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

John A. Shepherd1Corresponding Author Informationemail address, Bo Fan1, Ying Lu1, Lorena Marquez1, Khaled Salama2, Jimmy Hwang1, Ellen B. Fung3

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

1 Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA

2 Department of Pediatrics, University of Cairo, Cairo, Egypt

3 Children's Hospital Oakland Research Institute, Oakland, CA, USA

Corresponding Author InformationAddress 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.

PII: S1094-6950(10)00191-5

doi:10.1016/j.jocd.2010.05.003