ClinicalTrials.gg
CompletedNCT04171635Updated Feb 27, 2026

Quantitative Susceptibility Mapping (QSM) to Guide Iron Chelating Therapy

An observational study in MRI Scans, sponsored by Weill Medical College of Cornell University. Completed at 2 sites in United States. Open to participants aged 2 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-02-27.

Sponsored by Weill Medical College of Cornell University · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
55
Ages
2 Years and older
Sex
All
01

Study summary

The overall goal of this research is to help develop a new magnetic resonance (MR) method, Quantitative Susceptibility Mapping (QSM), to improve the measurement of liver iron concentrations without the need for a liver biopsy. Measurement of liver iron is important to diagnose and treat patients who have too much iron in their bodies (iron overload). Liver iron measurements by current MRI methods (R2 and R2*) can be inaccurate because of the effects of fat, fibrosis and other abnormalities. QSM should not be affected by these factors and should be free of these errors. In this study, MRI measurements (QSM, R2 and R2*) of iron in patients before liver transplant will be compared with chemical analysis of iron in liver explants (livers removed from patients undergoing liver transplant). The liver explants would otherwise be discarded. Investigators expect that this study will show that the new MRI method, QSM, is superior to the current MRI methods, R2 and R2*.

Read the detailed description

The overall objective of this research is to improve the safety of iron-chelating therapy (ICT) in patients with transfusional iron overload by developing an accurate non-invasive measurement of the liver iron concentration (LIC), the best measure of the body iron burden in all forms of systemic iron overload. The scientific premise is that quantitative susceptibility mapping (QSM) provides a quantitative biophysical connection to LIC. Safe ICT requires careful adjustment of the iron chelator dose to the body iron burden to optimize iron excretion while avoiding chelator toxicity, including gastrointestinal disorders, audiovisual impairment, neutropenia, arthropathy, growth retardation, and hepatic and renal failure. QSM enables accurate measurement of LIC by overcoming the inherent cellular interference in current R2 (=1/T2) and R2* (=R2+R2') estimates that lack a well-defined biophysical connection to the LIC. A fundamental biophysical limitation of the R2 and R2* approaches is that intravoxel contents other than iron, including fibrosis, steatosis and necroinflammation, also alter relaxation. In the liver, paramagnetic iron stored in ferritin and hemosiderin is the dominant susceptibility source for QSM. Consequently, magnetic susceptibility measured by QSM has a simple linear relationship with the concentration of iron in the liver and is little affected by fibrosis, steatosis and necroinflammation. The investigator's research plan has 3 specific aims:

Aim 1. Develop hQSM for accurate measurement of LIC without interfering errors. Investigators will optimize data acquisition and processing for free-breathing navigator acquisition with robust fat-water separation.

Aim 2. Validate hQSM using histology and chemical measurement of LIC in liver explants. Investigators will assess the accuracies of LICs measured by hQSM and R2* in patients before liver transplant with histologic examination using the reference standard of chemical measurement of LIC in liver explants.

Aim 3. Evaluate hQSM in patients with transfusional iron overload under ICT. In patients regularly transfused for thalassemia major, investigators will conduct a double-blind clinical study comparing the accuracy of hQSM and R2* in measuring annual changes in LIC, using regression against the year-long amount of iron administered in red blood cell transfusions and the year-long cumulative dose of iron chelator.

02

Conditions studied

  • MRI Scans

Keywords

  • Quantitative Susceptibility Mapping
  • Iron chelating therapy
  • Iron overload
  • Liver iron concentration
  • erythrocyte transfusion
  • liver transplantation
  • magnetic resonance imaging
  • thalassemia major
03

In context

Iron Overload

156 studies on the registry are indexed under Iron Overload; 6 are open to participants now.

This study's enrollment of 55 is below the median of 94 across 49 observational studies indexed under Iron Overload.

Browse Iron Overload studies →

Lead sponsor

Weill Medical College of Cornell University is the lead sponsor of 892 studies on the registry; 165 are open to participants now.

Of its 123 completed or terminated interventional studies of FDA-regulated products, 94 (76%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
2 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes
Sampling method
Non-probability sample

Study population

Healthy subjects will be selected from the community through personal contact and written description of the research, and online advertising.

Subjects will be selected at Columbia from those awaiting liver transplant to be enrolled in the study.

