Blood and Lymph Conditions

Diseases and Abnormalities at or Before Birth

All Conditions

Nutritional and Metabolic Diseases

Rare Diseases

Anemia, Sickle Cell

Thalassemia

Iron Overload

Hemochromatosis

Hemosiderosis

Metabolic Diseases

Iron Metabolism Disorders

Sickle Cell Anemia

Hemochromatosis Type 3

Micronutrients

All Drugs and Chemicals

Hematinics

Iron

Liver Extracts

Patients with iron overload or excessive body iron burden, a serious condition resulting from increased dietary gastro¬intestinal absorption, multiple erythrocyte transfusions, or both.

Interventions: R2\*-UTE, R2\*-GRE, and if clinically indicated, liver biopsy.

Ultra short echo time (UTE) magnetic resonance imaging (MRI). Study participants will undergo an MRI examination of the liver on a 1.5T MRI and a 3T MRI scanner each. Because liver biopsy metal needle fragments could interfere with the MRI measurements, the MRI exams will always precede liver biopsy. Multi-echo GRE sequences will be used to acquire images with increasing TEs. Images of the liver will be obtained in transversal slice orientation through the center of the liver at the level of the origin of the main portal vein. At equivalent slice locations R2\*-UTE scans will be performed.

R2*-UTE

Gradient-echo (GRE) magnetic resonance imaging (MRI). Study participants will undergo an MRI examination of the liver on a 1.5T MRI and a 3T MRI scanner each. Because liver biopsy metal needle fragments could interfere with the MRI measurements, the MRI exams will always precede liver biopsy. Multi-echo GRE sequences will be used to acquire images with increasing TEs. Images of the liver will be obtained in transversal slice orientation through the center of the liver at the level of the origin of the main portal vein. At equivalent slice locations R2\*-UTE scans will be performed.

R2*-GRE

Indications for liver biopsy include, but are not limited, to the need to quantify liver tissue iron and the need to obtain histopathological information of the liver tissue. Liver biopsies will only be performed if clinically indicated and will be done only once per patient. The technique to be used is coaxial percutaneous (transcapsular) technique; however, a coaxial transjugular technique may be performed in subjects with increased bleeding diathesis, since it is associated with less hemorrhagic risk. Healthy volunteers will not undergo liver biopsy.

Liver biopsy

Jane Hankins, MD, MS

Iron overload is a severe complication of multiple blood transfusions. As the body has no physiologic mechanism for clearing iron, repeated transfusions cause iron accumulation in organs and lead to iron toxicity. Accurate assessment of iron overload is paramount to quantify excessive iron accumulation and to monitor response to iron chelation therapy. Magnetic resonance imaging (MRI) methods have been used to noninvasively measure hepatic iron concentration (HIC). Although MRI-based measurements of transverse relaxation rates (R2 and R2\*) accurately predict biopsy-proven HICs below 15 mg Fe/g, previous studies have shown that their precision is limited for HICs above 15 mg Fe/g and inaccurate above 25 mg Fe/g. Current R2\* gradient-echo (GRE) MR techniques fail occasionally for very high iron overloads (HIC \~ 15-25 mg Fe/g) and always for massive iron overloads (HIC \> 25 mg Fe/g) because R2\* is so high that the MR signal decays before it can be measured accurately.

Overall accrual: 200 patients

Purpose: To determine if a new MRI (UTE) can measure the amount of iron in the liver of people with large amounts of iron and compare the results with the same patient's liver bx. Estimated patient accrual is 150. It is estimated that 41 of these patients will have clinical indication for liver biopsy.

The MIDAS study is a prospective and non-therapeutic study that will test a new MRI technique for the assessment of iron overload in the liver: the newly developed ultra short echo time (UTE), R2\*-UTE. The R2\*-UTE technique, developed by St. Jude investigators from the Department of Radiological Sciences, will be first tested in healthy volunteers for feasibility and implementation of the technique. The technique will then be tested in research participants, who will have both the R2\*-GRE and the R2\*-UTE techniques performed, in addition to a liver biopsy for liver iron quantitation if clinically indicated. Quantitation of liver tissue iron will be done at Mayo Clinic Laboratory in Rochester, Minnesota.

Primary Objective:

* To test the association of hepatic iron content (HIC) measured with the newly developed 1.5T R2\*-UTE technique and HIC quantified by liver biopsy in subjects with iron overload.

Secondary Objectives:

* To explore the relationship between 1.5T R2\*-UTE and 1.5T R2\*-GRE measurements in subjects with iron overload.
* To explore the relationship between 1.5T R2\*-UTE measurements with iron studies (serum iron and transferrin saturation) in subjects with iron.

Massive Iron Deposit Assessment

Hepatic iron content in the liver using liver biopsy

Hepatic iron content of the liver using MRI-derived 1.5T R2\*-UTE measurement, with results in Hz. R2\* is a measure obtained with MRI, i.e., MRI R2\*. It is measured in hertz (Hz). In lay terms, the MRI machine picks up a signal back from the tissue during the process of scanning the tissues. With every "picture taken", this signal is strong in the beginning and then wanes off. R2\* reflects how fast the signal wanes off. If there is too much iron in the tissue, the signal disappears faster, making the T2\* value low. T2\* is the reciprocal of R2\* (R2\*= 1/T2\*). So, if the signal drops fast, the T2\* is low and the R2\* is high. In this study, we are measuring the R2\* value. The higher the R2\*, the more iron in the liver tissue. We can compare the R2\* value with that of a liver biopsy to then use the R2\* value to tell us how much iron is in the liver without having to biopsy the liver.

