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Trudel G, Melkus G, Sheikh A, Ramsay T, Laneuville O. Marrow adipose tissue gradient is preserved through high protein diet and bed rest. A randomized crossover study. Bone Rep 2019; 11:100229. [PMID: 31799339 PMCID: PMC6883331 DOI: 10.1016/j.bonr.2019.100229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Marrow adipose tissue (MAT) has a peripheral to central distribution in adults, higher in peripheral bones. Similarly, the spine has a caudal to cephalad MAT distribution, higher in lumbar vertebras. Diet and the level of physical activities are known modulators of MAT with significant impact on bone; however, whether these can modulate the MAT gradient is unknown. OBJECTIVE To measure the effect of high protein diet and bed rest interventions on the lumbar MAT gradient. DESIGN PARTICIPANTS INTERVENTION In a prospective randomized crossover trial, 10 healthy men participated in 2 consecutive campaigns of 21days head-down-tilt-bed-rest (HDTBR). They received either whey protein and potassium bicarbonate-supplemented or control diet separated by a 4-month washout period. MAIN OUTCOME MEASURES Ten serial MRI measures of lumbar vertebral fat fraction (VFF) were performed at baseline, 10days and 20days of HDTBR and 3 and 28days after HDTBR of each bed rest campaign. RESULTS The mean L5-L1 VFF difference of 4.2 ± 1.2 percentage point higher at L5 (p = 0.008) constituted a caudal to cephalad lumbar MAT gradient. High protein diet did not alter the lumbar VFF differences during both HDTBR campaigns (all time points p > 0.05). Similarly, 2 campaigns of 21days of HDTBR did not change the lumbar VFF differences (all time points p > 0.05). CONCLUSIONS This pilot study established that the lumbar vertebral MAT gradient was not altered by a high protein nor by 2 × 21days bed rest interventions. These findings demonstrated that this lack of mechanical stimulus was not an important modulator of the lumbar MAT gradient. The highly preserved MAT gradient needs to be measured in more situations of health and disease and may potentially serve to detect pathological situations.
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Key Words
- BDC, baseline data collection
- Bed rest study
- DLR, German Aerospace Center
- FOV, field of view
- HDT, head-down tilt
- HDTBR, head-down-tilt-bed-rest
- IOP, in-phase and out-phase imaging
- Lumbar vertebral fat fraction
- MAT, marrow adipose tissue
- MEP, whey protein study
- MR, magnetic resonance
- Magnetic resonance imaging
- Marrow adipose tissue
- PDFF, proton-density fat fraction
- R, recovery
- ROI, region of interest
- TR, repetition time
- VFF, vertebral fat fraction
- Whey protein
- in-phase, echo time 1 (TE1)
- out-phase, echo time 2 (TE2)
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Affiliation(s)
- Guy Trudel
- Bone and Joint Research Laboratory, Department of Physical Medicine and Rehabilitation, Department of Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ontario, Canada
| | - Gerd Melkus
- The Ottawa Hospital Research Institute, Ontario, Canada
- Department of Radiology, University of Ottawa, Ontario, Canada
| | - Adnan Sheikh
- The Ottawa Hospital Research Institute, Ontario, Canada
- Department of Radiology, University of Ottawa, Ontario, Canada
| | - Tim Ramsay
- The Ottawa Hospital Research Institute, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Odette Laneuville
- Bone and Joint Research Laboratory, Department of Physical Medicine and Rehabilitation, Department of Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
- Department of Biology, Faculty of Science, University of Ottawa, Ontario, Canada
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52
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Bani Hassan E, Ghasem-Zadeh A, Imani M, Kutaiba N, Wright DK, Sepehrizadeh T, Duque G. Bone Marrow Adipose Tissue Quantification by Imaging. Curr Osteoporos Rep 2019; 17:416-428. [PMID: 31713178 DOI: 10.1007/s11914-019-00539-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The significance and roles of marrow adipose tissue (MAT) are increasingly known, and it is no more considered a passive fat storage but a tissue with significant paracrine and endocrine activities that can cause lipotoxicity and inflammation. RECENT FINDINGS Changes in the MAT volume and fatty acid composition appear to drive bone and hematopoietic marrow deterioration, and studying it may open new horizons to predict bone fragility and anemia development. MAT has the potential to negatively impact bone volume and strength through several mechanisms that are partially described by inflammaging and lipotoxicity terminology. Evidence indicates paramount importance of MAT in age-associated decline of bone and red marrow structure and function. Currently, MAT measurement is being tested and validated by several techniques. However, purpose-specific adaptation of existing imaging technologies and, more importantly, development of new modalities to quantitatively measure MAT are yet to be done.
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Affiliation(s)
- Ebrahim Bani Hassan
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Ali Ghasem-Zadeh
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
- Department of Medicine and Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Mahdi Imani
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Numan Kutaiba
- Austin Health, Department of Radiology, Heidelberg, VIC, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tara Sepehrizadeh
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia.
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia.
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53
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Momeni M, Asadzadeh M, Mowla K, Hanafi MG, Gharibvand MM, Sahraeizadeh A. Sensitivity and specificity assessment of DWI and ADC for the diagnosis of osteoporosis in postmenopausal patients. Radiol Med 2019; 125:68-74. [PMID: 31531809 DOI: 10.1007/s11547-019-01080-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this study, we prospectively investigated the diagnostic capability of diffusion-weighted magnetic resonance imaging (DWI) in assessing vertebral marrow changes in postmenopausal women with osteoporosis. MATERIALS AND METHODS Sixty postmenopausal women (mean age 60.2 ± 6.11 years) underwent both dual-energy X-ray absorptiometry (DEXA) of the spine and MRI. Results were acquired from each patient's L2 to L4, for a total of 180 lumbar vertebrae. Based on bone mineral density (BMD) measurements obtained from DEXA, the vertebrae were divided into three groups as follows: normal (n = 52), osteopenic (n = 92), and osteoporotic (n = 36). DWI of the vertebral body was performed to assess the apparent diffusion coefficient (ADC). The ADC outcomes were compared among the three groups and correlated with BMD. RESULTS ADC values (× 10-6 mm2/s) were significantly lower in the osteoporotic group (135.67 ± 44.10) in comparison to the normal group (561.85 ± 190.37) (P = 0.0001). The results showed a positive correlation between ADC and BMD values (r = 0.748, P = 0.0001). In receiver operating characteristic (ROC) analysis, the area under the curve for DWI was 0.912 (P = 0.001). A cut-off value of 400 mm2/s for the diagnosis of osteoporosis; had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 90.90%, 83.34%, 88.89%, 93.75%, and 76.93%, respectively. CONCLUSION ADC values correlated positively with BMD in women. DWI can allow quantitative evaluation of bone marrow changes and osteoporosis in postmenopausal women.