Eligibility criteria

Inclusion Criteria:

  • Established diagnosis of thalassemia major
  • Treatment with deferasirox formulated as Jadenu® as the sole iron chelating therapy (ICT)
  • Regular transfusion with records maintained in the Cornell Thalassemia Program
  • 2 years of age or older
  • Females who are not pregnant

Inclusion Criteria (for healthy subjects):

  • Men and women aged 21 years or older
  • Able and willing to give consent
  • No known hematological and liver disease
  • No for MRI

Exclusion Criteria:

  • A history of auditory or ocular toxicity related to ICT
  • A history of poor adherence to prescribed therapy
  • An inability to tolerate MRI examinations
  • Treatment for mental illness
  • Institutionalization or imprisonment
Terms in these criteria, in plain language(1)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

05

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
55 participants (actual)
Patient registry
No
Biospecimen retention
Samples without dna

Groups and cohorts

  • Patients with transfusional iron overload

    The subject population of patients with transfusional iron overload awaiting liver transplant has been chosen because of the clinical indication for MRI examination every three months and the availability of liver explants for analysis after transplant. Explants will receive QSM or R2\* MRI to provide a quantitative biophysical connection to liver iron concentration (LIC).

    Radiation: Quantitative Susceptibility Mapping (QSM) Magnetic Resonance Imaging (MRI) · Radiation: R2* Magnetic Resonance Imaging (MRI)

  • Healthy subjects

    Healthy control subjects over the age of 21 with no known hematological or liver disease and no contraindications for MRI

    Radiation: Quantitative Susceptibility Mapping (QSM) Magnetic Resonance Imaging (MRI) · Radiation: R2* Magnetic Resonance Imaging (MRI)

Interventions

  • RadiationQuantitative Susceptibility Mapping (QSM) Magnetic Resonance Imaging (MRI)

    Investigators will validate hepatic QSM (hQSM) using histological examination and chemical measurement of liver iron concentration (LIC). Patients will undergo clinical MRI in Aim 1. In patients with increased LIC their liver explants will undergo MRI, pathological examination, and chemical determination of the LIC.

  • RadiationR2* Magnetic Resonance Imaging (MRI)

    Investigators will be able to validate hQSM in measuring liver iron concentration (LIC) by comparing it to this traditional MRI technique

06

What researchers measure

Primary outcomes

  1. Demonstration of efficacy of quantitative susceptibility mapping (QSM) MRI in quantifying liver iron concentration (LIC)

    Investigators will assess the accuracy of liver iron concentrations measured by QSM in patients before liver transplant with histologic examination using the gold standard chemical measurement of LIC in liver explants.

    Time frame: Five years

Secondary outcomes

  1. Fibrosis as determined by in vivo R2*, an MRI method that provides quantitative information on iron levels

    R2\* is an imaging method used in MRI. R2\* = (1/T2\*) where R2\* is a relaxation rate measured in units of Hz (\[1/sec\]). R2\* is commonly used to look at iron levels by measuring the relaxation times of hydrogen nuclei affected by iron. The presence of the iron results in the shortening of proton relaxation times (T2\*), thus increasing R2\*.

    Time frame: Five years

  2. Fibrosis as determined by in vitro R2*, an MRI method that provides quantitative information on iron levels

    R2\* is an imaging method used in MRI. R2\* = (1/T2\*) where R2\* is a relaxation rate measured in units of Hz (\[1/sec\]). R2\* is commonly used to look at iron levels by measuring the relaxation times of hydrogen nuclei affected by iron. The presence of the iron results in the shortening of proton relaxation times (T2\*), thus increasing R2\*.

    Time frame: Five years

  3. Fibrosis as determined by in vivo hQSM, an MRI post-processing technique that provides quantitative information on iron levels

    Quantitative susceptibility mapping (QSM) is widely used by the imaging research community in applications to detect iron. Tissue can become magnetized in response to a magnetic field, and the extent of magnetization is known as susceptibility, which arises from unpaired electrons in iron or external sources such as contrast agents. QSM permits visualization of the sizes and shapes of iron sources, delivers precise estimates of iron concentrations (units: parts per billion \[ppb\] or parts per million \[ppm\]).

    Time frame: Five years

  4. Fibrosis as determined by in vitro hQSM, an MRI post processing technique that provides quantitative information on iron levels

    Quantitative susceptibility mapping (QSM) is widely used by the imaging research community in applications to detect iron. Tissue can become magnetized in response to a magnetic field, and the extent of magnetization is known as susceptibility, which arises from unpaired electrons in iron or external sources such as contrast agents. QSM permits visualization of the sizes and shapes of iron sources, delivers precise estimates of iron concentrations (units: parts per billion \[ppb\] or parts per million \[ppm\]).

    Time frame: Five years

  5. Steatosis as determined by in vivo R2*, an MRI method that provides quantitative information on iron levels

    R2\* is an imaging method used in MRI. R2\* = (1/T2\*) where R2\* is a relaxation rate measured in units of Hz (\[1/sec\]). R2\* is commonly used to look at iron levels by measuring the relaxation times of hydrogen nuclei affected by iron. The presence of the iron results in the shortening of proton relaxation times (T2\*), thus increasing R2\*.

