Measuring cardiac T2* is important as a number of transfused patients die from cardiac complications. However, patients can decrease the risk of cardiac complications if the total body iron store is accurately monitored. The 3 key reasons why LIC measurement is important are: 1) The LIC value is the best measurement of total body iron stores. [1] 2) Under normal circumstances, the liver is the primary site of iron storage. However, once a certain threshold of liver iron is exceeded, iron begins to accumulate in the heart and other organs. [4] 3) High LIC acts as an early warning sign of possible future cardiac complications as it prospectively predicts cardiac iron loading and cardiac disease. [2,3] FerriScan enables clinicians to determine when chelation therapy is effective and to adjust the therapy accordingly, minimising the risk of iron loading in other organs.

FerriScan is a MRI-based technology that works by analysing abdominal images that are acquired by MRI scanners. As no new equipment is required, a patient is able to have an MRI scan of their abdominal region at any one of the MRI centres around the world setup for FerriScan. The images acquired during the MRI scan are sent via a secure electronic link to the FerriScan central analysis centre for processing and a "Liver Iron Concentration" (LIC) report is produced. The report is made available to the MRI centre which in turn provides it to the referring clinician.

The LIC report provides a liver map and histogram showing the indicative iron distribution.

No. The FerriScan technology is only used to measure iron in the liver. For cardiac iron measurement, a cardiac T2* method is often used. The Resonance Health cardiac T2* test will be available soon. Please email info@ferriscan.com if you would like to receive more information on our upcoming cardiac T2* test.

All FerriScan analyses are conducted in an ISO-9001 and ISO-13485 certified facility. MRI scanners using FerriScan are regularly validated with quality standards. The centralised global data analysis service ensures results can be compared between clinics.

FerriScan VS liver biopsy Liver biopsy is an invasive and painful procedure which cannot be performed frequently. There is a high risk of sampling error due to significant heterogeneity of iron concentrations throughout the liver. The biopsy results may also be affected by the presence of other liver diseases. FerriScan VS liver T2* While the liver T2* test has relatively good sensitivity and specificity of LIC at 3.2 mg/g it has less satisfactory results at other clinically important threshold such as 7.0 mg/g. 7.0 mg/g is the upper limit of optimal range for LIC and increased risk of iron-induced complications and 15.0 mg/g, a threshold for greatly increased risk for cardiac disease and early death in patients with transfusional iron overload. The Liver T2* results may also be affected by the presence of liver fibrosis. FerriScan results are not affected by the presence of liver fibrosis. [7] FerriScan VS serum ferritin There is a weak correlation between serum ferritin and body iron stores as serum ferritin results are confounded by factors such as inflammation. Serum ferritin can only be used for monitoring trends in a patient's iron loading and does not give quantitative reliable information on the degree of iron loading. FerriScan VS Gandon method Although the Gandon method is a simple technique to use, a weak correlation has been demonstrated in patients with a LIC above 11.2 mg/g dw. [5] Patients with iron overload may have a LIC considerably above this level.

Yes, FerriScan is clinically proven as an accurate method for measuring liver iron concentration against liver biopsy.[6]

FerriScan has been setup in over 22 countries at more than 100 MRI centres around the world. Existing location can be found on our website www.ferriscan.com . FerriScan can be readily setup on most MRI scanners.

FerriScan is reimbursed in the following countries. Canada FerriScan is reimbused by the Canadian health service. The treating clinician must forward an application of each patient to the individual provinces Ministry of Health (MOH) for approval. Once approved, the MOH will grant a timeframe for the patient to have their FerriScan. New Zealand FerriScan is reimbursed in New Zealand by all Distrit Health Boards and most Private Insurers in the country. United Kingdom The Whittington Hospital has gained reimbursement from the NHS Trust. Reimbursement activities are ongoing for other regions and updates will continue to be included here. Your MRI centre will be able to provide you with details of the payment methods available.

[1] Angelucci E et al, Hepatic iron concentration and total body iron stores in thalassemia major. NEng J Med 2000; 343:327-31 [2] Telfer P et al, Hepatic iron concentration combined with long-term monitoring of serum ferritin to predict complication of iron overload in thalassemia major. British Journal of Haematology 2000; 110:971-77 [3] Noetzli L et al, Longitudinal analysis of heart and liver iron in thalassemia major. Blood 2008; 112:2973-78 [4] Jensen PD et al, Evaluation of myocardial iron by magnetic resonance imaging during iron chelation therapy with deferrioxamine: indication of close relation between myocardial iron content and chelatable iron pool. Blood 2003; 101:4632-39 [5] Rose C et al, Liver iron content assessment by routine and simple magnetic resonance imaging procedure in highly transfused patients. Eur J Haematology 2006; 77:145-49 [6] St Pierre T at al, Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood 2005; 105:855-61 [7] Olivieri N., Brittenham G., Iron-chelating therapy and the treatment of thalassemia. Blood 1997; 89:739-61

The new FerriScan Rapide Protocol announced in September 2009 takes about 10 minutes, which has reduced the scan time by approximately 60%. Results are then analysed and in most cases returned within 2 working days.