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Affiliation(s)
- Mohammad Momeni
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Asadzadeh
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Karim Mowla
- Department of Rheumatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Ghasem Hanafi
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Momen Gharibvand
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Aliakbar Sahraeizadeh
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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54
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Zebaze R, Osima M, Bui M, Lukic M, Wang X, Ghasem-Zadeh A, Eriksen EF, Vais A, Shore-Lorenti C, Ebeling PR, Seeman E, Bjørnerem Å. Adding Marrow Adiposity and Cortical Porosity to Femoral Neck Areal Bone Mineral Density Improves the Discrimination of Women With Nonvertebral Fractures From Controls. J Bone Miner Res 2019; 34:1451-1460. [PMID: 30883870 DOI: 10.1002/jbmr.3721] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/24/2019] [Accepted: 03/01/2019] [Indexed: 11/08/2022]
Abstract
Advancing age is accompanied by a reduction in bone formation and remodeling imbalance, which produces microstructural deterioration. This may be partly caused by a diversion of mesenchymal cells towards adipocytes rather than osteoblast lineage cells. We hypothesized that microstructural deterioration would be associated with an increased marrow adiposity, and each of these traits would be independently associated with nonvertebral fractures and improve discrimination of women with fractures from controls over that achieved by femoral neck (FN) areal bone mineral density (aBMD) alone. The marrow adiposity and bone microstructure were quantified from HR-pQCT images of the distal tibia and distal radius in 77 women aged 40 to 70 years with a recent nonvertebral fracture and 226 controls in Melbourne, Australia. Marrow fat measurement from HR-pQCT images was validated using direct histologic measurement as the gold standard, at the distal radius of 15 sheep, with an agreement (R2 = 0.86, p < 0.0001). Each SD higher distal tibia marrow adiposity was associated with 0.33 SD higher cortical porosity, and 0.60 SD fewer, 0.24 SD thinner, and 0.72 SD more-separated trabeculae (all p < 0.05). Adjusted for age and FN aBMD, odds ratios (ORs) (95% CI) for fracture per SD higher marrow adiposity and cortical porosity were OR, 3.39 (95% CI, 2.14 to 5.38) and OR, 1.79 (95% CI, 1.14 to 2.80), respectively. Discrimination of women with fracture from controls improved when cortical porosity was added to FN aBMD and age (area under the receiver-operating characteristic curve [AUC] 0.778 versus 0.751, p = 0.006) or marrow adiposity was added to FN aBMD and age (AUC 0.825 versus 0.751, p = 0.002). The model including FN aBMD, age, cortical porosity, trabecular thickness, and marrow adiposity had an AUC = 0.888. Results were similar for the distal radius. Whether marrow adiposity and cortical porosity indices improve the identification of women at risk for fractures requires validation in prospective studies. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Roger Zebaze
- Department of Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia.,Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Marit Osima
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Orthopaedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marko Lukic
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Xiaofang Wang
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Ali Ghasem-Zadeh
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Erik F Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angela Vais
- Hudson Institute for Medical Research, Monash University, Melbourne, Australia
| | - Catherine Shore-Lorenti
- Department of Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia
| | - Ego Seeman
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Åshild Bjørnerem
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
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55
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Swamy A, Burström G, Spliethoff JW, Babic D, Ruschke S, Racadio JM, Edström E, Terander AE, Dankelman J, Hendriks BHW. Validation of diffuse reflectance spectroscopy with magnetic resonance imaging for accurate vertebral bone fat fraction quantification. BIOMEDICAL OPTICS EXPRESS 2019; 10:4316-4328. [PMID: 31453013 PMCID: PMC6701522 DOI: 10.1364/boe.10.004316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 05/12/2023]
Abstract
Safe and accurate placement of pedicle screws remains a critical step in open and minimally invasive spine surgery. The diffuse reflectance spectroscopy (DRS) technique may offer the possibility of intra-operative guidance for pedicle screw placement. Currently, Magnetic Resonance Imaging (MRI) is one of the most accurate techniques used to measure fat concentration in tissues. Therefore, the purpose of this study is to compare the accuracy of fat content measured invasively in vertebrae using DRS and validate it against the Proton density fat fraction (PDFF) derived via MRI. Chemical shift-encoding-based water-fat imaging of the spine was first performed on six cadavers. PDFF images were computed and manually segmented. 23 insertions using a custom-made screw probe with integrated optical fibers were then performed under cone beam computer tomography (CBCT). DR spectra were recorded at several positions along the trajectory as the optical screw probe was inserted turn by turn into the vertebral body. Fat fractions determined via DRS and MRI techniques were compared by spatially correlating the optical screw probe position within the vertebrae on CBCT images with respect to the PDFF images. The fat fraction determined by DRS was found to have a high correlation with those determined by MRI, with a Pearson coefficient of 0.950 (P< 0.001) as compared with PDFF measurements calculated from the MRI technique. Additionally, the two techniques were found to be comparable for fat fraction quantification within vertebral bodies (R2 = 0.905).
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Affiliation(s)
- Akash Swamy
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands
- Department of In-body Systems, Philips Research, Royal Philips NV, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Department of Neurosurgery, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Jarich W. Spliethoff
- Department of In-body Systems, Philips Research, Royal Philips NV, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands
| | - Drazenko Babic
- Department of In-body Systems, Philips Research, Royal Philips NV, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands
| | - Stefan Ruschke
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
| | - John M. Racadio
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, USA
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Department of Neurosurgery, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Adrian Elmi Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Department of Neurosurgery, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - Benno H. W. Hendriks
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands
- Department of In-body Systems, Philips Research, Royal Philips NV, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands
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Schmeel FC, Vomweg T, Träber F, Gerhards A, Enkirch SJ, Faron A, Sprinkart AM, Schmeel LC, Luetkens JA, Thomas D, Kukuk GM. Proton density fat fraction MRI of vertebral bone marrow: Accuracy, repeatability, and reproducibility among readers, field strengths, and imaging platforms. J Magn Reson Imaging 2019; 50:1762-1772. [PMID: 30980694 DOI: 10.1002/jmri.26748] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/01/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chemical shift-encoding based water-fat MRI is an emerging method to noninvasively assess proton density fat fraction (PDFF), a promising quantitative imaging biomarker for estimating tissue fat concentration. However, in vivo validation of PDFF is still lacking for bone marrow applications. PURPOSE To determine the accuracy and precision of MRI-determined vertebral bone marrow PDFF among different readers and across different field strengths and imager manufacturers. STUDY TYPE Repeatability/reproducibility. SUBJECTS Twenty-four adult volunteers underwent lumbar spine MRI with one 1.5T and two different 3.0T MR scanners from two vendors on the same day. FIELD STRENGTH/SEQUENCE 1.5T and 3.0T/3D spoiled-gradient echo multipoint Dixon sequences. ASSESSMENT Two independent readers measured intravertebral PDFF for the three most central slices of the L1-5 vertebral bodies. Single-voxel MR spectroscopy (MRS)-determined PDFF served as the reference standard for PDFF estimation. STATISTICAL TESTS Accuracy and bias were assessed by Pearson correlation, linear regression analysis, and Bland-Altman plots. Repeatability and reproducibility were evaluated by Wilcoxon signed rank test, Friedman test, and coefficients of variation. Intraclass correlation coefficients were used to validate intra- and interreader as well as intraimager agreements. RESULTS MRI-based PDFF estimates of lumbar bone marrow were highly correlated (r2 = 0.899) and accurate (mean bias, -0.6%) against the MRS-determined PDFF reference standard. PDFF showed high linearity (r2 = 0.972-0.978) and small mean bias (0.6-1.5%) with 95% limits of agreement within ±3.4% across field strengths, imaging platforms, and readers. Repeatability and reproducibility of PDFF were high, with the mean overall coefficient of variation being 0.86% and 2.77%, respectively. The overall intraclass correlation coefficient was 0.986 as a measure for an excellent interreader agreement. DATA CONCLUSION MRI-based quantification of vertebral bone marrow PDFF is highly accurate, repeatable, and reproducible among readers, field strengths, and MRI platforms, indicating its robustness as a quantitative imaging biomarker for multicentric studies. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1762-1772.
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Affiliation(s)
- Frederic Carsten Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Toni Vomweg
- Radiology Institute Dr. von Essen (DVE), Coblenz, Rhineland-Palatinate (RLP), Germany
| | - Frank Träber
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Arnd Gerhards
- Radiology Institute Dr. von Essen (DVE), Coblenz, Rhineland-Palatinate (RLP), Germany
| | - Simon Jonas Enkirch
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Anton Faron
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Alois Martin Sprinkart
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Leonard Christopher Schmeel
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Julian Alexander Luetkens
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Daniel Thomas
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
| | - Guido Matthias Kukuk
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, North Rhine-Westphalia (NRW), Germany
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He J, Fang H, Li X. Vertebral bone marrow fat content in normal adults with varying bone densities at 3T magnetic resonance imaging. Acta Radiol 2019; 60:509-515. [PMID: 30130978 DOI: 10.1177/0284185118786073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sex-related differences of vertebral bone marrow fat in relation to varying bone densities have not yet been evaluated although some studies have reported an inverse association of bone marrow fat and bone mineral density (BMD). PURPOSE To evaluate the relationship between bone marrow fat and BMD and to demonstrate the sex-related differences of the vertebral bone marrow fat in normal adults with varying bone densities. MATERIAL AND METHODS A total of 123 normal adult volunteers were enrolled in this study. 1H-MRS of the lumbar spine was performed. The fat fraction (FF) values of vertebral bone marrow were measured. Volumetric BMD measurement was performed by quantitative computed tomography (QCT). All participants were divided into three groups according to BMD (normal, osteopenia, osteoporosis). The differences in the FF and body mass index (BMI) values of the three groups were compared, and partial correlation analysis was used to evaluate the correlation between FF values and BMD/BMI. RESULTS The FF values increased with decreasing BMD in both male and female participants. There were significant sex differences for the FF values in the normal bone density group ( P < 0.001). The FF values of the normal bone density group in male participants were significantly higher than those of the female participants ( P < 0.001). The FF values were significantly negative correlated with BMD for all participants (r = -0.820, P < 0.001). CONCLUSION The FF values of vertebral bone marrow correlated inversely with BMD. Sex-related differences of FF values was related to BMD.
