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Article

Liver Iron Content and Magnetic Resonance: A “Biopsy-Free” Quantification Method and Its Validation

by
Lorenzo Cinci
1,
Cosimo Nardi
1,
Martina Legato
1,
Valentina Carrai
2,
Valeria Santini
3,
Ginevra Danti
4,
Simone Busoni
5,
Susanna Pucci
6,
Luca Messerini
7 and
Linda Calistri
1,*
1
Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
2
Department of Hematology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
3
MDS Unit, Hematology, DMSC, AOU Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
4
Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
5
Department of Health Physics, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
6
Department of Agricultural, Food, Environmental and Forestry Sciences and Technologies, University of Florence, Piazzale delle Cascine, 18, 50144 Florence, Italy
7
Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
*
Author to whom correspondence should be addressed.
Livers 2026, 6(4), 60; https://doi.org/10.3390/livers6040060
Submission received: 28 February 2026 / Revised: 14 April 2026 / Accepted: 11 June 2026 / Published: 1 July 2026
(This article belongs to the Topic Advances in Gastrointestinal and Liver Disease: From Physiological Mechanisms to Clinical Practice, 2nd Edition)
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Abstract

Background/Objectives: Accurate liver iron content (LIC) quantification and monitoring are crucial for managing patients with hematological disorders. Biopsy-based LIC assessment is invasive and prone to sampling errors. This study aimed to develop a simple and safe method for calibrating MR scanner to accurately measure LIC. Methods: Five certified test objects with increasing aqueous Fe3+ solutions were used for R2* relaxometry to create a calibration curve with equation for converting R2* value to iron content (mg/g), using two different MR scanners. Additionally, two sets of test objects (aqueous and gelled solutions to mimic liver tissue) were developed to evaluate the feasibility of using homemade test objects. Our method was compared with two existing methods (Wood et al.’s equation and the Iron Calculator App) in 59 hematological patients, using the certified test object method as reference. We also compared our method with biopsy-based iron quantification (inductively coupled plasma optical emission spectroscopy) in four patients. Results: The equations derived from our homemade test objects were comparable to those from certified test objects across both MRI scanners. The literature methods consistently overestimated LIC compared to our method. For biopsy validation, our method was more accurate in two out of four cases. Conclusions: Our homemade calibration method offers a simple, reliable alternative for LIC quantification. The type of test object (aqueous or gelled) showed no significant difference. While biopsy-based methods remain useful, our MRI-based approach is quicker and avoids the limitations of biopsy sampling. This method, relying on the relationship between iron concentrations and relaxation times, could provide a more comprehensive and accurate assessment of liver iron levels.
Keywords: liver iron content; MRI relaxometry; R2* mapping; iron overload; calibration test objects; quantitative MRI; non-invasive assessment liver iron content; MRI relaxometry; R2* mapping; iron overload; calibration test objects; quantitative MRI; non-invasive assessment
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MDPI and ACS Style

Cinci, L.; Nardi, C.; Legato, M.; Carrai, V.; Santini, V.; Danti, G.; Busoni, S.; Pucci, S.; Messerini, L.; Calistri, L. Liver Iron Content and Magnetic Resonance: A “Biopsy-Free” Quantification Method and Its Validation. Livers 2026, 6, 60. https://doi.org/10.3390/livers6040060

AMA Style

Cinci L, Nardi C, Legato M, Carrai V, Santini V, Danti G, Busoni S, Pucci S, Messerini L, Calistri L. Liver Iron Content and Magnetic Resonance: A “Biopsy-Free” Quantification Method and Its Validation. Livers. 2026; 6(4):60. https://doi.org/10.3390/livers6040060

Chicago/Turabian Style

Cinci, Lorenzo, Cosimo Nardi, Martina Legato, Valentina Carrai, Valeria Santini, Ginevra Danti, Simone Busoni, Susanna Pucci, Luca Messerini, and Linda Calistri. 2026. "Liver Iron Content and Magnetic Resonance: A “Biopsy-Free” Quantification Method and Its Validation" Livers 6, no. 4: 60. https://doi.org/10.3390/livers6040060

APA Style

Cinci, L., Nardi, C., Legato, M., Carrai, V., Santini, V., Danti, G., Busoni, S., Pucci, S., Messerini, L., & Calistri, L. (2026). Liver Iron Content and Magnetic Resonance: A “Biopsy-Free” Quantification Method and Its Validation. Livers, 6(4), 60. https://doi.org/10.3390/livers6040060

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