Accuracy of magnetic resonance imaging in diagnosis of liver iron overload: A systematic review and meta-analysis

Maria Sarigianni, Aris Liakos, Efthymia Vlachaki, Paschalis Paschos, Eleni Athanasiadou, Victor Manuel Montori, Mohammad H Murad, Apostolos Tsapas

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background & Aims: Guidelines advocate use of magnetic resonance imaging (MRI) to estimate concentrations of iron in liver, to identify patients with iron overload, and to guide titration of chelation therapy. However, this recommendation was not based on a systematic synthesis and analysis of the evidence for MRI's diagnostic accuracy. Methods: We conducted a systematic review and meta-analysis to investigate the diagnostic accuracy of MRI in identifying liver iron overload in patients with hereditary hemochromatosis, hemoglobinopathy, or myelodysplastic syndrome; liver biopsy analysis was used as the reference standard. We searched MEDLINE and EMBASE databases, the Cochrane Library, and gray literature, and computed summary receiver operating curves by fitting hierarchical models. We assessed methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: Our final analysis included 20 studies (819 patients, total). Sensitivity and specificity values varied greatly, ranging from 0.00 to 1.00 and from 0.50 to 1.00, respectively. Because of substantial heterogeneity and variable positivity thresholds, we calculated only summary receiver operating curves (and summary estimate points for studies that used the same MRI sequences). T2 spin echoand T2* gradient-recalled echo MRI sequences accurately identified patients without liver iron overload (liver iron concentration > 7 mg Fe/g dry liver weight) (negative likelihood ratios, 0.10 and 0.05 respectively). However, these MRI sequences are less accurate in establishing a definite diagnosis of liver iron overload (positive likelihood ratio, 8.85 and 4.86, respectively). Conclusions: Based on a meta-analysis, measurements of liver iron concentration by MRI may be accurate enough to rule out iron overload, but not to definitely identify patients with this condition. Most studies did not use explicit and prespecified MRI thresholds for iron overload, therefore some patients may have been diagnosed inaccurately with this condition. More studies are needed of standardized MRI protocols and to determine the effects of MRI surveillance on the development of chronic liver disease and patient survival.

Original languageEnglish (US)
Pages (from-to)55-63
Number of pages9
JournalClinical Gastroenterology and Hepatology
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Iron Overload
Meta-Analysis
Magnetic Resonance Imaging
Liver
Iron
Chelation Therapy
Hemoglobinopathies
Hemochromatosis
Myelodysplastic Syndromes
MEDLINE
Libraries
Liver Diseases
Chronic Disease
Databases
Guidelines
Biopsy
Weights and Measures
Sensitivity and Specificity
Survival

Keywords

  • Diagnostic accuracy meta-analysis
  • Sickle cell disease
  • Thalassemia

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Accuracy of magnetic resonance imaging in diagnosis of liver iron overload : A systematic review and meta-analysis. / Sarigianni, Maria; Liakos, Aris; Vlachaki, Efthymia; Paschos, Paschalis; Athanasiadou, Eleni; Montori, Victor Manuel; Murad, Mohammad H; Tsapas, Apostolos.

In: Clinical Gastroenterology and Hepatology, Vol. 13, No. 1, 01.01.2015, p. 55-63.

Research output: Contribution to journalArticle

Sarigianni, Maria ; Liakos, Aris ; Vlachaki, Efthymia ; Paschos, Paschalis ; Athanasiadou, Eleni ; Montori, Victor Manuel ; Murad, Mohammad H ; Tsapas, Apostolos. / Accuracy of magnetic resonance imaging in diagnosis of liver iron overload : A systematic review and meta-analysis. In: Clinical Gastroenterology and Hepatology. 2015 ; Vol. 13, No. 1. pp. 55-63.
@article{727af612d8454db891d9e65d0c6d62ed,
title = "Accuracy of magnetic resonance imaging in diagnosis of liver iron overload: A systematic review and meta-analysis",
abstract = "Background & Aims: Guidelines advocate use of magnetic resonance imaging (MRI) to estimate concentrations of iron in liver, to identify patients with iron overload, and to guide titration of chelation therapy. However, this recommendation was not based on a systematic synthesis and analysis of the evidence for MRI's diagnostic accuracy. Methods: We conducted a systematic review and meta-analysis to investigate the diagnostic accuracy of MRI in identifying liver iron overload in patients with hereditary hemochromatosis, hemoglobinopathy, or myelodysplastic syndrome; liver biopsy analysis was used as the reference standard. We searched MEDLINE and EMBASE databases, the Cochrane Library, and gray literature, and computed summary receiver operating curves by fitting hierarchical models. We assessed methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: Our final analysis included 20 studies (819 patients, total). Sensitivity and specificity values varied greatly, ranging from 0.00 to 1.00 and from 0.50 to 1.00, respectively. Because of substantial heterogeneity and variable positivity thresholds, we calculated only summary receiver operating curves (and summary estimate points for studies that used the same MRI sequences). T2 spin echoand T2* gradient-recalled echo MRI sequences accurately identified patients without liver iron overload (liver iron concentration > 7 mg Fe/g dry liver weight) (negative likelihood ratios, 0.10 and 0.05 respectively). However, these MRI sequences are less accurate in establishing a definite diagnosis of liver iron overload (positive likelihood ratio, 8.85 and 4.86, respectively). Conclusions: Based on a meta-analysis, measurements of liver iron concentration by MRI may be accurate enough to rule out iron overload, but not to definitely identify patients with this condition. Most studies did not use explicit and prespecified MRI thresholds for iron overload, therefore some patients may have been diagnosed inaccurately with this condition. More studies are needed of standardized MRI protocols and to determine the effects of MRI surveillance on the development of chronic liver disease and patient survival.",
keywords = "Diagnostic accuracy meta-analysis, Sickle cell disease, Thalassemia",
author = "Maria Sarigianni and Aris Liakos and Efthymia Vlachaki and Paschalis Paschos and Eleni Athanasiadou and Montori, {Victor Manuel} and Murad, {Mohammad H} and Apostolos Tsapas",
year = "2015",
month = "1",
day = "1",
doi = "10.1016/j.cgh.2014.05.027",
language = "English (US)",
volume = "13",
pages = "55--63",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Accuracy of magnetic resonance imaging in diagnosis of liver iron overload