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Affiliation(s)
- Jie He
- Department of Radiology, The Third Hospital, Hebei Medical University, Hebei Province Biomechanical Key Laboratory of Orthopedics, Shijiazhuang, Hebei Province, PR China
| | - Hao Fang
- Department of Radiology, First Affiliated Hospital, Tianjin University of Chinese Medicine, Tianjin, PR China
| | - Xiaona Li
- Department of Radiology, The Third Hospital, Hebei Medical University, Hebei Province Biomechanical Key Laboratory of Orthopedics, Shijiazhuang, Hebei Province, PR China
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58
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Cheng X, Blake GM, Guo Z, Keenan Brown J, Wang L, Li K, Xu L. Correction of QCT vBMD using MRI measurements of marrow adipose tissue. Bone 2019; 120:504-511. [PMID: 30583123 DOI: 10.1016/j.bone.2018.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Quantitative computed tomography (QCT) measurements of volumetric bone mineral density (vBMD) are subject to errors due to variations in the amount of bone marrow adipose tissue (BMAT). The purpose of our study was to describe and validate a novel method to correct lumbar spine trabecular vBMD measurements for BMAT using chemical shift-encoded magnetic resonance imaging (CSE-MRI). METHODS CSE-MRI measurements of proton density fat fraction (PDFF) were used to correct QCT spine vBMD measurements for BMAT based on the H2O and K2HPO4 basis set equivalent densities of bone, red and yellow bone marrow. BMAT corrected and uncorrected vBMD measurements of the L1 vertebra were compared with dual-energy QCT (DEQCT) measurements in 18 subjects (mean age: 68 y, range 60 to 93 y). A further 400 subjects (mean age: 53 y, range 21 to 82 y) had 120 kVp single-energy QCT and CES-MRI scans of L2-L4 and the data used to simplify the adipose tissue correction by deriving a linear equation between the CSE-MRI vBMD correction and fractional BMAT content. RESULTS Application of the CSE-MRI derived vBMD correction changed the bias (95% limits of agreement) compared with DEQCT from 26.7 (11.0 to 42.4) mg/cm3 to 2.2 (-9.5 to 13.9) mg/cm3 at 80 kVp, and from 22.4 (3.3 to 41.6) mg/cm3 to 2.9 (-12.6 to 18.4) mg/cm3 at 120 kVp. Data for the 400 subjects gave the following relationship valid at 120 kVp: vBMD correction (mg/cm3) = -12.96 + 75.76 × BMAT. CONCLUSION CSE-MRI measurements of PDFF can be used to correct for BMAT content and improve the accuracy of lumbar spine QCT vBMD measurements calibrated using a K2HPO4 phantom.
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Affiliation(s)
- Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom.
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - J Keenan Brown
- Mindways Software Inc., Austin, TX, United States of America
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Kai Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Li Xu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
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59
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Abstract
Bone strength is affected not only by bone mineral density (BMD) and bone microarchitecture but also its microenvironment. Recent studies have focused on the role of marrow adipose tissue (MAT) in the pathogenesis of bone loss. Osteoblasts and adipocytes arise from a common mesenchymal stem cell within bone marrow and many osteoporotic states, including aging, medication use, immobility, over - and undernutrition are associated with increased marrow adiposity. Advancements in imaging technology allow the non-invasive quantification of MAT. This article will review magnetic resonance imaging (MRI)- and computed tomography (CT)-based imaging technologies to assess the amount and composition of MAT. The techniques that will be discussed are anatomic T1-weighted MRI, water-fat imaging, proton MR spectroscopy, single energy CT and dual energy CT. Clinical applications of MRI and CT techniques to determine the role of MAT in patients with obesity, anorexia nervosa, and type 2 diabetes will be reviewed.
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Affiliation(s)
- Vibha Singhal
- Pediatric Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Interventions, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
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60
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Paccou J, Penel G, Chauveau C, Cortet B, Hardouin P. Marrow adiposity and bone: Review of clinical implications. Bone 2019; 118:8-15. [PMID: 29477645 DOI: 10.1016/j.bone.2018.02.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 12/16/2022]
Abstract
There is growing interest in the relationship between bone marrow fat (BMF) and skeletal health. Progress in clinical studies of BMF and skeletal health has been greatly enhanced by recent technical advances in our ability to measure BMF non-invasively. Magnetic resonance imagery (MRI) with or without spectroscopy is currently the standard technique for evaluating BMF content and composition in humans. This review focuses on clinical studies of marrow fat and its relationship with bone. The amount of marrow fat is associated with bone mineral density (BMD). Several studies have reported a significant negative association between marrow fat content and BMD in both healthy and osteoporotic populations. There may also be a relationship between marrow fat and fracture (mostly vertebral fracture), but data are scarce and further studies are needed. Furthermore, a few studies suggest that a lower proportion of unsaturated lipids in vertebral BMF may be associated with reduced BMD and greater prevalence of fracture. Marrow fat might be influenced by metabolic diseases associated with bone loss and fractures, such as diabetes mellitus, obesity and anorexia nervosa. An intriguing aspect of bariatric (weight loss) surgery is that it induces bone loss and fractures, but with different impacts on marrow fat depending on diabetic status. In daily practice, the usefulness for clinicians of assessing marrow fat using MRI is still limited. However, the perspectives are exciting, particularly in terms of improving the diagnosis and management of osteoporosis. Further studies are needed to better understand the regulators involved in the marrow fat-bone relationship and the links between marrow fat, other fat depots and energy metabolism.
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Affiliation(s)
- Julien Paccou
- Université de Lille, Université Littoral Côte d'Opale, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000 Lille, France; Service de rhumatologie, CHRU, 59000 Lille, France.
| | - Guillaume Penel
- Université de Lille, Université Littoral Côte d'Opale, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000 Lille, France
| | - Christophe Chauveau
- Univ. Littoral Côte d'Opale, Univ. Lille, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-62300 Boulogne-sur-Mer, France
| | - Bernard Cortet
- Université de Lille, Université Littoral Côte d'Opale, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000 Lille, France; Service de rhumatologie, CHRU, 59000 Lille, France
| | - Pierre Hardouin
- Univ. Littoral Côte d'Opale, Univ. Lille, EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, F-62300 Boulogne-sur-Mer, France
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Lee SH, Yoo HJ, Yu SM, Hong SH, Choi JY, Chae HD. Fat Quantification in the Vertebral Body: Comparison of Modified Dixon Technique with Single-Voxel Magnetic Resonance Spectroscopy. Korean J Radiol 2018; 20:126-133. [PMID: 30627028 PMCID: PMC6315074 DOI: 10.3348/kjr.2018.0174] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/03/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the lumbar vertebral bone marrow fat-signal fractions obtained from six-echo modified Dixon sequence (6-echo m-Dixon) with those from single-voxel magnetic resonance spectroscopy (MRS) in patients with low back pain. Materials and Methods Vertebral bone marrow fat-signal fractions were quantified by 6-echo m-Dixon (repetition time [TR] = 7.2 ms, echo time (TE) = 1.21 ms, echo spacing = 1.1 ms, total imaging time = 50 seconds) and single-voxel MRS measurements in 25 targets (23 normal bone marrows, two focal lesions) from 24 patients. The point-resolved spectroscopy sequence was used for localized single-voxel MRS (TR = 3000 ms, TE = 35 ms, total scan time = 1 minute 42 seconds). A 2 × 2 × 1.5 cm3 voxel was placed within the normal L2 or L3 vertebral body, or other lesions including a compression fracture or metastasis. The bone marrow fat spectrum was characterized on the basis of the magnitude of measurable fat peaks and a priori knowledge of the chemical structure of triglycerides. The imaging-based fat-signal fraction results were then compared to the MRS-based results. Results There was a strong correlation between m-Dixon and MRS-based fat-signal fractions (slope = 0.86, R2 = 0.88, p < 0.001). In Bland-Altman analysis, 92.0% (23/25) of the data points were within the limits of agreement. Bland-Altman plots revealed a slight but systematic error in the m-Dixon based fat-signal fraction, which showed a prevailing overestimation of small fat-signal fractions (< 20%) and underestimation of high fat-signal fractions (> 20%). Conclusion Given its excellent agreement with single-voxel-MRS, 6-echo m-Dixon can be used for visual and quantitative evaluation of vertebral bone marrow fat in daily practice.
