where the majority of respondents preferred obtaining information from a specialist (69%). CONCLUSION This study elucidates the patients' needs for information and identifies the general practitioner (GP) as the preferred source to obtain information about HH. PRACTICE IMPLICATIONS These results may have important implications in future strategies for HH awareness, giving a special emphasis on GPs as the main players.
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Affiliation(s)
- Emerência Teixeira
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal; FCUP - Faculty of Science, University of Porto, Porto, Portugal
| | - Júlio Borlido-Santos
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - Pierre Brissot
- National Reference Centre for Rare Iron Overload Disorders of Genetic Origin and Inserm U-991, Pontchaillou University Hospital, Rennes, France
| | - Barbara Butzeck
- Haemochromatose-Vereinigung Deutschland e.V.(HVD), Koeln, Germany; EFAPH - European Federation of Associations of Patients with Haemochromatosis, Croissy-sur-Seine, France
| | - Françoise Courtois
- FFAMH - Fédération Française des Associations de Malades de l'Hemochromatose, Paris, France; EFAPH - European Federation of Associations of Patients with Haemochromatosis, Croissy-sur-Seine, France
| | - Robert W Evans
- Doctor-on-a-Chip Laboratory, Department of Electronic and Computer Engineering, School of Engineering and Design, Brunel University, Uxbridge, United Kingdom; The Haemochromatosis Society, Hertfordshire, United Kingdom
| | - Janet Fernau
- The Haemochromatosis Society, Hertfordshire, United Kingdom
| | | | | | - Milena Paneque
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal; CGPP - Centre for Predictive and Preventive Medicine, Porto, Portugal
| | - Brigitte Pineau
- FFAMH - Fédération Française des Associations de Malades de l'Hemochromatose, Paris, France
| | - Graça Porto
- IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal; CGPP - Centre for Predictive and Preventive Medicine, Porto, Portugal; CHP-HSA, Porto Hospital Center - Santo António Hospital, Porto, Portugal; Associação Portuguesa de Hemocromatose, Porto, Portugal.
| | - Robert Sorrill
- Associazione per lo Studio di Emocromatosi e delle Malattie da Sovraccarico di Ferro, Monza, Italy
| | - Mayka Sanchez
- IMPPC - Institute of Predictive and Personalized Medicine of Cancer, Badalona, Barcelona, Spain; IJC - Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic Diseases (LGEM 830) Radboud University Medical Centre, Nijmegen, The Netherlands; Hemochromatose Vereniging Nederland, Leidschendam, The Netherlands
| | - Ketil Toska
- Norwegian Haemochromatosis Association, Bergen, Norway
| | - Judit Varkonyi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary; Hemokromatozisos Betegek Eyesülete, Budapest, Hungary
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Hernando D, Levin YS, Sirlin CB, Reeder SB. Quantification of liver iron with MRI: state of the art and remaining challenges. J Magn Reson Imaging 2014; 40:1003-21. [PMID: 24585403 DOI: 10.1002/jmri.24584] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/14/2014] [Indexed: 12/11/2022] Open
Abstract
Liver iron overload is the histological hallmark of hereditary hemochromatosis and transfusional hemosiderosis, and can also occur in chronic hepatopathies. Iron overload can result in liver damage, with the eventual development of cirrhosis, liver failure, and hepatocellular carcinoma. Assessment of liver iron levels is necessary for detection and quantitative staging of iron overload and monitoring of iron-reducing treatments. This article discusses the need for noninvasive assessment of liver iron and reviews qualitative and quantitative methods with a particular emphasis on magnetic resonance imaging (MRI). Specific MRI methods for liver iron quantification include signal intensity ratio as well as R2 and R2* relaxometry techniques. Methods that are in clinical use, as well as their limitations, are described. Remaining challenges, unsolved problems, and emerging techniques to provide improved characterization of liver iron deposition are discussed.
