{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T08:34:17Z","timestamp":1772181257012,"version":"3.50.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1178","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to investigate whether secondary iron overload in the liver mimics cirrhosis on abdominal CT scans, particularly in patients with end-stage renal disease (ESRD), and to develop a diagnostic algorithm to differentiate these conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a radio-pathologic correlation study involving 4 patient groups: (1) patients with nodular regenerative hyperplasia (NRH) and no hepatic iron deposition, (2) ESRD patients with CT scans suggesting cirrhosis, (3) patients with biopsy-proven cirrhosis and hepatic iron overload, and (4) patients with biopsy-proven cirrhosis without hepatic iron overload. Two board-certified radiologists reviewed all cases in a blinded manner, and liver-related laboratory tests, along with features of portal hypertension, were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CT scans of ESRD patients with secondary hepatic iron overload showed irregular liver contours resembling cirrhosis. However, these patients lacked thrombocytopenia, oesophageal varices, and other clinical markers of portal hypertension, which were consistently present in true cirrhosis cases. These findings suggest that imaging alone cannot reliably diagnose cirrhosis in ESRD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Secondary hepatic iron deposition in ESRD patients can create CT features that mimic cirrhosis. A comprehensive evaluation of clinical, laboratory, and imaging data is crucial for accurate diagnosis and to prevent unnecessary liver biopsies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>This study emphasizes the importance of a multidisciplinary diagnostic approach for ESRD patients with suspected cirrhosis. The proposed algorithm helps differentiate true cirrhosis from secondary iron overload, reducing unnecessary invasive procedures, optimizing pre-transplant evaluations, and enhancing patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqaf280","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T19:05:36Z","timestamp":1763665536000},"page":"386-393","source":"Crossref","is-referenced-by-count":0,"title":["Secondary iron overload in end-stage renal disease patients being evaluated for kidney transplantation may mimic cirrhosis by CT scan: a radio-pathologic correlation study"],"prefix":"10.1093","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8877-0680","authenticated-orcid":false,"given":"Hafiz","family":"Ghani","sequence":"first","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasan","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahra","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Gosnell","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esteban","family":"Arroyave","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Saldarriaga","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laxmi","family":"Dongur","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahra","family":"Sarrafan-Chaharsoughi","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Mujtaba","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kashif","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L","family":"Kueht","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather L","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX 77555,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"2026022702512637900_tqaf280-B1","doi-asserted-by":"publisher","first-page":"471","DOI":"10.2215\/CJN.05021107","article-title":"Kidney transplantation as primary therapy for end-stage renal disease: a national kidney foundation\/kidney disease outcomes quality initiative (NKF\/KDOQITM) conference","volume":"3","author":"Abecassis","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026022702512637900_tqaf280-B2","doi-asserted-by":"publisher","first-page":"2574","DOI":"10.1007\/s00261-018-1508-1","article-title":"CT evaluation of the renal donor and recipient","volume":"43","author":"Vernuccio","year":"2018","journal-title":"Abdom Radiol (NY)"},{"key":"2026022702512637900_tqaf280-B3","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1001\/archsurg.2012.1466","article-title":"Evaluation of potential renal transplant recipients with computed tomography angiography","volume":"147","author":"Smith","year":"2012","journal-title":"Arch Surg"},{"key":"2026022702512637900_tqaf280-B4","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1002\/cld.740","article-title":"Con: liver biopsy remains the gold standard to evaluate fibrosis in patients with nonalcoholic fatty liver disease","volume":"13","author":"Berger","year":"2019","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"2026022702512637900_tqaf280-B5","doi-asserted-by":"publisher","first-page":"16820","DOI":"10.3748\/wjg.v20.i45.16820","article-title":"Non-invasive diagnosis of advanced fibrosis and cirrhosis","volume":"720","author":"Sharma","year":"2014","journal-title":"World J Gastroenterol"},{"key":"2026022702512637900_tqaf280-B6","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1053\/j.gastro.2018.12.036","article-title":"Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease","volume":"156","author":"Castera","year":"2019","journal-title":"Gastroenterology"},{"key":"2026022702512637900_tqaf280-B7","doi-asserted-by":"publisher","first-page":"S35","DOI":"10.1046\/j.1523-1755.1999.055suppl.69035.x","article-title":"Iron overload in renal failure patients: changes since the introduction of erythropoietin therapy","volume":"69","author":"Eschbach","year":"1999","journal-title":"Kidney Int Suppl"},{"key":"2026022702512637900_tqaf280-B8","doi-asserted-by":"publisher","first-page":"865669","DOI":"10.3389\/fmed.2022.865669","article-title":"Iron overload in chronic kidney disease: less ferritin, more T2MRI","volume":"9","author":"Nashwan","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"2026022702512637900_tqaf280-B9","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1681\/ASN.2006080856","article-title":"Clinical aspects of iron use in the anemia of kidney disease","volume":"18","author":"H\u00f6rl","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"2026022702512637900_tqaf280-B10","doi-asserted-by":"publisher","first-page":"e312","DOI":"10.1016\/j.lpm.2017.10.014","article-title":"Iatrogenic iron overload and its potential consequences in patients on hemodialysis","volume":"46","author":"Rostoker","year":"2017","journal-title":"Presse