In Brief | Radilology, Paediatrics & Oncology
PAEDIATRICS: No Standard MRI Protocol Yet Exists for Detecting Iron Overload in Childhood Cancer Patients
[13 July 2026 }
Review Snapshot
| Design | Narrative literature review; PubMed search through 13 June 2024, supplemented by manual bibliography review |
| Scope | 605 publications (1995–2024) on systemic iron overload; 230 (43%) paediatric-focused, of which 147 concerned beta-thalassaemia and only 2 addressed long-term secondary haemochromatosis in childhood cancer survivors |
| Organs & Techniques Reviewed | Liver, pancreas, spleen, and heart, assessed via signal intensity ratio (SIR) and T2/T2*/R2/R2* relaxometry MRI |
| Key Gap | No paediatric-oncology-specific MRI protocol has been validated; the effect of chemotherapy (versus transfusion) on iron metabolism in children remains unstudied |
Summary
Secondary haemochromatosis is an under-characterised long-term complication in childhood cancer survivors, and liver biopsy — the traditional reference standard for assessing iron burden — is considered too invasive for routine paediatric use.
This review examined MRI-based alternatives, principally signal intensity ratio (SIR) and T2/T2*/R2/R2* relaxometry, across the liver, pancreas, spleen, and heart. Of 605 relevant publications identified, only 2 addressed long-term secondary haemochromatosis specifically in childhood cancer survivors, and most paediatric oncology data came from single-centre studies. R2*-based liver iron concentration, corrected for confounders such as hepatic fat, currently has the strongest evidence base and is available on both 1.5T and 3T scanners.
Pancreatic assessment is complicated by regional variation (T2* is higher in the head than the body) and technical challenges — one cited study could not evaluate all three pancreatic regions in 45% of subjects. Splenic and cardiac iron overload showed weak or inconsistent correlation with hepatic siderosis, and no established MRI cut-off currently predicts cardiac iron burden.
The authors call for paediatric-oncology-specific protocols and routine iron-burden screening to be incorporated into treatment follow-up.
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