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Abdominal Lymphadenopathy in ß-Thalassemia: MRI Features and Correlation with Liver Iron Overload and Posttransfusion Chronic Hepatitis C

¹ Department of Radiology, MRI Unit, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece.
³ First Department of Pediatrics, "Aghia Sophia" Children's Hospital, Thalassemia Unit, University of Athens, Athens, Greece.
⁴ Thalassemia Unit, "Aghios Georgios" Hospital, Chania, Greece.

View larger version (113K): [in a new window]   Fig. 1A —29-year-old woman with ß-thalassemia, severe iron overload (serum ferritin, 5,300 ng/mL), and mild level of activity of chronic hepatitis C. T1-weighted gradient-echo image shows multiple hypointense perihepatic lymph nodes (arrows). Both liver and spleen are markedly hypointense with signal intensities equal to background noise.

View larger version (112K): [in a new window]   Fig. 1B —29-year-old woman with ß-thalassemia, severe iron overload (serum ferritin, 5,300 ng/mL), and mild level of activity of chronic hepatitis C. T1-weighted gradient-echo image shows paraortic lymph node is in caudal section (arrow), with signal equal to background noise. Lymph node-to-muscle signal intensity (SI) ratio is 0.08; liver-to-muscle SI ratio, 0.045; and spleen-to-muscle SI ratio, 0.07.

View larger version (114K): [in a new window]   Fig. 2 —26-year-old man with ß-thalassemia and severe iron overload (serum ferritin, 3,200 ng/mL). T1-weighted gradient-echo image shows hypointense lymph nodes at porta hepatis (arrow) with signal intensities equal to that of liver. Spleen is enlarged but is less hypointense than liver—that is, with less iron deposition. Lymph node-to-muscle signal intensity (SI) ratio is 0.06; liver-to-muscle SI ratio, 0.055; and spleen-to-muscle SI ratio, 0.64.

View larger version (131K): [in a new window]   Fig. 3 —34-year-old woman with ß-thalassemia, moderate iron overload (serum ferritin, 1,120 ng/mL), and severe activity of hepatic inflammation with histologic findings of hepatic cirrhosis; patient underwent splenectomy 16 years earlier. T1-weighted gradient-echo image shows multiple enlarged and hypointense perihepatic lymph nodes (arrows). Both liver and lymph nodes are moderately hypointense. Lymph node-to-muscle signal intensity (SI) ratio is 0.73 and liver-to-muscle SI ratio is 0.77.

View larger version (17K): [in a new window]   Fig. 4 —Graph shows correlation between liver-to-muscle and lymph node-to-muscle signal intensity ratios on T1-weighted gradient-echo sequence (TR/TE, 182/4.6; flip angle, 90°) for 19 thalassemic patients with abdominal lymphadenopathy (r =0.83, p < 0001).

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