Impact of severe hepatic iron overload on MR and ultrasound time-harmonic elastography

Hepatic iron overload, as observed in hemochromatosis, is a relevant contributor to chronic liver disease and can promote liver fibrosis, which plays a key role in hepatic morbidity and mortality. We herein report the case of a lean 36-year-old Caucasian male with chronic hepatopathy related to severe iron overload. In this case, imaging-based staging of liver-fibrosis was not possible using multi-driver, multifrequency magnetic resonance (MR)-based tomoelastography (MRE). Resulting images revealed anatomically precise cut-outs of the liver and uniquely demonstrated an unprecedented limitation of this high-precision protocol. While liver biopsy revealed only mild hepatitis and early perisinusoidal fibrosis, reliable MRE-based measurement of liver stiffness was not possible. Only additional use of ultrasound-based elastography (USE) confirmed slight stiffening of the liver, ruling out severe cirrhosis. In conclusion, this case study underlines the importance of diagnostic time-harmonic elastography using different modalities. Based on our experience, we make suggestions for more reliable prognostic evaluation of liver fibrosis in this poorly reviewed clinical scenario.