椎体骨髓R2*与肝硬化患者肝铁负荷相关并关联生存期
回顾性分析190例肝硬化患者，测量椎体骨髓和肝脏R2*值并估算肝铁浓度。椎体骨髓R2*与肝铁指标相关，且无肝铁过载患者中重度骨髓铁过载与5年总死亡率升高相关（HR 3.981，p=0.014）。
要点
- 椎体骨髓R2*与肝R2*、肝铁浓度、铁蛋白正相关，与总铁结合力负相关。
- 无肝铁过载的肝硬化患者中，重度骨髓铁过载提示5年生存期较差。
- 骨髓R2*或可为肝硬化患者提供额外风险分层信息。
关键影像表现/征象
- 椎体骨髓铁过载在肝铁正常、轻度、中度过载组中分别占28.7%、51.5%、85.6%。
- 重度椎体骨髓铁过载在相应三组中分别占23.3%、35.2%、50.0%。
诊断标准与关键数值
- 椎体骨髓R2*与肝R2*及肝铁浓度相关（r=0.347，p<0.001）。
- 椎体骨髓R2*与铁蛋白相关（r=0.210，p=0.004），与总铁结合力负相关（r=-0.186，p=0.019）。
- 肝R2*（OR 1.010，p=0.002）和总铁结合力（OR 0.990，p=0.035）是中度椎体骨髓铁过载的独立预测因子。
- 无肝铁过载患者中，重度椎体骨髓铁过载与5年总死亡率相关（HR 3.981，p=0.014）。
临床应用与阅片要点
- 在肝硬化患者MRI报告中可关注椎体骨髓R2*值，尤其肝铁正常者。
- 骨髓R2*与肝功能指标及Child-Pugh评分无相关性，解读时需结合肝铁状态。
局限性
- 回顾性单中心研究，样本量有限。
- 未报告骨髓铁过载的具体R2*阈值及诊断敏感度、特异度。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To evaluate vertebral bone-marrow (BM) iron content using R2* relaxometry in patients with cirrhosis, determine its correlation with hematologic and hepatic indices, and assess the relationship between BM iron overload and survival.
MATERIALS AND METHODS: This retrospective study analyzed 190 patients who underwent liver magnetic resonance elastography between January 2018 and October 2024. Liver and vertebral BM R2* values were measured, and liver iron concentration (LIC) was estimated. Patients were categorized into normal, mild, or moderate liver and vertebral BM iron overload groups. Correlations were assessed using Spearman's rank correlation coefficient, independent predictors were assessed using binary logistic regression, and survival was analyzed using Cox proportional hazards regression.
RESULTS: Vertebral BM iron overload was observed in 28.7%, 51.5%, and 85.6% of patients with normal, mild, and moderate liver iron overload, respectively, wherein moderate iron overload comprised of 23.3%, 35.2%, and 50.0% of these groups. Vertebral BM R2* correlated with liver R2* and LIC (r = 0.347; p < 0.001), ferritin (r = 0.210; p = 0.004), and total iron-binding capacity (TIBC) (r = -0.186; p = 0.019). Liver R2* (odds ratio (OR), 1.010; p = 0.002) and TIBC (OR, 0.990; p = 0.035) were independent predictors of moderate vertebral BM iron overload. Vertebral BM R2* showed no correlation with liver function markers or Child-Pugh score. However, among patients without liver iron overload, moderate vertebral BM iron overload was associated with 5-year overall mortality (hazard ratio (HR), 3.981; p = 0.014).
CONCLUSION: Vertebral BM R2* correlated with LIC and was associated with decreased survival in patients with normal liver iron.
KEY POINTS: Question Do vertebral bone-marrow R2* values correlate with liver iron metrics in patients with cirrhosis, and are they associated with overall survival? Findings Higher vertebral bone-marrow R2* values were observed across liver iron categories and were associated with poorer survival among patients with normal liver iron. Clinical relevance Vertebral bone-marrow R2* quantification may provide additional information for risk assessment in patients with cirrhosis with normal liver iron.
引用
- Cho SW, Kim Y, Park J, et al. Bone marrow R2* correlates with liver iron load and is associated with decreased survival in patients with cirrhosis without liver iron overload. Eur Radiol. 2026. PMID: 42115473. doi:10.1007/s00330-026-12614-4
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。