Dual-Energy X-ray Absorptiometry With Serum Ferritin Predicts Liver Iron Concentration and Changes in Concentration Better Than Ferritin Alone

Shepherd, John A.; Fan, Bo; Lu, Ying; Marquez, Lorena; Salama, Khaled; Hwang, Jimmy; Fung, Ellen B.

doi:10.1016/j.jocd.2010.05.003

« Previous Next »Journal of Clinical Densitometry
Volume 13, Issue 4 , Pages 399-406, October 2010

Dual-Energy X-ray Absorptiometry With Serum Ferritin Predicts Liver Iron Concentration and Changes in Concentration Better Than Ferritin Alone

John A. Shepherd
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
- Address correspondence to: John A. Shepherd, PhD, Department of Radiology and Biomedical Imaging, University of California at San Francisco, 1635 Divisadero Street, Suite 525, San Francisco, CA 94115.
Bo Fan
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
Ying Lu
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
Lorena Marquez
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
Khaled Salama
- Department of Pediatrics, University of Cairo, Cairo, Egypt
Jimmy Hwang
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
Ellen B. Fung
- Children's Hospital Oakland Research Institute, Oakland, CA, USA

Received 18 November 2009; received in revised form 3 May 2010; accepted 4 May 2010. published online 22 July 2010.

Abstract

Accurate assessment of liver iron concentration (LIC) is critical for optimal monitoring of iron toxicity in multitransfused patients. Serum ferritin is the most widely used although its association to LIC is only modest. We studied if a liver-specific measure using dual-energy X-ray absorptiometry (DXA) systems could improve LIC estimates over ferritin alone in Thalassemia (Thal) patients. Thirty-seven patients with Thal (19.2±9.0yr, 20 male) were studied and 10 had multiple visits. Height, weight, ferritin, whole-body DXA, and hepatic superconducting quantum interference device (SQUID) were measured within 5wk. DXA hepatic density was measured using right rib, whole liver, and multiple subliver regions. The best agreement to SQUID LIC was found using a combination of ferritin, weight, DXA subliver region 3 bone mineral content (BMC), and right rib BMC. DXA with ferritin improved the ferritin alone correlation from R²=0.35 to R²=0.62. Serial LIC changes using DXA were associated with serial SQUID changes (r=0.73, p=0.02). Changes in ferritin alone were not significant (p=0.06). We conclude that the addition of whole-body DXA measures and body weight substantially increased the accuracy of LIC and change in LIC estimates over the use of ferritin alone and could be useful when magnetic resonance imaging or SQUID is not available.