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Affiliation(s)
- Diego Hernando
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Brissot P, Bardou-Jacquet E, Troadec MB, Mosser A, Island ML, Detivaud L, Loréal O, Jouanolle AM. Molecular diagnosis of genetic iron-overload disorders. Expert Rev Mol Diagn 2014; 10:755-63. [DOI: 10.1586/erm.10.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Evidence for the high importance of co-morbid factors in HFE C282Y/H63D patients cared by phlebotomies: results from an observational prospective study. PLoS One 2013; 8:e81128. [PMID: 24339903 PMCID: PMC3855242 DOI: 10.1371/journal.pone.0081128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/09/2013] [Indexed: 12/17/2022] Open
Abstract
Despite type I haemochromatosis (HC) is mainly associated with the HFE C282Y/C282Y genotype, a second genotype -C282Y/H63D- has mostly been described in other patients. Its association with HC, apart from any associated co-morbid factors, remains unclear and complex to interpret for physicians. This study assesses the weight of this genotype and the role of co-morbid factors in the occurrence of iron overload. This prospective study included the C282Y/C282Y (n = 172) and C282Y/H63D (n = 58) patients enrolled in a phlebotomy program between 2004 and 2007 in a blood centre of western Brittany (Brest, France), where HC is frequent. We compared prevalence of these two genotypes, as well as patients' profile regarding degree of iron overload and prevalence of co-morbid factors. First, we confirmed the obvious deficit of C282Y/H63D compound heterozygotes among patients cared by phlebotomies. This genotype was 3.0 times less frequent than the C282Y/C282Y genotype among those patients (18.9% vs. 56.0%) whereas it was 4.9 times more frequent in the general population (4.3% vs. 0.9%; p<0.0001). Despite a similar level of hyperferritinaemia, the C282Y/H63D patients who came to medical attention had a milder plasma iron overload, reflected by a lower transferrin saturation median (52.0% vs. 84.0%; p<0.0001). They also exhibited more frequently co-morbid factors, as heavy drinking (26.0% vs. 13.9%; p = 0.0454), overweight (66.7% vs. 39.4%; p = 0.0005) or both (21.3% vs. 2.6%; p<0.0001). Ultimately, they required a lower amount of iron removed to reach depletion (2.1 vs. 3.4 g; p<0.0001), clearly reflecting their lower tissue iron. This study confirms that H63D is a discrete genetic susceptibility factor whose expression is most visible in association with other co-factors. It highlights the importance of searching for co-morbidities in these diagnostic situations and of providing lifestyle and dietary advice.
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Abstract
Hereditary hemochromatosis is an inherited iron overload disorder caused by inappropriately low hepcidin secretion leading to increased duodenal absorption of dietary iron, most commonly in C282Y homozygous individuals. This can result in elevated serum ferritin, iron deposition in various organs and ultimately end-organ damage, although there is incomplete biochemical and clinical penetrance and variable phenotypic expression of the HFE mutation in hereditary hemochromatosis. An elevated SF >1000 mg/l [corrected] is associated with an increased risk of cirrhosis and mortality in C282Y homozygotes.Conversely, a SF <1000 µg/l is associated with a very low likelihood of cirrhosis, making liver biopsy unnecessary among C282Y homozygotes in the absence of concomitant risk factors for liver disease. Phlebotomy remains the mainstay of treatment and new treatments being studied include erythrocytapheresis and 'mini-hepcidins'. Iron overload is being recognized to play a carcinogenic role in hepatocellular carcinoma and other cancers, possibly supporting iron depletion in these patients.
