This patient had frequent blood transfusions due to underlying myelofibrosis. In hemosiderosis, there is iron overload involving the liver and spleen, with a reduction in the signal intensity in these organs on the T1 in-phase images compared to the T1 out-of-phase images. This is the opposite pattern to diffuse steatosis. Secondary hemochromatosis may be associated with hemosiderosis, diagnosed when there is end organ damage.