MRI-derived R2\* Using 1.5T GRE Technique in Hz. R2\* is a measure obtained with MRI, i.e., MRI R2\*. It is measured in hertz (Hz). In lay terms, the MRI machine picks up a signal back from the tissue during the process of scanning the tissues. With every "picture taken", this signal is strong in the beginning and then wanes off. R2\* reflects how fast the signal wanes off. If there is too much iron in the tissue, the signal disappears faster, making the T2\* value low. T2\* is the reciprocal of R2\* (R2\*= 1/T2\*). So, if the signal drops fast, the T2\* is low and the R2\* is high. In this study, we are measuring the R2\* value. The higher the R2\*, the more iron in the liver tissue. We can compare the R2\* value with that of a liver biopsy to then use the R2\* value to tell us how much iron is in the liver without having to biopsy the liver.

MRI-derived R2\* value using 1.5T R2\*-UTE in Hz. R2\* is a measure obtained with MRI, i.e., MRI R2\*. It is measured in hertz (Hz). In lay terms, the MRI machine picks up a signal back from the tissue during the process of scanning the tissues. With every "picture taken", this signal is strong in the beginning and then wanes off. R2\* reflects how fast the signal wanes off. If there is too much iron in the tissue, the signal disappears faster, making the T2\* value low. T2\* is the reciprocal of R2\* (R2\*= 1/T2\*). So, if the signal drops fast, the T2\* is low and the R2\* is high. In this study, we are measuring the R2\* value. The higher the R2\*, the more iron in the liver tissue. We can compare the R2\* value with that of a liver biopsy to then use the R2\* value to tell us how much iron is in the liver without having to biopsy the liver.

MRI-derived R2\* value using 1.5T R2\*-UTE in Hz for patients who have had serum iron and transferrin saturation measurements. R2\* is a measure obtained with MRI, i.e., MRI R2\*. It is measured in hertz (Hz). In lay terms, the MRI machine picks up a signal back from the tissue during the process of scanning the tissues. With every "picture taken", this signal is strong in the beginning and then wanes off. R2\* reflects how fast the signal wanes off. If there is too much iron in the tissue, the signal disappears faster, making the T2\* value low. T2\* is the reciprocal of R2\* (R2\*= 1/T2\*). So, if the signal drops fast, the T2\* is low and the R2\* is high. In this study, we are measuring the R2\* value. The higher the R2\*, the more iron in the liver tissue. We can compare the R2\* value with that of a liver biopsy to then use the R2\* value to tell us how much iron is in the liver without having to biopsy the liver.

Serum iron measurements from eligible patients had 1.5T R2\*-UTE and serum iron and transferrin saturation measurements.

Iron Transferrin Saturation in % measurements Transferrin Saturation measurements from eligible patients had 1.5T R2\*-UTE and serum iron and transferrin saturation measurements.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Regional One Health

St. Jude Children's Research Hospital

Eligible iron-overloaded patients with both liver biopsy measurement and 1.5T R2\*-UTE measurement

Iron-overloaded Patients

All eligible patients with history of 12 or more lifetime erythrocyte transfusions, and need for liver iron content assessment

Arm 1

Age, Categorical

Age, Continuous

Sex: Female, Male

Ethnicity (NIH/OMB)

Asian

Black or African American

White

More than one race

Unknown or Not Reported

Race/Ethnicity, Customized

United States

Region of Enrollment

Jane Hankins, MD

Eligible iron-overloaded patients with both liver biopsy measurement and 1.5T R2\*-UTE measurement.

Hepatic Iron Content in the Liver Using Liver Biopsy

MRI-derived R2* Values Using 1.5T UTE Technique

Iron-overloaded patients defined as having more than 12 transfusions in their lifetime as measured with R2\* using 1.5T GRE.

Iron-overloaded patients had 1.5T R2\*-GRE measurements.

MRI-derived R2* Using 1.5T GRE Technique

Iron-overloaded patients with R2\* using 1.5T UTE

Iron-overloaded patients had 1.5T R2\*-UTE-measurement.

MRI Derived R2* Using 1.5T UTE Technique

1.5T R2\*-UTE from eligible patients who had 1.5T R2\*-UTE, serum iron, and transferrin saturation measurements.

R2* Using 1.5T UTE Technique for Patients With Serum Iron and Transferrin Saturation Measurements

Serum Iron Measurements

Iron-overloaded patients had 1.5T R2\*-UTE and serum iron and transferrin saturation measurements.

Serum Iron Measurements Compared With 1.5T R2* UTE

Iron-overloaded patients with 1.5T R2\*-UTE and serum iron and transferrin saturation measurements.

Transferrin Saturation Measurements

All eligible patients with history of 12 or more lifetime erythrocyte transfusions, and need for liver iron content assessment.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Massive Iron Deposit Assessment	NCT01572922	Iron Overload Excessive Body ...	R2-UTE R2-GRE Liver biopsy	-	St. Jude Children's Research Hospital
Massive Iron Deposit Assessment	NCT01572922	Iron Overload Excessive Body ...	R2-UTE R2-GRE Liver biopsy	-	St. Jude Children's Research Hospital

Spots Global Cancer Trial Database for excessive body iron burden