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Affiliation(s)
- Pushpjeet Kanwar
- Liver Center for Excellence, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
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Mohammad A, Carey JJ, Storan E, Scarry M, Coughlan RJ, Lee JM. High prevalence of fibromyalgia in patients with HFE-related hereditary hemochromatosis. J Clin Gastroenterol 2013. [PMID: 23188073 DOI: 10.1097/mcg.0b013e31826f7ad7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Subjects with HFE-related hereditary hemochromatosis (HH) may present with arthralgias, fatigue, and stiffness, yet little is known on the presence of fibromyalgia syndrome (FMS) in these subjects. We determined the prevalence of FMS in a cohort of subjects with HH and evaluated its relationship to subject demographics, disease status, and quality of life. METHODS In a cross-sectional study we collected data on 395 consecutive subjects diagnosed with HH who were attending a tertiary referral Hepatology outpatient clinic at Galway University Hospital, Ireland (between October 2009 and June 2010). Subjects underwent a standard assessment including history, clinical examination, and functional assessments for pain and disability. Univariate logistic regression was applied to determine risk factors independently associated with prevalent FMS in these subjects. RESULTS Three hundred ninety-five subjects met the inclusion criteria. Mean age was 43 years (range, 21 to 59 y) and 260 (66%) were males. One hundred seventy (43%) of the subjects were diagnosed with FMS. Among those with fibromyalgia fatigue and ≥ 11 tender points were present in all of the subjects, widespread pain in 150 (88%), depression in 70 (41%), and arthralgia/joint stiffness in 70 (41%). In subjects with FMS 33% reported some functional impairment (HAQ-DI>0), with 10% reporting moderate-severe functional impairment (HAQ-DI ≥ 1.5). CONCLUSIONS This study reveals a high prevalence of FMS (43%) among subjects with HFE-related hemochromatosis. Prospective studies are needed to better understand the risk factors for FMS in such patients.
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Affiliation(s)
- Ausaf Mohammad
- Department of Rheumatology, Merlin Park University Hospital, Galway, Ireland.
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Sulpice L, Rayar M, Boucher E, Pele F, Pracht M, Meunier B, Boudjema K. Intrahepatic cholangiocarcinoma: impact of genetic hemochromatosis on outcome and overall survival after surgical resection. J Surg Res 2012. [PMID: 23183056 DOI: 10.1016/j.jss.2012.10.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The influence of genetic hemochromatosis (GH) on outcomes following surgical resections for intrahepatic cholangiocarcinoma (ICC) has not been evaluated. METHODS All patients with ICC who underwent a surgical resection between January 1997 and August 2011 were analyzed retrospectively. Risk factors were assessed by univariate and multivariate analyses. RESULTS Eighty-seven patients were analyzed; 16 of these patients (18.4%) had GH. Among the 71 non-GH patients, 52 (73.2%) and 19 (26.8%) had normal or cirrhotic parenchyma, respectively. There was no significant difference in survival between the GH and non-GH patients. A univariate analysis showed that major hepatectomy (P = 0.012), intraoperative blood transfusion (P = 0.007), tumor size >5 cm (P = 0.006), several nodules (P < 0.001), and microvascular invasion (P = 0.04) were significantly associated with poor survival. A multivariate analysis showed that intraoperative blood infusion (HR 0.37; CI 95% [0.19; 0.71]) and more than one nodule (HR 2.5; CI 95% [1.06; 5.8]) were associated with a lower survival rate. CONCLUSION Although the incidence of GH was high in our series, the presence of GH did not affect the outcomes after a liver hepatectomy for ICC. GH does not appear to increase recurrences or worsen the overall and disease-free survival.
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Affiliation(s)
- Laurent Sulpice
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France.
