Evaluation of the clinical utility of liver MRI T2* as a surrogate marker in liver iron overload: Experience from a Malaysian haematology referral centre

Introduction: Thalassaemia significantly contributes to the disease burden in Southeast Asia, particularly due to complications such as liver iron overload from long-term blood transfusions. The assessment of liver iron overload moves from liver biopsy towards non-invasive methods by utilizing MRI T2* technique. This study evaluated the clinical utility of MRI T2* as a gold standard for assessing hepatic iron overload, and investigated its correlation with serum ferritin and other clinical parameters. Materials and Methods: A one-year cross-sectional study was conducted on Thalassaemia patients who underwent MRI T2* in the year 2025. Liver iron concentration (LIC) was calculated using cvi-42 post-processing software and the serum ferritin levels, transfusion regimen, and demographic data were recorded. The relationships between T2* values, serum ferritin, and other clinical parameters were then analysed. Results: A total of 158 Thalassaemia patients, predominantly transfusion-dependent, were enrolled. HbE-Beta Thalassaemia was the most common subtype (48.1%), followed by Beta-Thalassaemia Major (24.7%). Severe liver iron overload was observed in 63.3% of patients, with Malay patients exhibiting higher severity than Chinese patients (p<0.001). Serum ferritin levels showed a strong negative correlation with liver T2* values (Rs = -0.699, p < 0.001)However, the type of Thalassaemia, transfusion duration and regimen were not significantly associated with T2* values or LIC. Conclusion: Liver MRI T2* demonstrated an effective assessment of hepatic iron overload, exhibiting a strong correlation with serum ferritin levels. These findings elucidate the reliability of MRI T2* imaging to be utilized in the management of transfusion-related iron overload.