Med"},{"key":"2026022702512637900_tqaf280-B11","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/j.amjmed.2012.02.009","article-title":"Epidemic of iron overload in dialysis population caused by intravenous iron products: a plea for moderation","volume":"125","author":"Vaziri","year":"2012","journal-title":"Am J Med"},{"key":"2026022702512637900_tqaf280-B12","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s13244-014-0350-4","article-title":"Radiological diagnosis of dialysis-associated complications","volume":"5","author":"Zandieh","year":"2014","journal-title":"Insights Imaging"},{"key":"2026022702512637900_tqaf280-B13","doi-asserted-by":"publisher","first-page":"891","DOI":"10.3390\/diagnostics12040891","article-title":"MRI appearance of focal lesions in liver iron overload","volume":"12","author":"Pecorelli","year":"2022","journal-title":"Diagnostics (Basel)"},{"key":"2026022702512637900_tqaf280-B14","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1016\/j.jhep.2004.08.014","article-title":"Unique hypervascular nodules in alcoholic liver cirrhosis: identical to focal nodular hyperplasia-like nodules?","volume":"41","author":"Nakashima","year":"2004","journal-title":"J Hepatol"},{"key":"2026022702512637900_tqaf280-B15","doi-asserted-by":"publisher","first-page":"22","DOI":"10.5152\/dir.2015.15094","article-title":"Different forms of iron accumulation in the liver on MRI","volume":"22","author":"\u0130dilman","year":"2016","journal-title":"Diagn Interv Radiol"},{"key":"2026022702512637900_tqaf280-B16","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1093\/ndt\/gfq024","article-title":"Combined liver-kidney transplantation in patients with cirrhosis and chronic kidney disease","volume":"25","author":"Baccaro","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"2026022702512637900_tqaf280-B17","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1590\/S0004-2803.202200001-12","article-title":"Hepatic alterations in kidney transplant recipients from the largest kidney transplant center in Brazil","volume":"59","author":"Vieira","year":"2022","journal-title":"Arq Gastroenterol"},{"key":"2026022702512637900_tqaf280-B18","doi-asserted-by":"publisher","first-page":"22","DOI":"10.5152\/dir.2015.15094","article-title":"Different forms of iron accumulation in the liver on MRI","volume":"22","author":"Idilman","year":"2015","journal-title":"Diagn Interv Radiol"},{"key":"2026022702512637900_tqaf280-B19","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4253\/wjge.v16.i3.98","article-title":"Computed tomography for the prediction of oesophageal variceal bleeding: a surrogate or complementary to the gold standard?","volume":"16","author":"Fouad","year":"2024","journal-title":"World J Gastrointest Endosc"},{"key":"2026022702512637900_tqaf280-B20","doi-asserted-by":"publisher","first-page":"2314","DOI":"10.1007\/s00261-022-03550-0","article-title":"Quantitative and qualitative liver CT: imaging feature association with histopathologically confirmed hepatic cirrhosis","volume":"47","author":"Rubino","year":"2022","journal-title":"Abdom Radiol (NY)"},{"key":"2026022702512637900_tqaf280-B21","doi-asserted-by":"publisher","first-page":"993","DOI":"10.2214\/AJR.09.3409","article-title":"Radiologic mimics of cirrhosis","volume":"194","author":"Jha","year":"2010","journal-title":"AJR Am J Roentgenol"},{"key":"2026022702512637900_tqaf280-B22","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1148\/rg.2018170079","article-title":"Liver iron quantification with MR imaging: a primer for radiologists","volume":"38","author":"Labranche","year":"2018","journal-title":"Radiographics"},{"key":"2026022702512637900_tqaf280-B23","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1053\/j.jrn.2022.08.004","article-title":"Relation of liver siderosis to liver fibrosis in hemodialysis patients with severe hyperferritinemia secondary to high doses of intravenous iron supplementation","volume":"33","author":"Ibrahim","year":"2023","journal-title":"J Ren Nutr"},{"key":"2026022702512637900_tqaf280-B24","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1148\/radiol.2015141856","article-title":"Dual-energy CT for patients suspected of having liver iron overload: can virtual iron content imaging accurately quantify liver iron content?","volume":"277","author":"Luo","year":"2015","journal-title":"Radiology"},{"key":"2026022702512637900_tqaf280-B25","doi-asserted-by":"publisher","first-page":"e15319","DOI":"10.1111\/ctr.15319","article-title":"Impact of delayed listing after initiating kidney transplant evaluation on transplant outcomes","volume":"38","author":"Ly","year":"2024","journal-title":"Clin Transplant"},{"key":"2026022702512637900_tqaf280-B26","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1111\/j.1600-6143.2010.03213.x","article-title":"Marked variation of the association of ESRD duration before and after wait listing on kidney transplant outcomes","volume":"10","author":"Schold","year":"2010","journal-title":"Am J Transplant"},{"key":"2026022702512637900_tqaf280-B27","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1046\/j.1523-1755.1998.00787.x","article-title":"Patient survival after renal transplantation: I. The impact of dialysis pre-transplant","volume":"53","author":"Cosio","year":"1998","journal-title":"Kidney Int"},{"key":"2026022702512637900_tqaf280-B28","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1046\/j.1523-1755.2000.00287.x","article-title":"Effect of waiting time on renal transplant outcome","volume":"58","author":"Meier-Kriesche","year":"2000","journal-title":"Kidney Int"},{"key":"2026022702512637900_tqaf280-B29","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1097\/00007890-200211270-00005","article-title":"Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis","volume":"74","author":"Meier-Kriesche","year":"2002","journal-title":"Transplantation"}],"container-title":["British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjr\/advance-article-pdf\/doi\/10.1093\/bjr\/tqaf280\/65416133\/tqaf280.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/99\/1178\/386\/65416133\/tqaf280.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/99\/1178\/386\/65416133\/tqaf280.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T07:51:33Z","timestamp":1772178693000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/99\/1178\/386\/8332251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":29,"journal-issue":{"issue":"1178","published-online":{"date-parts":[[2025,11,20]]},"published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/bjr\/tqaf280","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,11,20]]}}}