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Evaluation of MR imaging with T1 and T2* mapping for the determination of hepatic iron overload. Eur Radiol 2012; 22:2478-86. [PMID: 22645044 DOI: 10.1007/s00330-012-2506-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/30/2012] [Accepted: 04/15/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate MRI using T1 and T2* mapping sequences in patients with suspected hepatic iron overload (HIO). METHODS Twenty-five consecutive patients with clinically suspected HIO were retrospectively studied. All underwent MRI and liver biopsy. For the quantification of liver T2* values we used a fat-saturated multi-echo gradient echo sequence with 12 echoes (TR = 200 ms, TE = 0.99 ms + n × 1.41 ms, flip angle 20°). T1 values were obtained using a fast T1 mapping sequence based on an inversion recovery snapshot FLASH sequence. Parameter maps were analysed using regions of interest. RESULTS ROC analysis calculated cut-off points at 10.07 ms and 15.47 ms for T2* in the determination of HIO with accuracy 88 %/88 %, sensitivity 84 %/89.5 % and specificity 100 %/83 %. MRI correctly classified 20 patients (80 %). All patients with HIO only had decreased T1 and T2* relaxation times. There was a significant difference in T1 between patients with HIO only and patients with HIO and steatohepatitis (P = 0.018). CONCLUSIONS MRI-based T2* relaxation diagnoses HIO very accurately, even at low iron concentrations. Important additional information may be obtained by the combination of T1 and T2* mapping. It is a rapid, non-invasive, accurate and reproducible technique for validating the evidence of even low hepatic iron concentrations. KEY POINTS • Hepatic iron overload causes fibrosis, cirrhosis and increases hepatocellular carcinoma risk. • MRI detects iron because of the field heterogeneity generated by haemosiderin. • T2* relaxation is very accurate in diagnosing hepatic iron overload. • Additional information may be obtained by T1 and T2* mapping.
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Szőke D, Panteghini M. Diagnostic value of transferrin. Clin Chim Acta 2012; 413:1184-9. [PMID: 22546612 DOI: 10.1016/j.cca.2012.04.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 12/12/2022]
Abstract
Despite the growing interest in hepcidin and other relatively new biomarkers, guidelines and clinical pathways continue to recommend traditional markers, such as serum transferrin (Tf) and ferritin, as laboratory tests for the diagnostic evaluation of iron-related disorders. In this study, we aimed to critically evaluate the diagnostic role of Tf relying on the highest level of available evidence by a comprehensive literature search. The role of Tf in iron deficiency (ID) and iron overload (IO) syndrome as well as a risk marker was evaluated. The low accuracy of Tf and Tf saturation (TS) in the diagnosis and management of ID conditions does not permit definitively recommending their use, even if recently published guidelines still consider the TS investigation as a complementary test for ferritin. If a tissue IO is suspected, TS is often used, even if it may not be the best test for detecting this condition. Nevertheless, clinical guidelines strongly recommend the use of TS as a first-level test for performing genetic diagnosis of hereditary hemochromatosis. Recently reported data indicating elevated TS as a risk factor for diabetes mellitus, cancer, and total mortality, may provide useful additions to the debate over whether or not to screen for IO using TS.
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Affiliation(s)
- Dominika Szőke
- Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Dipartimento di Scienze Cliniche Luigi Sacco, Università degli Studi, Milano, Italy.
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Siddique A, Kowdley KV. Review article: the iron overload syndromes. Aliment Pharmacol Ther 2012; 35:876-93. [PMID: 22385471 DOI: 10.1111/j.1365-2036.2012.05051.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 06/26/2011] [Accepted: 02/08/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Iron overload syndromes encompass a wide range of hereditary and acquired conditions. Major developments in the field of genetics and the discovery of hepcidin as a central regulator of iron homeostasis have greatly increased our understanding of the pathophysiology of iron overload syndromes. AIM To review advances in iron regulation and iron overload syndrome with special emphasis on hereditary haemochromatosis, the prototype iron overload syndrome. METHODS A PubMed search using words such as 'iron overload', 'hemochromatosis', 'HFE', 'Non-HFE', 'secondary iron overload' was undertaken. RESULTS Iron overload is associated with significant morbidity and mortality. Sensitive diagnostic tests and effective therapy are widely available and can prevent complications associated with iron accumulation in end- organs. Therapeutic phlebotomy remains the cornerstone of therapy for removal of excess body iron, but novel therapeutic agents including oral iron chelators have been developed for iron overload associated with anaemia. CONCLUSIONS Iron overload disorders are common. Inexpensive screening tests as well as confirmatory diagnostic tests are widely available. Increased awareness of the causes and importance of early diagnosis and knowledge of the appropriate use of genetic testing are encouraged. The availability of novel treatments should increase therapeutic options for patients with iron overload disorders.
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Affiliation(s)
- A Siddique
- Department of Hepatology, Virginia Mason Medical Center, Seattle, WA, USA.
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