T2 - A systematic review and meta-analysis

AU - Sarigianni, Maria

AU - Liakos, Aris

AU - Vlachaki, Efthymia

AU - Paschos, Paschalis

AU - Athanasiadou, Eleni

AU - Montori, Victor Manuel

AU - Murad, Mohammad H

AU - Tsapas, Apostolos

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background & Aims: Guidelines advocate use of magnetic resonance imaging (MRI) to estimate concentrations of iron in liver, to identify patients with iron overload, and to guide titration of chelation therapy. However, this recommendation was not based on a systematic synthesis and analysis of the evidence for MRI's diagnostic accuracy. Methods: We conducted a systematic review and meta-analysis to investigate the diagnostic accuracy of MRI in identifying liver iron overload in patients with hereditary hemochromatosis, hemoglobinopathy, or myelodysplastic syndrome; liver biopsy analysis was used as the reference standard. We searched MEDLINE and EMBASE databases, the Cochrane Library, and gray literature, and computed summary receiver operating curves by fitting hierarchical models. We assessed methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: Our final analysis included 20 studies (819 patients, total). Sensitivity and specificity values varied greatly, ranging from 0.00 to 1.00 and from 0.50 to 1.00, respectively. Because of substantial heterogeneity and variable positivity thresholds, we calculated only summary receiver operating curves (and summary estimate points for studies that used the same MRI sequences). T2 spin echoand T2* gradient-recalled echo MRI sequences accurately identified patients without liver iron overload (liver iron concentration > 7 mg Fe/g dry liver weight) (negative likelihood ratios, 0.10 and 0.05 respectively). However, these MRI sequences are less accurate in establishing a definite diagnosis of liver iron overload (positive likelihood ratio, 8.85 and 4.86, respectively). Conclusions: Based on a meta-analysis, measurements of liver iron concentration by MRI may be accurate enough to rule out iron overload, but not to definitely identify patients with this condition. Most studies did not use explicit and prespecified MRI thresholds for iron overload, therefore some patients may have been diagnosed inaccurately with this condition. More studies are needed of standardized MRI protocols and to determine the effects of MRI surveillance on the development of chronic liver disease and patient survival.

AB - Background & Aims: Guidelines advocate use of magnetic resonance imaging (MRI) to estimate concentrations of iron in liver, to identify patients with iron overload, and to guide titration of chelation therapy. However, this recommendation was not based on a systematic synthesis and analysis of the evidence for MRI's diagnostic accuracy. Methods: We conducted a systematic review and meta-analysis to investigate the diagnostic accuracy of MRI in identifying liver iron overload in patients with hereditary hemochromatosis, hemoglobinopathy, or myelodysplastic syndrome; liver biopsy analysis was used as the reference standard. We searched MEDLINE and EMBASE databases, the Cochrane Library, and gray literature, and computed summary receiver operating curves by fitting hierarchical models. We assessed methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: Our final analysis included 20 studies (819 patients, total). Sensitivity and specificity values varied greatly, ranging from 0.00 to 1.00 and from 0.50 to 1.00, respectively. Because of substantial heterogeneity and variable positivity thresholds, we calculated only summary receiver operating curves (and summary estimate points for studies that used the same MRI sequences). T2 spin echoand T2* gradient-recalled echo MRI sequences accurately identified patients without liver iron overload (liver iron concentration > 7 mg Fe/g dry liver weight) (negative likelihood ratios, 0.10 and 0.05 respectively). However, these MRI sequences are less accurate in establishing a definite diagnosis of liver iron overload (positive likelihood ratio, 8.85 and 4.86, respectively). Conclusions: Based on a meta-analysis, measurements of liver iron concentration by MRI may be accurate enough to rule out iron overload, but not to definitely identify patients with this condition. Most studies did not use explicit and prespecified MRI thresholds for iron overload, therefore some patients may have been diagnosed inaccurately with this condition. More studies are needed of standardized MRI protocols and to determine the effects of MRI surveillance on the development of chronic liver disease and patient survival.

KW - Diagnostic accuracy meta-analysis

KW - Sickle cell disease

KW - Thalassemia

UR - http://www.scopus.com/inward/record.url?scp=84916915830&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84916915830&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2014.05.027

DO - 10.1016/j.cgh.2014.05.027

M3 - Article

C2 - 24993364

AN - SCOPUS:84916915830

VL - 13

SP - 55

EP - 63

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 1

ER -