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Affiliation(s)
- Sang Hyup Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Man Yu
- Department of Radiological Science, College of Health Science, Gimcheon University, Gimcheon, Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Ja-Young Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Dong Chae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Maurice F, Dutour A, Vincentelli C, Abdesselam I, Bernard M, Dufour H, Lefur Y, Graillon T, Kober F, Cristofari P, Jouve E, Pini L, Fernandez R, Chagnaud C, Brue T, Castinetti F, Gaborit B. Active cushing syndrome patients have increased ectopic fat deposition and bone marrow fat content compared to cured patients and healthy subjects: a pilot 1H-MRS study. Eur J Endocrinol 2018; 179:307-317. [PMID: 30108093 DOI: 10.1530/eje-18-0318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Glucocorticoid excess is one of the most important causes of bone disorders. Bone marrow fat (BMF) has been identified as a l new mediator of bone metabolism. Cushing syndrome (CS), is a main regulator of adipose tissue distribution but its impact on BMF is unknown. The objective of the study was to evaluate the effect of chronic hypercortisolism on BMF. DESIGN This was a cross-sectional study. Seventeen active and seventeen cured ACTH-dependent CS patients along with seventeen controls (matched with the active group for age and sex) were included. METHODS the BMF content of the femoral neck and L3 vertebrae were measured by 1H-MRS on a 3-Tesla wide-bore magnet. BMD was evaluated in patients using dual-energy X-ray absorptiometry. RESULTS Active CS patients had higher BMF content both in the femur (82.5±2.6%) and vertebrae (70.1±5.1%) compared to the controls (70.8±3.6%, p=0.013 and 49.0±3.7% p=0.005, respectively). In cured CS patients (average remission time of 43 months), BMF content was not different from controls at both sites (72.3±2.9% (femur) and 46.7%±5.3% (L3)). BMF content was positively correlated with age, fasting plasma glucose, HbA1c, triglycerides and visceral adipose tissue in the whole cohort and negatively correlated with BMD values in the CS patients . CONCLUSIONS Accumulation of BMF is induced by hypercortisolism. In remission patients BMF reached values of controls. Further studies are needed to determine whether this increase in marrow adiposity in CS is associated with bone loss.
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Affiliation(s)
- F Maurice
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
- Department of Endocrinology, Pôle ENDO, APHM, Marseille, France
| | - A Dutour
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
- Department of Endocrinology, Pôle ENDO, APHM, Marseille, France
| | - C Vincentelli
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
- Department of Endocrinology, Pôle ENDO, APHM, Marseille, France
| | - I Abdesselam
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - M Bernard
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - H Dufour
- Department of Neurosurgery, APHM, CHU Timone, Marseille, France
| | - Y Lefur
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - T Graillon
- Department of Neurosurgery, APHM, CHU Timone, Marseille, France
| | - F Kober
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | | | - E Jouve
- Medical Evaluation Department, Assistance-Publique Hôpitaux de Marseille, CIC-CPCET, Marseille, France
| | - L Pini
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - R Fernandez
- Radiology Department, Conception Hospital, Marseille, France
| | - C Chagnaud
- Radiology Department, Conception Hospital, Marseille, France
| | - T Brue
- Aix-Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
- Department of Endocrinology, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares Hypophysaires HYPO, Marseille, France
| | - F Castinetti
- Aix-Marseille Univ, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
- Department of Endocrinology, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares Hypophysaires HYPO, Marseille, France
| | - B Gaborit
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
- Department of Endocrinology, Pôle ENDO, APHM, Marseille, France
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Martel D, Leporq B, Bruno M, Regatte RR, Honig S, Chang G. Chemical shift-encoded MRI for assessment of bone marrow adipose tissue fat composition: Pilot study in premenopausal versus postmenopausal women. Magn Reson Imaging 2018; 53:148-155. [PMID: 30006022 DOI: 10.1016/j.mri.2018.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/27/2022]
Abstract
OBJECT To quantify and compare subregional proximal femur bone marrow fat composition in premenopausal and postmenopausal women using chemical shift-encoded-MRI (CSE-MRI). MATERIALS AND METHODS A multi gradient-echo sequence at 3 T was used to scan both hips of premenopausal (n = 9) and postmenopausal (n = 18) women. Subregional fat composition (saturation, poly-unsaturation, mono-unsaturation) was quantitatively assessed in the femoral head, femoral neck, Ward's triangle, greater trochanter, and proximal shaft in bone marrow adipose tissue and separately within red and yellow marrow adipose tissue. RESULTS Significant differences in fat composition in postmenopausal compared to premenopausal women, which varied depending on the subregion analyzed, were found. Within both whole and yellow marrow adipose tissue, postmenopausal women demonstrated higher saturation (+14.7% to +43.3%), lower mono- (-11.4% to -33%) and polyunsaturation (-52 to -83%) (p < 0.05). Within red marrow adipose tissue, postmenopausal women demonstrated lower fat quantity (-16% to -24%) and decreased polyunsaturation (-80 to -120%) in the femoral neck, greater trochanter, and Ward's triangle (p < 0.05). CONCLUSION CSE-MRI can be used to detect subregional differences in proximal femur marrow adipose tissue composition between pre- and post-menopausal women in clinically feasible scan times.
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Affiliation(s)
- Dimitri Martel
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York City, NY, USA.
| | - Benjamin Leporq
- University of Lyon, Laboratoire CREATIS, CNRS UMR 5220, Inserm U1206, INSA-Lyon, UJM Saint-Etienne, UCBL Lyon 1, Lyon, France
| | - Mary Bruno
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York City, NY, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York City, NY, USA
| | - Stephen Honig
- Osteoporosis Center, Hospital for Joint Diseases, New York University School of Medicine, New York City, NY, USA
| | - Gregory Chang
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York City, NY, USA
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Belavy DL, Quittner MJ, Ridgers ND, Shiekh A, Rantalainen T, Trudel G. Specific Modulation of Vertebral Marrow Adipose Tissue by Physical Activity. J Bone Miner Res 2018; 33:651-657. [PMID: 29336053 DOI: 10.1002/jbmr.3357] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/23/2017] [Accepted: 12/02/2017] [Indexed: 11/09/2022]
Abstract
Marrow adipose tissue (MAT) accumulation with normal aging impacts the bone, hemopoiesis, and metabolic pathways. We investigated whether exercise was associated with lower MAT, as measured by vertebral marrow fat fraction (VFF) on magnetic resonance imaging. A total of 101 healthy individuals (54 females) aged 25 to 35 years without spine or bone disease but with distinct exercise histories were studied. Long-distance runners (67 km/wk, n = 25) exhibited lower mean lumbar VFF (27.9% [8.6%] versus 33.5% [6.0%]; p = 0.0048) than non-sporting referents (n = 24). In habitual joggers (28 km/wk, n = 30), mean lumbar VFF was 31.3% (9.0%) (p = 0.22 versus referents) and 6.0 percentage points lower than referents at vertebrae T10 , T11 , and T12 (p ≤ 0.023). High-volume road cycling (275 km/wk, n = 22) did not impact VFF. 3D accelerations corresponding to faster walking, slow jogging, and high-impact activities correlated with lower VFF, whereas low-impact activities and sedentary time correlated with higher mean lumbar VFF (all p ≤ 0.05). Given an estimated adipose bone marrow conversion of 7% per decade of life, long distance runners, with 5.6 percentage points lower VFF, showed an estimated 8-year younger vertebral marrow adipose tissue phenotype. Regression analysis showed a 0.7 percentage point reduction in mean lumbar VFF with every 9.4 km/wk run (p = 0.002). This study presents the first evidence in humans or animals that specific volumes and types of exercise may influence the age-determined adipose marrow conversion and result in low MAT. These results identify a potentially modifiable risk factor for prevalent chronic conditions related to bone metabolism, hemopoietic production, and other metabolic functions with potential global health applications. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Daniel L Belavy
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Matthew J Quittner
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Nicola D Ridgers
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Adnan Shiekh
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Timo Rantalainen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Guy Trudel
- Department of Medicine, Division of Physical Medicine and Rehabilitation, Bone and Joint Research Laboratory, University of Ottawa, Ottawa, Canada
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Gezer NS, Balcı A, Kalemci O, Köremezli N, Başara Akın I, Ur K. Vertebral body bone mineral density in patients with lumbar spondylolysis: a quantitative CT study. Diagn Interv Radiol 2018; 23:385-389. [PMID: 28765098 DOI: 10.5152/dir.2017.16463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Spondylolysis is known to be a part of a disease process, which describes a defect in the pars interarticularis of vertebra. We aimed to use quantitative computed tomography (QCT) to measure vertebral body bone mineral density (BMD) in patients with lumbar spondylolysis and compare it with readings in controls. METHODS Forty symptomatic patients with lumbar spondylolysis aged 18-52 years and 40 matched controls of same sex and approximate age (±2 years) were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5 and mean BMD was calculated for each case. RESULTS Of 40 patients, 22 (55%) demonstrated L5 spondylolysis, 14 (35%) L4 spondylolysis, three (7.5%) L3 spondylolysis, and one (2.5%) L2 spondylolysis. Spondylolisthesis was found in 29 patients (73%). Patients with spondylolisthesis were significantly older than patients without spondylolisthesis (42±6.9 vs. 37.2±5.4, P = 0.024). Mean BMD value of the patient group was significantly lower than that of the controls (105±24 mg/cm³ vs. 118.7±25.6 mg/cm³, P = 0.015). Subgroup analysis of 19 patients and 19 controls under the age of 40 revealed that the mean BMD value of the patients was significantly lower than that of the controls in the younger age group as well (108.7±23.5 mg/cm³ vs. 130±25.8 mg/cm³, P = 0.009). CONCLUSION This study demonstrated that patients with spondylolysis had significantly lower mean vertebral body BMD compared with controls.
