Kidney R2* Mapping for Noninvasive Evaluation of Iron Overload in Paroxysmal Nocturnal Hemoglobinuria

Koichi Ito; Kazuyuki Ohgi; Koichiro Kimura; Koichi Ishitaki; Akiyoshi Yamashita; Hiroyuki Yokote; Shunji Tsukuda; Ko Matsushita; Yuko Naraoka; Amon Fujioka; Tatsuki Ono

doi:10.2463/mrms.mp.2023-0114

MAJOR PAPER

Kidney R2* Mapping for Noninvasive Evaluation of Iron Overload in Paroxysmal Nocturnal Hemoglobinuria

Koichi Ito , Kazuyuki Ohgi, Koichiro Kimura, Koichi Ishitaki, Akiyoshi Yamashita, Hiroyuki Yokote, Shunji Tsukuda, Ko Matsushita, Yuko Naraoka, Amon Fujioka, Tatsuki Ono

Author information

Koichi Ito Corresponding author
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Kazuyuki Ohgi
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Koichiro Kimura
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Department of Diagnostic Radiology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
Koichi Ishitaki
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Department of Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kanagawa, Kawasaki, Japan
Akiyoshi Yamashita
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Hiroyuki Yokote
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Shunji Tsukuda
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Ko Matsushita
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Yuko Naraoka
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Amon Fujioka
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
Tatsuki Ono
Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan

Keywords: iron deposition, kidney, magnetic resonance imaging, paroxysmal nocturnal hemoglobinuria, R2* mapping

JOURNAL OPEN ACCESS

2025 Volume 24 Issue 2 Pages 204-209

DOI https://doi.org/10.2463/mrms.mp.2023-0114

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Abstract

Purpose: The kidney iron deposition can cause kidney damage and renal insufficiency in paroxysmal nocturnal hemoglobinuria (PNH) patients. Assessment of iron deposition in the kidney is essential for the early diagnosis of renal damage in PNH patients. The purpose of this study was to evaluate kidney R2* (T2* reciprocals) values in PNH patients using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ).

Methods: Two radiologists measured the R2* values of the renal cortex in 14 PNH patients and 13 healthy volunteers using IDEAL-IQ. Lactate dehydrogenase (LDH), a reliable marker of intravascular hemolysis, was also measured in all participants.

Results: The kidney R2* values were significantly higher in PNH patients compared with those in healthy volunteers (P < 0.001). High inter-operator reproducibility of the measurements was also acquired using IDEAL-IQ. LDH levels were also significantly higher in PNH patients compared with those in healthy volunteers (P < 0.001). Kidney R2* values strongly correlated with LDH levels in PNH patients.

Conclusion: IDEAL-IQ has a possibility of becoming a useful method for the noninvasive evaluation of renal iron overload in PNH patients.

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