Streamlining liver iron assessment: accuracy and limitations of 3D qDixon MRI for liver iron overload quantification

Fei Peng; Chaotian Luo; Xiaojing Ning; Linlin Liang; Chaojie Huang; Mingrui Yang; Cheng Tang; Huiting Zhang; Peng Peng

doi:10.1016/j.ejrad.2025.112237

Streamlining liver iron assessment: accuracy and limitations of 3D qDixon MRI for liver iron overload quantification

Eur J Radiol. 2025 Jun 12:190:112237. doi: 10.1016/j.ejrad.2025.112237. Online ahead of print.

Authors

Fei Peng¹, Chaotian Luo¹, Xiaojing Ning¹, Linlin Liang¹, Chaojie Huang¹, Mingrui Yang¹, Cheng Tang², Huiting Zhang³, Peng Peng⁴

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021 Guangxi, China.
² Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021 Guangxi, China; NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, Guangxi 530021, China.
³ MR Research Collaboration, Siemens Healthineers Ltd., Wuhan 430000, China.
⁴ Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021 Guangxi, China; NHC Key Laboratory of Thalassemia Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning, Guangxi 530021, China. Electronic address: doublep@126.com.

PMID: 40554144
DOI: 10.1016/j.ejrad.2025.112237

Abstract

Objective: To prospectively evaluate the accuracy and limitations of the 1.5 T 3D-Dixon sequence (qDixon) in quantifying liver iron concentration (LIC), using FerriScan technology-determined LIC and the 1.5 T multi-echo GRE sequence (ME-GRE) as reference standards.

Methods: A total of 161 chronic transfusion-dependent patients, 83 men and 43 women with a mean age of 21.04 years, were scanned using ME-GRE and qDixon sequences; among them, 67 were scanned using FerriScan technology. R2* values (ME-GRE-R2* and qDixon-R2*) and LIC were obtained for both sequences. Comparative analysis was conducted using concordance correlation coefficients (CCC), Bland-Altman plots, and linear regression. A piecewise regression model was constructed to determine the upper limit for quantifying LIC using the qDixon.

Results: The qDixon-LIC and ME-GRE-LIC showed mean differences of 0.22, 0.01, -0.27, and 6.8 mg/g dry weight (dw) in normal, mild, moderate, and severe liver iron overload with corresponding CCC values of 0.986, 0.982, 0.956, and 0.216, respectively. The piecewise regression model established a 28.47 mg/g dw threshold for accurate liver iron quantification using qDixon, beyond which qDixon-R2* reached 892.86 s^-1. Below this threshold, qDixon demonstrated a strong linear correlation with FerriScan in estimating LIC (r = 0.82, p < 0.001), with a negligible mean difference of 1.68 mg/g dw and a CCC of 0.984.

Conclusion: The 1.5 T qDixon sequence can be used to quantitatively assess LIC within a specific range (LIC < 28.47 mg/g dw), simplifying clinical workflow procedures.

Keywords: Dixon Technique; Iron overload; Liver; Magnetic resonance imaging; R2* relaxometry.