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Affiliation(s)
- Naciye Sinem Gezer
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
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Rajapakse CS, Kobe EA, Batzdorf AS, Hast MW, Wehrli FW. Accuracy of MRI-based finite element assessment of distal tibia compared to mechanical testing. Bone 2018; 108:71-78. [PMID: 29278746 PMCID: PMC5803422 DOI: 10.1016/j.bone.2017.12.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
High-resolution MRI-derived finite element analysis (FEA) has been used in translational research to estimate the mechanical competence of human bone. However, this method has yet to be validated adequately under in vivo imaging spatial resolution or signal-to-noise conditions. We therefore compared MRI-based metrics of bone strength to those obtained from direct, mechanical testing. The study was conducted on tibiae from 17 human donors (12 males and five females, aged 33 to 88years) with no medical history of conditions affecting bone mineral homeostasis. A 25mm segment from each distal tibia underwent MR imaging in a clinical 3-Tesla scanner using a fast large-angle spin-echo (FLASE) sequence at 0.137mm×0.137mm×0.410mm voxel size, in accordance with in vivo scanning protocol. The resulting high-resolution MR images were processed and used to generate bone volume fraction maps, which served as input for the micro-level FEA model. Simulated compression was applied to compute stiffness, yield strength, ultimate strength, modulus of resilience, and toughness, which were then compared to metrics obtained from mechanical testing. Moderate to strong positive correlations were found between computationally and experimentally derived values of stiffness (R2=0.77, p<0.0001), yield strength (R2=0.38, p=0.0082), ultimate strength (R2=0.40, p=0.0067), and resilience (R2=0.46, p=0.0026), but only a weak, albeit significant, correlation was found for toughness (R2=0.26, p=0.036). Furthermore, experimentally derived yield strength and ultimate strength were moderately correlated with MRI-derived stiffness (R2=0.48, p=0.0022 and R2=0.58, p=0.0004, respectively). These results suggest that high-resolution MRI-based finite element (FE) models are effective in assessing mechanical parameters of distal skeletal extremities.
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Affiliation(s)
- Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, United States; Department of Orthopaedic Surgery, University of Pennsylvania, United States.
| | - Elizabeth A Kobe
- Department of Radiology, University of Pennsylvania, United States
| | | | - Michael W Hast
- Department of Orthopaedic Surgery, University of Pennsylvania, United States
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, United States
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Xu K, Sigurdsson S, Gudnason V, Hue T, Schwartz A, Li X. Reliable quantification of marrow fat content and unsaturation level using in vivo MR spectroscopy. Magn Reson Med 2018; 79:1722-1729. [PMID: 28714169 PMCID: PMC5930928 DOI: 10.1002/mrm.26828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/29/2017] [Accepted: 06/15/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop a novel technique for reliable quantification of bone marrow fat content and composition using in vivo MR spectroscopy (MRS). METHODS An MRS quantification method combining both advantages of Voigt line shape model and time-domain analysis was developed. The proposed method was tested using computer-simulated data and in vivo data acquired at lumbar vertebral bodies of 23 subjects (age, 83.8 ± 3.7 y; male, n = 13; female, n = 10) from L1 to L4. Reliability and reproducibility were calculated for the quantification results. Comparisons between the proposed method and some conventional methods were conducted. RESULTS Low mean absolute percentage errors and low mean coefficients of variation for computer simulations suggest that the proposed method is accurate and precise. By using this method, marrow fat content can be quantified reliably, even for data with low spectral resolution and low signal-to-noise ratio (SNR). Unsaturation level can be reliably quantified for data with moderate spectral resolution and moderate SNR. Results obtained from in vivo data using the proposed method demonstrated better model fit than conventional methods. CONCLUSION The method proposed in this study has better performance than conventional methods in the quantification of bone marrow MRS data and has great potential for wide applications of studying marrow fat content and composition. Magn Reson Med 79:1722-1729, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Kaipin Xu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California, USA
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, IS 201 Iceland
- University of Iceland, Reykjavik, Iceland
| | - Trisha Hue
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Ann Schwartz
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California, USA
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Singh S, Bray T, Hall-Craggs M. Quantifying bone structure, micro-architecture, and pathophysiology with MRI. Clin Radiol 2018; 73:221-230. [DOI: 10.1016/j.crad.2017.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/18/2017] [Indexed: 02/07/2023]
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Singhal V, Tulsiani S, Campoverde KJ, Mitchell DM, Slattery M, Schorr M, Miller KK, Bredella MA, Misra M, Klibanski A. Impaired bone strength estimates at the distal tibia and its determinants in adolescents with anorexia nervosa. Bone 2018; 106:61-68. [PMID: 28694162 PMCID: PMC5694353 DOI: 10.1016/j.bone.2017.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Altered bone microarchitecture and higher marrow adipose tissue (MAT) may reduce bone strength. High resolution pQCT (HRpQCT) allows assessment of volumetric BMD (vBMD), and size and microarchitecture parameters of bone, while 1H-magnetic resonance spectroscopy (1H-MRS) allows MAT evaluation. We have reported impaired microarchitecture at the non-weight bearing radius in adolescents with anorexia nervosa (AN) and that these changes may precede aBMD deficits. Data are lacking regarding effects of AN on microarchitecture and strength at the weight-bearing tibia in adolescents and young adults, and the impact of changes in microarchitecture and MAT on strength estimates. OBJECTIVE To compare strength estimates at the distal tibia in adolescents/young adults with AN and controls in relation to vBMD, bone size and microarchitecture, and spine MAT. DESIGN AND METHODS This was a cross-sectional study of 47 adolescents/young adults with AN and 55 controls 14-24years old that assessed aBMD and body composition using DXA, and distal tibia vBMD, size, microarchitecture and strength estimates using HRpQCT, extended cortical analysis, individual trabecular segmentation, and finite element analysis. Lumbar spine MAT (1H-MRS) was assessed in a subset of 19 AN and 22 controls. RESULTS Areal BMD Z-scores were lower in AN than controls. At the tibia, AN had greater cortical porosity, lower total and cortical vBMD, cortical area and thickness, trabecular number, and strength estimates than controls. Within AN, strength estimates were positively associated with lean mass, aBMD, vBMD, bone size and microarchitectural parameters. MAT was higher in AN, and associated inversely with strength estimates. CONCLUSIONS Adolescents/young adults with AN have impaired microarchitecture at the weight-bearing tibia and higher spine MAT, associated with reduced bone strength.
