Matter et al. Diabetology & Metabolic Syndrome 2010, 2:23 http://www.dmsjournal.com/content/2/1/23 Open Access RESEARCH BioMed Central © 2010 Matter et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research Gradient-echo magnetic resonance imaging study of pancreatic iron overload in young Egyptian beta-thalassemia major patients and effect of splenectomy Randa M Matter* 1 , Khalid E Allam 2 and Amany M Sadony 1 Abstract Background: Thalassemic patients suffer from diabetes mellitus secondary to hemosiderosis. Aims: The study aimed to evaluate pancreatic iron overload by T2*-weighted Gradient-echo magnetic resonance imaging (MRI) in young beta-thalassemia major patients and to correlate it with glucose disturbances, hepatic hemosiderosis, serum ferritin and splenectomy. Methods: Forty thalassemic patients (20 non diabetic, 10 diabetic, and 10 with impaired glucose tolerance) were recruited from Pediatric Hematology Clinic, in addition to 20 healthy controls. All patients underwent clinical assessment and laboratory investigations included complete blood count, liver function tests, serum ferritin and oral glucose tolerance test (OGTT). A T2*-weighted gradient-echo sequence MRI was performed with 1.5 T scanner and signal intensity ratio (SIR) of the liver and the pancreas to noise were calculated. Results: Significant reduction in signal intensity ratio (SIR) of the liver and the pancreas was shown in thalassemic patients compared to controls (P < 0.0001), Thalassemic patients with abnormal glucose tolerance; including diabetics and thalassemics with impaired glucose tolerance; displayed a higher degree of pancreatic and hepatic siderosis compared to thalassemics with normal glucose tolerance or controls (P < 0.001, P < 0.0001). Splenectomized thalassemic patients had significantly lower SIR of pancreas compared to non splenectomized patients (P < 0.05). A strong correlation was present between hepatic and pancreatic siderosis in studied patients (P < 0.001). Conclusions: pancreatic siderosis can be detected by T2* gradient-echo MRI since childhood in thalassemic patients, and is more evident in patients with abnormal glucose tolerance. After splenectomy, iron deposition may be accelerated in the pancreas. Follow up of thalassemic patients using pancreatic MRI together with intensive chelation therapy may help to prevent the development of overt diabetes. Introduction Thalassemic patients affected by systemic iron overload, often die owing to iron induced failure of vital organs such as heart and liver. Impairment of the endocrine and exocrine function of the pancreas is a common complica- tion in patients with beta-thalassemia major [1,2]. The incidence of impaired glucose tolerance and diabetes in thalassemia major patients varied from 9% to 15% depending on the age of assessment, the intensity of chelation, transfusion and related patient compliance [3,4]. The etiology of diabetes in β-thalassemia is increased peripheral resistance to insulin and direct toxic effect of excess iron in the acinar and beta cells of pan- creas resulting in insulin deficiency [5]. Structural abnor- malities of the pancreas have been described on sonography [1,6]. * Correspondence: randa_matar@yahoo.com 1 Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt Full list of author information is available at the end of the article