Computerized Measurement of Iron in Liver Biopsies: A Comparison With Biochemical Iron Measurement

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Abstract
The measurement of stainable hepatic iron using a microcomputer image analysis system was compared with standard biochemical measurements of liver iron content in 103 liver biopsy specimens-29 of idiopathic hemochromatosis, 51 of alcoholic liver disease and 23 of various nonalcoholic liver diseases. Sections were stained using Perls' method for iron; the mean area staining positively for iron was measured and expressed as a percentage of the area of biopsy measured. Biochemical (biochemical hepatic iron [μmol/gm dry wt]/age) and morphometrical (morphometrical hepatic iron [%]/age × 100) hepatic iron indices were calculated. Patients in the idiopathic hemochromatosis group had significantly higher biochemical hepatic iron concentrations (p < 0.001) compared with the alcoholic liver disease and nonalcoholic liver disease groups: 284 (range = 119 to 631), 21 (range = 2 to 65) and 15 (range = 3 to 31) μmol/gm dry wt, respectively. The biochemical hepatic iron index was also significantly higher (p < 0.001) in the hemochromatosis group compared with the alcoholic liver disease and nonalcoholic liver disease groups: 5.8 (range = 2.1 to 13.7), 0.4 (range = 0 to 1.6) and 0.4 (range = 0 to 1.1), respectively. Computerized measurements were significantly higher in the hemochromatosis group (p < 0.001) compared with the alcoholic liver disease and nonalcoholic liver disease groups: 9.72% (range = 1.50% to 29.26%), 0.13% (range = 0% to 1.20%) and 0.03% (range = 0% to 0.40%), respectively. The morphometrical hepatic iron index was also significantly higher (p < 0.001) in the hemochromatosis group compared with the alcoholic liver disease and nonalcoholic liver disease groups: 19.32 (range = 2.60 to 75.10), 0.21 (range = 0 to 1.90) and 0.09 (range = 0 to 1.10), respectively. There was no overlap between the hemochromatosis and the alcoholic liver disease and nonalcoholic liver disease groups. Significant linear relationships were demonstrated between morphometrical and biochemical measurements of hepatic iron (p < 0.001) and morphometrical and biochemical hepatic iron indices (p < 0.001). We conclude that computerized measurements of stainable hepatic iron show a significant linear relationship with biochemical iron measurements. Also, the morphometrical hepatic iron index, like the biochemical hepatic iron index, may help differentiate idiopathic hemochromatosis from other disorders with increased hepatic iron levles. (Hepatology 1990;12:26-30).