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Affiliation(s)
- Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States; Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States.
| | - Shreya Tulsiani
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Karen Joanie Campoverde
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Deborah M Mitchell
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States; Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
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Neumayer B, Widek T, Stollberger R, Scheurer E. Reproducibility of relaxometry of human lumbar vertebrae at 3 Tesla using 1
H MR spectroscopy. J Magn Reson Imaging 2017; 48:153-159. [DOI: 10.1002/jmri.25912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/14/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Bernhard Neumayer
- Ludwig Boltzmann Institute for Clinical Forensic Imaging; Graz Austria
- BioTechMed-Graz; Austria
| | - Thomas Widek
- Ludwig Boltzmann Institute for Clinical Forensic Imaging; Graz Austria
- BioTechMed-Graz; Austria
| | - Rudolf Stollberger
- BioTechMed-Graz; Austria
- Institute of Medical Engineering; Graz University of Technology; Graz Austria
| | - Eva Scheurer
- Institute of Forensic Medicine; University of Basel; Basel Switzerland
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Correlative Analysis of Vertebral Trabecular Bone Microarchitecture and Mechanical Properties: A Combined Ultra-high Field (7 Tesla) MRI and Biomechanical Investigation. Spine (Phila Pa 1976) 2017; 42:E1165-E1172. [PMID: 28338579 DOI: 10.1097/brs.0000000000002163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN High-resolution imaging and biomechanical investigation of ex-vivo vertebrae. OBJECTIVE The aim of this study was to assess bone microarchitecture of cadaveric vertebrae using ultra-high field (UHF) 7 Tesla magnetic resonance imaging (MRI) and to determine whether the corresponding microarchitecture parameters were related to bone mineral density (BMD) and bone strength assessed by dual-energy x-ray absorptiometry (DXA) and mechanical compression tests. SUMMARY OF BACKGROUND DATA Limitations of DXA for the assessment of bone fragility and osteoporosis have been recognized and criteria of microarchitecture alteration have been included in the definition of osteoporosis. Although vertebral fracture is the most common osteoporotic fracture, no study has assessed directly vertebral trabecular bone microarchitecture. METHODS BMD of 24 vertebrae (L2, L3, L4) from eight cadavers was investigated using DXA. The bone volume fraction (BVF), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp) of each vertebra were quantified using UHF MRI. Measurements were performed by two operators to characterize the inter-rater reliability. The whole set of specimens underwent mechanical compression tests to failure and the corresponding failure stress was calculated. RESULTS The inter-rater reliability for bone microarchitecture parameters was good with intraclass correlation coefficients ranging from 0.82 to 0.94. Failure load and stress were significantly correlated with BVF, Tb.Sp, and BMD (P < 0.05). Tb.Th was only correlated with the failure stress (P < 0.05). Multiple regression analysis demonstrated that the combination of BVF and BMD improved the prediction of the failure stress from an adjusted R = 0.384 for BMD alone to an adjusted R = 0.414. CONCLUSION We demonstrated for the first time that the vertebral bone microarchitecture assessed with UHF MRI was significantly correlated with biomechanical parameters. Our data suggest that the multimodal assessment of BMD and trabecular bone microarchitecture with UHF MRI provides additional information on the risk of vertebral bone fracture and might be of interest for the future investigation of selected osteoporotic patients. LEVEL OF EVIDENCE N /A.
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Chang G, Boone S, Martel D, Rajapakse CS, Hallyburton RS, Valko M, Honig S, Regatte RR. MRI assessment of bone structure and microarchitecture. J Magn Reson Imaging 2017; 46:323-337. [PMID: 28165650 PMCID: PMC5690546 DOI: 10.1002/jmri.25647] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis is a disease of weak bone and increased fracture risk caused by low bone mass and microarchitectural deterioration of bone tissue. The standard-of-care test used to diagnose osteoporosis, dual-energy x-ray absorptiometry (DXA) estimation of areal bone mineral density (BMD), has limitations as a tool to identify patients at risk for fracture and as a tool to monitor therapy response. Magnetic resonance imaging (MRI) assessment of bone structure and microarchitecture has been proposed as another method to assess bone quality and fracture risk in vivo. MRI is advantageous because it is noninvasive, does not require ionizing radiation, and can evaluate both cortical and trabecular bone. In this review article, we summarize and discuss research progress on MRI of bone structure and microarchitecture over the last decade, focusing on in vivo translational studies. Single-center, in vivo studies have provided some evidence for the added value of MRI as a biomarker of fracture risk or treatment response. Larger, prospective, multicenter studies are needed in the future to validate the results of these initial translational studies. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:323-337.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Sean Boone
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Dimitri Martel
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert S Hallyburton
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Mitch Valko
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Stephen Honig
- Osteoporosis Center, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York, USA
| | - Ravinder R Regatte
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
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75
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Bray TJP, Singh S, Latifoltojar A, Rajesparan K, Rahman F, Narayanan P, Naaseri S, Lopes A, Bainbridge A, Punwani S, Hall-Craggs MA. Diagnostic utility of whole body Dixon MRI in multiple myeloma: A multi-reader study. PLoS One 2017; 12:e0180562. [PMID: 28672007 PMCID: PMC5495520 DOI: 10.1371/journal.pone.0180562] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/16/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine which of four Dixon image types [in-phase (IP), out-of-phase (OP), fat only (FO) and water-only (WO)] is most sensitive for detecting multiple myeloma (MM) focal lesions on whole body MRI (WB-MRI) images. METHODS Thirty patients with clinically-suspected MM underwent WB-MRI at 3 Tesla. Unenhanced IP, OP, FO and WO Dixon images were generated and read by four radiologists. On each image type, each radiologist identified and labelled all visible myeloma lesions in the bony pelvis. Each identified lesion was compared with a reference standard consisting of pre- and post-contrast Dixon and diffusion weighted imaging (read by a further consultant radiologist) to determine whether the lesion was truly positive. Lesion count, true positives, sensitivity, and positive predictive value were compared across the four Dixon image types. RESULTS Lesion count, true positives, sensitivity and confidence scores were all significantly higher on FO images than on IP images (p>0.05). DISCUSSION FO images are more sensitive than other Dixon image types for MM focal lesions, and should be preferentially read by radiologists to improve diagnostic accuracy and reporting efficiency.
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Affiliation(s)
- Timothy J. P. Bray
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Saurabh Singh
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Arash Latifoltojar
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Kannan Rajesparan
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Farzana Rahman
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Priya Narayanan
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Sahar Naaseri
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Andre Lopes
- Cancer Research UK and UCL Clinical Trials Centre, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics Department, University College London Hospitals, London, United Kingdom
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, United Kingdom
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Bastos CM, Araújo IM, Nogueira-Barbosa MH, Salmon CEG, de Paula FJA, Troncon LEA. Reduced bone mass and preserved marrow adipose tissue in patients with inflammatory bowel diseases in long-term remission. Osteoporos Int 2017; 28:2167-2176. [PMID: 28405731 DOI: 10.1007/s00198-017-4014-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/15/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED Bone marrow adipose tissue has not been studied in patients with inactive inflammatory bowel disease. We found that these patients have preserved marrow adiposity even with low bone mass. Factors involved in bone loss in active disease may have long-lasting effects but do not seem to affect bone marrow adiposity. INTRODUCTION Reduced bone mass is known to occur at varying prevalence in patients with inflammatory bowel diseases (IBD) because of inflammation, malnutrition, and steroid therapy. Osteoporosis may develop in these patients as the result of an imbalanced relationship between osteoblasts and adipocytes in bone marrow. This study aimed to evaluate for the first time bone mass and bone marrow adipose tissue (BMAT) in a particular subgroup of IBD patients characterized by long-term, steroid-free remission. METHODS Patients with Crohn's disease (CD; N = 21) and ulcerative colitis (UC; N = 15) and controls (C; N = 65) underwent dual X-ray energy absorptiometry and nuclear magnetic resonance spectroscopy of the L3 lumbar vertebra for BMAT assessment. RESULTS Both the CD and UC subgroups showed significantly higher proportions of patients than controls with Z-score ≤-2.0 at L1-L4 (C 1.54%; CD 19.05%; UC 20%; p = 0.02), but not at other sites. The proportions of CD patients with a T-score ˂-1.0 at the femoral neck (C 18.46%; CD 47.62%; p = 0.02) and total hip (C 16.92%; CD 42.86%; p = 0.03) were significantly higher than among controls. There were no statistically significant differences between IBD patients and controls regarding BMAT at L3 (C 28.62 ± 8.15%; CD 29.81 ± 6.90%; UC 27.35 ± 9.80%; p = 0.67). CONCLUSIONS IBD patients in long-term, steroid-free remission may have a low bone mass in spite of preserved BMAT. These findings confirm the heterogeneity of bone disorders in IBD and may indicate that factors involved in bone loss in active disease may have long-lasting effects on these patients.