    Time frame: Five years

  6. Steatosis as determined by in vitro R2*, an MRI method that provides quantitative information on iron levels

    R2\* is an imaging method used in MRI. R2\* = (1/T2\*) where R2\* is a relaxation rate measured in units of Hz (\[1/sec\]). R2\* is commonly used to look at iron levels by measuring the relaxation times of hydrogen nuclei affected by iron. The presence of the iron results in the shortening of proton relaxation times (T2\*), thus increasing R2\*.

    Time frame: Five years

  7. Steatosis as determined by in vivo hQSM, an MRI post-processing technique that provides quantitative information on iron levels

    Quantitative susceptibility mapping (QSM) is widely used by the imaging research community in applications to detect iron. Tissue can become magnetized in response to a magnetic field, and the extent of magnetization is known as susceptibility, which arises from unpaired electrons in iron or external sources such as contrast agents. QSM permits visualization of the sizes and shapes of iron sources, delivers precise estimates of iron concentrations (units: parts per billion \[ppb\] or parts per million \[ppm\]).

    Time frame: Five years

  8. Steatosis as determined by in vitro hQSM, an MRI post-processing technique that provides quantitative information on iron levels

    Quantitative susceptibility mapping (QSM) is widely used by the imaging research community in applications to detect iron. Tissue can become magnetized in response to a magnetic field, and the extent of magnetization is known as susceptibility, which arises from unpaired electrons in iron or external sources such as contrast agents. QSM permits visualization of the sizes and shapes of iron sources, delivers precise estimates of iron concentrations (units: parts per billion \[ppb\] or parts per million \[ppm\]).

    Time frame: Five years

  9. Necroinflammation as determined by in vivo R2*, an MRI method that provides quantitative information on iron levels

    R2\* is an imaging method used in MRI. R2\* = (1/T2\*) where R2\* is a relaxation rate measured in units of Hz (\[1/sec\]). R2\* is commonly used to look at iron levels by measuring the relaxation times of hydrogen nuclei affected by iron. The presence of the iron results in the shortening of proton relaxation times (T2\*), thus increasing R2\*.

    Time frame: Five years

  10. Necroinflammation as determined by in vitro R2*, an MRI method that provides quantitative information on iron levels

    R2\* is an imaging method used in MRI. R2\* = (1/T2\*) where R2\* is a relaxation rate measured in units of Hz (\[1/sec\]). R2\* is commonly used to look at iron levels by measuring the relaxation times of hydrogen nuclei affected by iron. The presence of the iron results in the shortening of proton relaxation times (T2\*), thus increasing R2\*.

    Time frame: Five years

  11. Necroinflammation as determined by in vivo hQSM, an MRI post-processing technique that provides quantitative information on iron levels

    Quantitative susceptibility mapping (QSM) is widely used by the imaging research community in applications to detect iron. Tissue can become magnetized in response to a magnetic field, and the extent of magnetization is known as susceptibility, which arises from unpaired electrons in iron or external sources such as contrast agents. QSM permits visualization of the sizes and shapes of iron sources, delivers precise estimates of iron concentrations (units: parts per billion \[ppb\] or parts per million \[ppm\]).

    Time frame: Five years

  12. Necroinflammation as determined by in vitro hQSM, an MRI post-processing technique that provides quantitative information on iron levels

    Quantitative susceptibility mapping (QSM) is widely used by the imaging research community in applications to detect iron. Tissue can become magnetized in response to a magnetic field, and the extent of magnetization is known as susceptibility, which arises from unpaired electrons in iron or external sources such as contrast agents. QSM permits visualization of the sizes and shapes of iron sources, delivers precise estimates of iron concentrations (units: parts per billion \[ppb\] or parts per million \[ppm\]).

    Time frame: Five years

07

Study locations

2 sites
  • Weill Cornell Medical College
    New York, New York 10021, United States
  • Columbia University Medical Center
    New York, New York 10032, United States
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Feb 27, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04171635
Responsible party
Sponsor
First posted
Nov 21, 2019
Start date
Dec 16, 2019
Primary completion
Dec 31, 2025
Completion
Dec 31, 2025
Last update
Feb 27, 2026

Study contacts

Gary M Brittenham, MD
principal investigator · Columbia University
Yi Wang, PhD
principal investigator · Weill Medical College of Cornell University
Sujit S Sheth, MD
principal investigator · Weill Medical College of Cornell University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Feb 2026. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Start the discussion