No additional hardware or software is required. FerriScan can be implemented on most 1.5T MRI scanners. An abdominal/chest coil is required during the FerriScan processes (which most MRI centres are equipped with). The setup scanning protocol is provided by Resonance Health and a FerriScan Phantom Pack (scanner setup verification tool) is also provided to validate the scanner.

To obtain optimal sensitivity and specificity over a large range of liver iron concentrations the fundamental 1/T2 value needs to be measured rather than 1/T1 or 1/T2*. This necessitates a long TR to minimise T1 effects and prevents the use of a breath-hold scan. As a result, modest breathing artefacts are expected and are compensated for during the FerriScan Analysis.

The FerriScan Analysis process has multiple steps to determine the fundamental 1/T2 values of tissue. Critical to the analysis are: the use of an external reference (saline infusion bag); the sampling of structured and unstructured noise from spaces all around the patient; and the measurement of the RF signal attenuation profile through the entire cross section of the patient.

A minimum of one third of the saline bag must be visible in most of the images displaying the liver, with the images displaying the largest cross-section of the liver being the most important. The saline bag needs to be as stationary as possible. Breathing artefact through the bag should be minimised by placing it off to the side of the patient where possible. We recommend that the bag is not placed on top of a patient's arm where possible. There is no difference if the bag is placed to the left or to the right of the patient.

The only acceptable movements are: postural relaxation as the patient relaxes during the scan and the movement caused by breathing. Unacceptable patient movements include: gross movements of the torso of more than a couple of millimetres left or right across the FOV (a few pixels at 256 x N); rotation causing a similar shift in liver tissue at any point; or any perceivable shift along the bore of the MRI scanner. Shifts in the saline bag of greater than approximately 1.25 cm (half an inch) are also unacceptable. Unacceptable patient movement, including movement causing significant shift of the saline bag, will require the patient to be rescanned. It is possible to identify unacceptable patient movement at the time of scanning. You may choose to view the images directly after the scan, while the patient is still in the scanner. If this is performed and unacceptable movement is detected, a rescan can be performed immediately, rather than having to call the patient back. Detection of unacceptable movement can be performed by sequentially comparing the 5 echo times for a given image cross-section in the same window (i.e. rather than a side by side comparison). Where the patient has moved unacceptably, the earlier echo time series should be re-acquired to obtain a complete set of echo time series (6, 9, 12, 15 and 18ms) without movement.

Scanners commonly in use with FerriScan include: Siemens Avanto, Siemens Symphony, Siemens Sonata and Philips Intera. GE scanners must be currently operating ScanTools 14 or later in order to be FerriScan compliant. Currently Picker and Shimadzu-Marconi scanners are not supported for use with FerriScan.

Previous experience has shown that some scanners require a larger bandwidth to achieve 6ms echo times. An increased bandwidth of approximately 400 Hz/Pixel has been a common solution. GE scanners running old software (prior to ScanTools 14) will probably not be able to achieve a 6ms echo time without the use of fractional echoes (currently not suitable for use with FerriScan).

The FerriScan protocol requires a single spin echo. Many of the sequences adapted for use with FerriScan were modified from a fast spin echo (FSE) sequence, and this may be reflected in sequence names.

For those parameters that are not explicitly stated for FerriScan it is advised that where there is an option to fix a value across all the series, that this is performed.

No, although these changes result in difficulties for low signal to noise ratio (SNR) situations, a correctly setup scanner can still perform Ferriscan and return valid measurements. It is recommended that for scanners that that cannot fix receiver gain, that 3 saline bags are included for data acquisition of the FerriScan Phantom Pack.

All date fields must be in the format of DD MMM YYYY (e.g. 01 Jan 2001).

The "Patient ID" field and the "Reference" field are for the patient code maintained by your organisation. As a secondary confirmation of the patient's identity we check these fields against the "Patient ID" tag in the DICOM header. If there is a mismatch we will contact you to confirm the correct details and to inform you of the fields we are trying to match. The Patient ID will appear on the upper left portion of the FerriScan Liver Iron Measurement Report.

A typical dataset is 2.5 - 3 Mb uncompressed (a single image is typically around 130 Kb in size). As a zip file (set of zip files) you may expect sizes of 1 - 1.5 Mb.