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Affiliation(s)
- C M Bastos
- Gastroenterology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - I M Araújo
- Endocrinology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - M H Nogueira-Barbosa
- Radiology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - C E G Salmon
- Department of Physics, Ribeirão Preto Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | - F J A de Paula
- Endocrinology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - L E A Troncon
- Gastroenterology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
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Wang CY, Hsu YJ, Peng YJ, Lee HS, Chang YC, Chang CS, Chiang SW, Hsu YC, Lin MH, Huang GS. Knee subchondral bone perfusion and its relationship to marrow fat and trabeculation on multi-parametric MRI and micro-CT in experimental CKD. Sci Rep 2017; 7:3073. [PMID: 28596576 PMCID: PMC5465086 DOI: 10.1038/s41598-017-03059-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/21/2017] [Indexed: 12/16/2022] Open
Abstract
The pathogenesis of chronic kidney disease (CKD) is multifactorial. In the progression of CKD arthropathy, arteriosclerosis may alter the knee subchondral bone marrow by altering blood flow through the bone vasculature. Herein, multi-parametric MRI assessment, including dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), magnetic resonance spectroscopy (MRS), MRI T2*, contrast enhanced MR angiography (CE-MRA), and micro-CT were applied in a rodent nephrectomy model to: 1) investigate the blood perfusion of subchondral bone marrow and its relationship to fat water content and trabeculation pattern in CKD and 2) demonstrate the feasibility of using multi-parametric MRI parameters as imaging biomarkers to evaluate the disease’s progression. Two groups of rats in our study underwent either 1) no intervention or 2) 5/6 nephrectomy. We found that in the CKD group, perfusion amplitude A and elimination constant kel values were significantly decreased, and vascular permeability kep was significantly increased. MRS showed that fat fraction (FF) was significantly lower, water fraction (WF) was significantly higher in the CKD group. Micro-CT showed a significant loss of trabecular bone. Knee subchondral bone marrow perfusion deficiency in experimental CKD may be associated with decreased fat content, increased water content, and sparse trabeculation.
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Affiliation(s)
- Chao-Ying Wang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan.,Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei, Taiwan
| | - Chih-Shan Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Wei Chiang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Huang Lin
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Karampinos DC, Ruschke S, Dieckmeyer M, Diefenbach M, Franz D, Gersing AS, Krug R, Baum T. Quantitative MRI and spectroscopy of bone marrow. J Magn Reson Imaging 2017; 47:332-353. [PMID: 28570033 PMCID: PMC5811907 DOI: 10.1002/jmri.25769] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Bone marrow is one of the largest organs in the human body, enclosing adipocytes, hematopoietic stem cells, which are responsible for blood cell production, and mesenchymal stem cells, which are responsible for the production of adipocytes and bone cells. Magnetic resonance imaging (MRI) is the ideal imaging modality to monitor bone marrow changes in healthy and pathological states, thanks to its inherent rich soft‐tissue contrast. Quantitative bone marrow MRI and magnetic resonance spectroscopy (MRS) techniques have been also developed in order to quantify changes in bone marrow water–fat composition, cellularity and perfusion in different pathologies, and to assist in understanding the role of bone marrow in the pathophysiology of systemic diseases (e.g. osteoporosis). The present review summarizes a large selection of studies published until March 2017 in proton‐based quantitative MRI and MRS of bone marrow. Some basic knowledge about bone marrow anatomy and physiology is first reviewed. The most important technical aspects of quantitative MR methods measuring bone marrow water–fat composition, fatty acid composition, perfusion, and diffusion are then described. Finally, previous MR studies are reviewed on the application of quantitative MR techniques in both healthy aging and diseased bone marrow affected by osteoporosis, fractures, metabolic diseases, multiple myeloma, and bone metastases. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:332–353.
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Affiliation(s)
- Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Maximilian Diefenbach
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Baum
- Section for Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
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Thornton D, Gordon CM. Restrictive Eating Disorders and Skeletal Health in Adolescent Girls and Young Women. Calcif Tissue Int 2017; 100:449-460. [PMID: 27339670 PMCID: PMC9767748 DOI: 10.1007/s00223-016-0164-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/10/2016] [Indexed: 12/19/2022]
Abstract
This article reviews the effects of restrictive eating disorders on bone health. The relationship between eating disorders and amenorrhea is discussed in detail. The pathologic impact of malnutrition on bone is explored by examining the results of studies using various available imaging techniques. The multiple hormonal alterations seen in adolescents and young women with anorexia nervosa are reviewed, as well as how these alterations may influence bone turnover, density, structure, and strength. The diagnostic clinical evaluation for adolescents and young women with these disorders is also outlined. Available treatment options, including those that hold promise for efficacy, as well as those we deemed to be ineffective, are considered from both the clinical and mechanistic standpoints. Finally, future research opportunities are offered, including intriguing work in the area of fat and bone interactions.
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Affiliation(s)
- Darcey Thornton
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave MLC 4000, Cincinnati, OH, 45229, USA
| | - Catherine M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave MLC 4000, Cincinnati, OH, 45229, USA.
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Measurement of vertebral bone marrow proton density fat fraction in children using quantitative water-fat MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 30:449-460. [PMID: 28382554 DOI: 10.1007/s10334-017-0617-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the feasibility of employing a 3D time-interleaved multi-echo gradient-echo (TIMGRE) sequence to measure the proton density fat fraction (PDFF) in the vertebral bone marrow (VBM) of children and to examine cross-sectional changes with age and intra-individual variations from the lumbar to the cervical region in the first two decades of life. MATERIALS AND METHODS Quantitative water-fat imaging of the spine was performed in 93 patients (49 girls; 44 boys; age median 4.5 years; range 0.1-17.6 years). For data acquisition, a six-echo 3D TIMGRE sequence was used with phase correction and complex-based water-fat separation. Additionally, single-voxel MR spectroscopy (MRS) was performed in the L4 vertebrae of 37 patients. VBM was manually segmented in the midsagittal slice of each vertebra. Univariable and multivariable linear regression models were calculated between averaged lumbar, thoracic and cervical bone marrow PDFF and age with adjustments for sex, height, weight, and body mass index percentile. RESULTS Measured VBM PDFF correlated strongly between imaging and MRS (R 2 = 0.92, slope = 0.94, intercept = -0.72%). Lumbar, thoracic and cervical VBM PDFF correlated significantly (all p < 0.001) with the natural logarithm of age. Differences between female and male patients were not significant (p > 0.05). CONCLUSION VBM development in children showed a sex-independent cross-sectional increase of PDFF correlating with the natural logarithm of age and an intra-individual decrease of PDFF from the lumbar to the cervical region in all age groups. The present results demonstrate the feasibility of using a 3D TIMGRE sequence for PDFF assessment in VBM of children.
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A fast method for the quantification of fat fraction and relaxation times: Comparison of five sites of bone marrow. Magn Reson Imaging 2017; 39:157-161. [PMID: 28263827 DOI: 10.1016/j.mri.2017.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE Bone marrow is found either as red bone marrow, which mainly contains haematopoietic cells, or yellow bone marrow, which mainly contains adipocytes. In adults, red bone marrow is principally located in the axial skeleton. A recent study has introduced a method to simultaneously estimate the fat fraction (FF), the T1 and T2* relaxation times of water (T1w, T2*w) and fat (T1f and T2*f) in the vertebral bone marrow. The aim of the current study was to measure FF, T1w, T1f, T2*w and T2*f in five sites of bone marrow, and to assess the presence of regional variations. METHODS MRI experiments were performed at 1.5T on five healthy volunteers (31.6±15.6years) using a prototype chemical-shift-encoded 3D multi-gradient-echo sequence (VIBE) acquired with two flip angles. Acquisitions were performed in the shoulders, lumbar spine and pelvis, with acquisition times of <25seconds per sequence. Signal intensities of magnitude images of the individual echoes were used to fit the signal and compute FF, T1w, T1f, T2*w and T2*f in the humerus, sternum, vertebra, ilium and femur. RESULTS Regional variations of fat fraction and relaxation times were observed in these sites, with higher fat fraction and longer T1w in the epiphyses of long bones. A high correlation between FF and T1w was measured in these bones (R=0.84 in the humerus and R=0.84 in the femur). In most sites, there was a significant difference between water and fat relaxation times, attesting the relevance of measuring these parameters separately. CONCLUSION The method proposed in the current study allowed for measurements of FF, T1w, T1f, T2*w and T2*f in five sites of bone marrow. Regional variations of these parameters were observed and a strong negative correlation between the T1 of water and the fat fraction in bones with high fat fractions was found.
