Abstract:dr. pietrangelo replies: MRI can undoubtedly be a useful noninvasive alternative to liver biopsy for quantifying the hepatic iron concentration.It may make it possible to avoid performing so many live...dr. pietrangelo replies: MRI can undoubtedly be a useful noninvasive alternative to liver biopsy for quantifying the hepatic iron concentration.It may make it possible to avoid performing so many liver biopsies, such as those performed for workups of unexplained hyperferritinemia without clear evidence of liver disease 1 (often encountered in nonhemochromatotic hereditary iron overload 2 ), or for the follow-up of known iron-overload disorders.However, the purpose of the biopsy in the proposed algorithm in my article is not for the detection or quantification of hepatic iron overload but for the diagnosis of hereditary hemochromatosis.My definition of this disease may be at variance with that adopted by Dr. Castiella and colleagues. 3In my view, in patients with nondiagnostic genetic tests and persistent biochemical signs of iron overload, confirmation of clinically suspected hereditary hemochromatosis requires documentation not only of the presence but also of the typical cellular-distribution pattern of excess iron in hepatic tissues. 4Both can be assessed with biopsy, whereas current MRI techniques provide only the quantitative data.Read More