Siderosis

In patients suffering from transfusional siderosis, the liver shows a similar decrease in SI as that seen in hemochromatosis. However, transfusional siderosis can easily be distinguished by examination of the SI of the spleen and pancreas. While the spleen demonstrates decreased SI in patients with transfusional siderosis, it usually does not show any SI decrease in cases of hemochromatosis. In contrast, the pancreas usually demonstrates a significant drop of SI in cases of hemochromatosis,but remains unchanged in patients with transfusional siderosis; only in cases of extreme transfusional

Fig. 11a-j. Patient with longstanding hemochromatosis and subsequent development of liver cirrhosis and portal hypertension. The T2-weighted images (a-f) show typical signs of liver cirrhosis with hypertrophy of liver segment I and a nodular surface of the liver. Due to the already advanced liver cirrhosis, the SI of the liver parenchyma is not as low as in cases of hemochromatosis without cirrhosis since the inflammatory changes in cirrhosis increase the SI of the liver. However, a decreased SI of the pancreatic tissue (b-d) can be noted together with the beginnings of pancreatic atrophy. The spleen is enlarged and multiple collateral vessels in the splenic hilum can be depicted, draining into the left renal vein (b-f) (arrows). On pre-contrast Tl-weighted images (g), multiple small areas of low SI can be noted that correspond to areas of increased iron storage. The nodular appearance of the cirrhotic liver is much more obvious on dynamic images after Gd-BOPTA, shown here in the arterial phase (h) and portal-venous phase (i). Additionally, irregular portal-venous collaterals (arrow) can be seen near the small curvature of the stomach on the portal-venous phase image (i). Only a slight increase of liver parenchymal SI can be noted on the hepatobiliary phase image (j), although excretion of Gd-BOPTA into the gall bladder is evident

Fig. 11a-j. Patient with longstanding hemochromatosis and subsequent development of liver cirrhosis and portal hypertension. The T2-weighted images (a-f) show typical signs of liver cirrhosis with hypertrophy of liver segment I and a nodular surface of the liver. Due to the already advanced liver cirrhosis, the SI of the liver parenchyma is not as low as in cases of hemochromatosis without cirrhosis since the inflammatory changes in cirrhosis increase the SI of the liver. However, a decreased SI of the pancreatic tissue (b-d) can be noted together with the beginnings of pancreatic atrophy. The spleen is enlarged and multiple collateral vessels in the splenic hilum can be depicted, draining into the left renal vein (b-f) (arrows). On pre-contrast Tl-weighted images (g), multiple small areas of low SI can be noted that correspond to areas of increased iron storage. The nodular appearance of the cirrhotic liver is much more obvious on dynamic images after Gd-BOPTA, shown here in the arterial phase (h) and portal-venous phase (i). Additionally, irregular portal-venous collaterals (arrow) can be seen near the small curvature of the stomach on the portal-venous phase image (i). Only a slight increase of liver parenchymal SI can be noted on the hepatobiliary phase image (j), although excretion of Gd-BOPTA into the gall bladder is evident

Fig. 12a, b. Transfusional siderosis in a 7-year old boy after multiple blood transfusions and chemotherapy for right-sided nephroblastoma. Both T2-weighted (a) and Tl-weighted (b) images reveal decreased SI of the liver and spleen, while the SI of the pancreas is unaffected. This is due to the presence of iron storage in the macrophages of the spleen and liver, rather than in hepatocytes, as occurs in hemochromatosis (see Fig. 13)

Fig. 12a, b. Transfusional siderosis in a 7-year old boy after multiple blood transfusions and chemotherapy for right-sided nephroblastoma. Both T2-weighted (a) and Tl-weighted (b) images reveal decreased SI of the liver and spleen, while the SI of the pancreas is unaffected. This is due to the presence of iron storage in the macrophages of the spleen and liver, rather than in hepatocytes, as occurs in hemochromatosis (see Fig. 13)

Fig. 13a, b. Hemochromatosis. Both T2-weighted (a) and Tl-weighted (b) images reveal a dramatically decreased SI of the liver parenchyma while the SI of the spleen remains normal. This permits the differential diagnosis of transfusional siderosis (see Fig. 12) to be excluded since the SI of the spleen is also affected in transfusional siderosis

Fig. 13a, b. Hemochromatosis. Both T2-weighted (a) and Tl-weighted (b) images reveal a dramatically decreased SI of the liver parenchyma while the SI of the spleen remains normal. This permits the differential diagnosis of transfusional siderosis (see Fig. 12) to be excluded since the SI of the spleen is also affected in transfusional siderosis iron overload (i.e. after transfusion of >100 units of blood) is the SI of the pancreas affected [55].

Comparable findings are observed with cardiac MR imaging. Whereas no changes in imaging characteristics are seen in the myocardium of patients with transfusional siderosis, in cases of he-mochromatosis the myocardium usually demonstrates decreased SI.

Transfusional siderosis frequently occurs in patients suffering from hematological diseases in which erythrocyte transfusion needs to be performed regularly [52].

In addition, parenteral iron overload may occur in patients with rhabdomyolysis in which the bound iron of myoglobin is liberated into the blood and absorbed secondarily by reticuloen-dothelial cells [53] (Fig. 12,13).

Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook


Post a comment