MRI Order Name for Liver and Pancreatic Iron Assessment
Order an "MRI Abdomen with R2 Relaxometry" or "MRI Liver/Pancreas with Multi-Echo Gradient Echo T2/R2* Sequence for Iron Quantification."**
Recommended Sequence Specifications
The specific technical name you should communicate to your radiology department is:
- Multi-echo gradient echo (MEGE) sequence with R2 mapping* 1
- Alternative acceptable terminology: "Multi-echo spoiled gradient echo sequence for R2 relaxometry"* 2
Key Technical Parameters to Include in Your Order
When ordering this study, specify the following protocol requirements based on consensus guidelines from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and Society of Abdominal Radiology (SAR) 1:
Essential Protocol Elements:
- Short echo times (TE < 1 msec) 1
- Short echo spacing (< 1 msec) 1
- 6-12 echo times 1
- Noise correction 1
- Fat correction (confounder-corrected methods preferred) 1
Field Strength Selection:
- 1.5 Tesla is preferred for severe iron overload (suspected liver iron concentration > 26-40 mg/g) 1
- Both 1.5T and 3.0T are acceptable for first-line iron quantification in most cases 1
Pancreatic Iron Assessment
For pancreatic iron specifically, the same multi-echo T2* gradient echo sequence is validated and transferable across vendors 3. The technique measures global pancreatic T2* as the mean of values over the head, body, and tail 3.
Clinical Ordering Language
Practical order wording: "MRI abdomen for liver iron quantification using R2* relaxometry with multi-echo gradient echo sequence. Please include pancreas if assessing for systemic iron overload."
Important Caveats
- R2-based relaxometry is the first-line method* with the highest level of evidence for liver iron quantification 1
- The sequence simultaneously provides proton density fat fraction (PDFF), which is advantageous in patients with coexisting liver disease 1
- Some vendors now offer inline R2 processing* that provides immediate liver iron concentration without offline post-processing 4, 2
- Ensure your radiology department uses confounder-corrected methods that avoid fat- and noise-related biases 1