2596 disorders including cancer and cardiovascular diseases. The most common cause of an elevated plasma ferritin level other than an increase in iron stores per se is inflammation. In inflammation, liver disease, cancer and some other diseases, the serum ferritin concentration is increased disproportionally to stores, suggesting an addi- tional effect of ferritin turnover [9–11]. Iron behaves like a contrast agent with a T2* effect. Under these conditions the concentration is proportional to R2* (=1/T2*). In determining iron stores, MRI can replace invasive liver biopsy, and is less influenced by coexisting conditions than is the case with serum ferritin [12]. Different MRI protocols are available based on the measurement of signal intensity ratios and relaxometry techniques [13–15]. In particular, gradient-recalled echo (GRE) sequences are accurate for the estimation of hepatic iron concentration [16]. Obviously, in these MRI examina- tions pre-“contrast” series are not available, so the results in patients must be compared with those in other patients and healthy controls. Recently, an analysis method aimed at making the results independent of the quality of the shim and interindividual variations was validated by biopsy in 149 patients [17]. Gandon et al. used a set of five gradient echo sequences for determining the signal intensity values in regions of interest located within liver and (reference) muscle tissue to determine liver/muscle signal ratios. An algorithm yields hepatic iron concentration by selecting the most accurate outcome from the receiver operating char- acteristic curve of each sequence [17]. This method applied in 28 patients showed significant correlation with blood plasma ferritin content (Spearman’s r = 0.66; P < 0.001) and a slightly improved correlation coefficient when limited to those patients known to not have inflammation (r = 0.82; n = 17; P < 0.001) [18]. Concerning haematological disease, there was correlation between liver iron content and plasma ferritin level (r= 0.79; n= 13; P= 0.001). It was concluded that in patients without inflammation and in patients with haematological disease the content of ferritin in blood is a better predictor of liver iron content than in other patient categories [18]. One should be aware that serum ferritin Fig. 2 Relationship between liver T2* values and serum ferritin concentrations in the entire study population. Dashed lines represent the reference range for liver T2* values and an arbitrary limit of 2,000 μg/L for serum ferritin (n=64; r=0.465; P<0.011) (repro- duced with permission from Perifanis et al. [19]) levels can be confounded by factors such as infection, inflammation and malignancy, resulting in inaccurate reflections of tissue iron concentration. In the literature, correlations of MRI measures of liver iron content and plasma ferritin concentration are scarcely documented. In recent studies of thalassaemia patients, serum ferritin levels were shown to correlate significantly with liver T2 values, T2* values and/or with the liver-to-muscle signal ratios [19, 20]. An example showing a significant inverse correlation between T2* and serum ferritin is shown in Fig. 2. Alústiza et al. [21] compared the method of Gandon with the results of biopsies, and the results indicated a positive argument for the reproducibility of Gandon’s technique. Several other authors also use Gandon’s meth- od, for example, as inclusion criteria in a trial [22] or in a study in patients with beta-thalassaemia [23]. At this time, the method of Gandon et al. [17] appears to be the most suitable technique for the noninvasive measurement of liver iron concentration in view of the important histological correlations. Compared with an earlier biopsy-validated method [13], inter- and intraob- server correlations are better [24]. The enhanced accuracy is probably the result of the automated preselection of one of the five most sensitive sequences in the estimated liver iron concentration range. Correlation with serum ferritin depends on inflammation/infection parameters and on underlying disease, reflecting the more reliable measure- ment of body iron stores by MRI compared with serum ferritin. The question is raised whether MRI protocols to measure liver iron concentration can be applied to MR systems other than that on which they are validated. The reproducibility observed by Alústiza et al. [21] reinforces the possibility of using this method on any 1.5-T MR system. A limitation in Gandon’s method is that signal measurements must be performed with the body coil, because when using smaller coils (such as the phased-array coil) for signal reception the reference signal intensities in muscle signal are unreliable. The requirement of good B0 and B1 field homogeneity over the entire field of view and field-dependent changes in relaxation behaviour should be