Demir Birikimine Bağlı Yetmezlik Gelişen Endokrin Organların T2 Ve T2* Değerlerinin Belirlenmesi

Abstract

The purpose of this study at first stage is to determine the normal R2/T2 for thyroid and pituitary gland, and R2*/T2* values for pancreas, and then at the second stage to evaluate if there is any difference between tl evalues of normal subjects and thlassemia major patients and to determine cut-off values for these endocrin glands by the help of the results of first stage. For control group, between August 2010 and September 2011, patients who were admitted to the Hacettepe University Department of Radiology for brain-pituitary gland, neck or abdominal MR imaging because of any other medical reasons were included to the study; those patients did not have any known abnormalities about thyroid, pituitary gland and pancreas, and they had no anemia or no risk for iron overload. Those patients' ages were between 10-80 years. The results of those control subjects were accepted as reference values for the evaluation of beta thalassemia major patients at second stage. Thalassemia research groups were comprised of the patients between 10-50 years of age and they were divided into two subgroups as insufficient or not for each organ. Some blood tests were performed for the evaluation of any insufficiency; FSH, LH, cortisol and ACTH, additionally eustradiol for women and testosteron for men for pituitary functions; TSH, free T3 and free T4 levels for thyroid functions; fasting blood glucose and fasting blood insulin levels for pancreas. When a patient had an abnormal result according to the laboratory reference values for any of those tests were accepted as insufficiency with the related organ. All the images of control and beta thalassemia major patients were performed with 1,5 T MRI system; multi TE SE sequences for thyroid and pituitary gland, and multi TE GRE sequences were prefered for pancreas. A special soft ware was used for image analysis. In all organ groups, a significant difference was found between control subjects and thalassemia major patients about R2/T2 and R2*/T2* values (for pituitary gland and pancreas p<0,001 and for thyroid gland p<0,009). The best specifisity and sensitivity values were obtained in pituitary gland group, these values were 100% and %85,7 respectively. There were no significant difference between the subgroups (insufficient or not) of thalassemia major patients according to R2/T2 and R2*/T2* values and also there were no sinificant difference between those values and serum ferritin levels for each subgroup of thalassemia patients. Among all of the three thalassemia groups, only pituitary R2/T2 values were in correlation with cardiac iron overload (p=0,011). There were no significant correlation cardiac and liver iron overload with the values of both thyroid and pancreas, and also there was no correlation between liver iron overload and the values of pituitary gland.