Comparison of whole liver and small region-of-interest measurements of MRI liver R2* in children with iron overload

M. Beth McCarville, Claudia M. Hillenbrand, Ralf B. Loeffler, Matthew P. Smeltzer, Ruitan Song, Chin-Shang Li, Jane S. Hankins

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Background: Measurement of liver MRI T2* and R2* is emerging as a reliable alternative to liver biopsy for the quantitation of liver iron content. A systematic investigation of the influence of the region-of-interest size and placement has not been conducted. Objective: To compare small and whole liver region-of-interest (ROI) MRI R2* values to each other and to biopsy liver iron content in patients with iron overload. Materials and methods: Forty-one iron-overloaded patients, ages 7-35 years, underwent biopsy for liver iron content quantitation and MRI for liver R2* measurement within 30 days. Three reviewers independently used small and whole liver ROIs to measure R2*. Inter-reviewer agreement was assessed with the intra-class correlation coefficient (ICC). Associations between R2* and liver iron content were investigated using Spearman's rank-order correlation and Monte Carlo estimated exact P values. Results: Biopsy liver iron content and small and whole liver ROI R2* measurements were strongly associated for all reviewers (all P < 0.0001). Although inter-reviewer agreement was excellent for both ROI methods (ICC = 0.98-0.99), the small ROI technique more frequently led to inter-reviewer differences larger than 75 Hz, slightly higher R2* values, larger standard errors and greater range in values. Conclusion: Small and whole liver ROI techniques are strongly associated with biopsy liver iron content. We found slightly greater inter-reviewer variability in R2* values using the small ROI technique. Because such variability could adversely impact patient management when R2* values are near a threshold of iron chelation therapy, we recommend using a whole liver ROI.

Original languageEnglish (US)
Pages (from-to)1360-1367
Number of pages8
JournalPediatric Radiology
Issue number8
StatePublished - Aug 2010
Externally publishedYes


  • Iron overload
  • Liver iron content
  • MRI
  • Sickle cell anemia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)


Dive into the research topics of 'Comparison of whole liver and small region-of-interest measurements of MRI liver R2* in children with iron overload'. Together they form a unique fingerprint.

Cite this