Quantification of iron and fat in the liver... in the PACS?

excess iron in the liver can be linked to haemochromatosis, a hereditary anomaly that causes excessive absorption and storage of iron in the body. It can lead to serious complications (cirrhosis, hepatocellular carcinoma, etc.), which is why early detection and treatment are essential. It is all the more difficult to diagnose because it is an asymptomatic disease. For many years, the diagnostic hypothesis could only be confirmed by a liver biopsy.

Advances in imaging methods
Genetic testing can now diagnose most types of haemochromatosis, but there are still some atypical forms. Because of its sensitivity to the presence of iron, Magnetic Resonance Imaging (MRI) has been a major advance, which now allows the amount of iron in the liver to be precisely quantified. The drop in liver signal is analysed on gradient echo sequences with decreasing echo times, and using the paraspinal muscles as a reference. This has shown that MRI could give an evaluation of the liver's iron load equivalent to the biopsy results.

Professor Yves Gandon, Rennes University Hospital
This field, and the transition from theory to practical applications, has fascinated Professor Yves Gandon, head of the medical imaging department at the Rennes University Hospital, for more than 15 years. On top of the medical validation of these techniques, he has also developed the computer algorithms to automate the calculations. Concretely, the radiologist must position five regions of interest on the relevant MRI image and the resulting curves are directly generated. A website alreadyexists where this calculation can be performed online. This requires a few minutes of manual operations to connect to the internet and to the website, enter the measurements, and obtain the result.

And where does the PACS come in?
The installation of the new Telemis-Medical PACS at the Rennes University Hospital was also an opportunity to smooth out and facilitate operations. Following the collaboration between the hospital and Telemis, Professor Gandon was able to create a plug-in version of the algorithm for his PACS. Concretely, any PACS user just needs to select the relevant image and click the IronByMr shortcut. All the other operations (updating and loading the plug-in and the images) are completely automatic, requiring no time and no actions. simply position the ROIs for the graphical results to be displayed and reintegrated into the PACS. A proposed report is also displayed as a draft.

All Telemis PACS?
To share this tool with the medical community as much as possible, Prof. Gandon decided to make his plug-in available to all Telemis customers. «Just visit the website www.ironbymr.fr and follow the instructions,» says the Professor. «The upshot is that all radiologists who use Telemis can now use this algorithm to quantify iron and fat in the liver at 1.5 T and 3 T, just as easily as the radiologists at the Rennes University Hospital do.»
May 1, 2014