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Manhard MK, Nyman JS, Does MD. Advances in imaging approaches to fracture risk evaluation. Transl Res 2017; 181:1-14. [PMID: 27816505 PMCID: PMC5357194 DOI: 10.1016/j.trsl.2016.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/19/2016] [Accepted: 09/27/2016] [Indexed: 01/23/2023]
Abstract
Fragility fractures are a growing problem worldwide, and current methods for diagnosing osteoporosis do not always identify individuals who require treatment to prevent a fracture and may misidentify those not a risk. Traditionally, fracture risk is assessed using dual-energy X-ray absorptiometry, which provides measurements of areal bone mineral density at sites prone to fracture. Recent advances in imaging show promise in adding new information that could improve the prediction of fracture risk in the clinic. As reviewed herein, advances in quantitative computed tomography (QCT) predict hip and vertebral body strength; high-resolution HR-peripheral QCT (HR-pQCT) and micromagnetic resonance imaging assess the microarchitecture of trabecular bone; quantitative ultrasound measures the modulus or tissue stiffness of cortical bone; and quantitative ultrashort echo-time MRI methods quantify the concentrations of bound water and pore water in cortical bone, which reflect a variety of mechanical properties of bone. Each of these technologies provides unique characteristics of bone and may improve fracture risk diagnoses and reduce prevalence of fractures by helping to guide treatment decisions.
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Affiliation(s)
- Mary Kate Manhard
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN
| | - Jeffry S Nyman
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN; Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Mark D Does
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN; Electrical Engineering, Vanderbilt University, Nashville, TN.
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Veldhuis-Vlug AG, Rosen CJ. Mechanisms of marrow adiposity and its implications for skeletal health. Metabolism 2017; 67:106-114. [PMID: 28081773 PMCID: PMC5325679 DOI: 10.1016/j.metabol.2016.11.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/02/2016] [Accepted: 11/22/2016] [Indexed: 12/11/2022]
Abstract
The bone marrow niche is composed of cells from hematopoietic and mesenchymal origin. Both require energy to power differentiation and these processes are intimately connected to systemic metabolic homeostasis. Glycolysis is the preferred substrate for mesenchymal stromal cells in the niche, although fatty acid oxidation and glutaminolysis are important during stage specific differentiation. Autophagy and lipophagy, in part triggered by adenosine monophosphate-activated protein kinase (AMPK), may also play an important but temporal specific role in osteoblast differentiation. Enhanced marrow adiposity is caused by clinical factors that are genetically, environmentally, and hormonally mediated. These determinants mediate a switch from the osteogenic to the adipogenic lineage. Preliminary evidence supports an important role for fuel utilization in those cell fate decisions. Although both the origin and function of the marrow adipocyte remain to be determined, and in some genetic mouse models high marrow adiposity may co-exist with greater bone mass, in humans changes in marrow adiposity are closely linked to adverse changes in skeletal metabolism. This supports an intimate relationship between bone and fat in the marrow. Future studies will likely shed more light on the relationship of cellular as well as whole body metabolism on the ultimate fate of bone marrow stromal cells.
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Maciel JG, de Araújo IM, Carvalho AL, Simão MN, Bastos CM, Troncon LEA, Salmon CEG, de Paula FJA, Nogueira-Barbosa MH. Marrow Fat Quality Differences by Sex in Healthy Adults. J Clin Densitom 2017; 20:106-113. [PMID: 27637728 DOI: 10.1016/j.jocd.2016.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 01/19/2023]
Abstract
Several studies have demonstrated the relationship between bone marrow adiposity (BMAT) and bone mass. 1H magnetic resonance spectroscopy is a noninvasive technique able to assess both BMAT quantity and quality. The aim of our study was to perform quantitative and qualitative analyses of BMAT and to investigate its association with bone mineral density (BMD) in healthy nonobese volunteers. Fifty-one healthy volunteers, 21 men and 30 women, underwent 1.5 T 1H magnetic resonance spectroscopy of the lumbar spine. BMD was determined by dual-energy X-ray absorptiometry of the lumbar spine. Correlation analysis was performed to evaluate association among lipids fractions, BMD, and age. The female and male volunteers had similar body mass index and BMD (p > 0.05). Our data demonstrated an inverse correlation of BMD and BMAT with age, with a stronger correlation of saturated lipids (r = 0.701; p < 0.0001) compared with unsaturated lipids (UL) (r = 0.278; p = 0.004). Importantly, female subjects had the highest amount of UL (confidence interval: 0.685%-1.722%; p < 0.001). Our study reports that men and women with similar BMD and body mass index have striking differences in bone marrow lipids composition, namely women have higher UL than men. In addition, we believe that our study brings new insights to the complex network involving BMAT and other factors that influence bone integrity.
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Affiliation(s)
- Jamilly G Maciel
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil.
| | - Iana M de Araújo
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil
| | - Adriana L Carvalho
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil
| | - Marcelo N Simão
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil
| | - Clara M Bastos
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil
| | - Luiz E A Troncon
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil
| | - Carlos E G Salmon
- Department of Physics, Faculty of Philosophy, Sciences and Arts of Ribeirao Preto, University of Sao Paulo (USP), Ribeirão Preto, Brazil
| | - Francisco J A de Paula
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto, Brazil
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85
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Oei L, Koromani F, Rivadeneira F, Zillikens MC, Oei EHG. Quantitative imaging methods in osteoporosis. Quant Imaging Med Surg 2016; 6:680-698. [PMID: 28090446 DOI: 10.21037/qims.2016.12.13] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteoporosis is characterized by a decreased bone mass and quality resulting in an increased fracture risk. Quantitative imaging methods are critical in the diagnosis and follow-up of treatment effects in osteoporosis. Prior radiographic vertebral fractures and bone mineral density (BMD) as a quantitative parameter derived from dual-energy X-ray absorptiometry (DXA) are among the strongest known predictors of future osteoporotic fractures. Therefore, current clinical decision making relies heavily on accurate assessment of these imaging features. Further, novel quantitative techniques are being developed to appraise additional characteristics of osteoporosis including three-dimensional bone architecture with quantitative computed tomography (QCT). Dedicated high-resolution (HR) CT equipment is available to enhance image quality. At the other end of the spectrum, by utilizing post-processing techniques such as the trabecular bone score (TBS) information on three-dimensional architecture can be derived from DXA images. Further developments in magnetic resonance imaging (MRI) seem promising to not only capture bone micro-architecture but also characterize processes at the molecular level. This review provides an overview of various quantitative imaging techniques based on different radiological modalities utilized in clinical osteoporosis care and research.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW This study aims to describe bone marrow fat changes in diabetes and to discuss the potential role of marrow fat in skeletal fragility. RECENT FINDINGS Advances in non-invasive imaging have facilitated marrow fat research in humans. In contrast to animal studies which clearly demonstrate higher levels of marrow fat in diabetes, human studies have shown smaller and less certain differences. Marrow fat has been reported to correlate with A1c, and there may be a distinct marrow lipid saturation profile in diabetes. Greater marrow fat is associated with impaired skeletal health. Marrow fat may be a mediator of skeletal fragility in diabetes. Circulating lipids, growth hormone alterations, visceral adiposity, and hypoleptinemia have been associated with greater marrow fat and may represent potential mechanisms for the putative effects of diabetes on marrow fat, although other factors likely contribute. Additional research is needed to further define the role of marrow fat in diabetic skeletal fragility and to determine whether marrow fat is a therapeutic target.
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Affiliation(s)
- Tiffany Y Kim
- University of California, San Francisco, 1700 Owens St, Room 349, San Francisco, CA, 94158, USA.
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
| | - Anne L Schafer
- University of California, San Francisco, 1700 Owens St, Room 349, San Francisco, CA, 94158, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
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87
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Li G, Xu Z, Yuan W, Chang S, Chen Y, Calimente H, Hu J. Short- and midterm reproducibility of marrow fat measurements using mDixon imaging in healthy postmenopausal women. Skeletal Radiol 2016; 45:1385-90. [PMID: 27502625 DOI: 10.1007/s00256-016-2448-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/05/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We tested the short- and midterm reproducibility of vertebral marrow fat fraction (FF) measurements using mDixon imaging. MATERIALS AND METHODS Thirty postmenopausal women underwent mDixon scans to obtain L1-4 FF from three slices per vertebra by two independent observers (session 1). Measurements were repeated after 6 weeks (session 2) and 6 months (session 3). The mean FF for three regions of interest per vertebra was calculated. The coefficients of variation (CVs) were calculated for each participant and imaging session, and the intraclass correlation coefficients (ICCs) were calculated to assess interobserver and intersession agreements. RESULTS There were no significant differences in FF measurements among the three slices, imaging sessions or observers. The mean intrasubject CV for FF measurement reproducibility was 1.94 %. The interobserver agreement for the average FF value was excellent (ICC ≥0.945 for each session). The ICC for intersession agreement was excellent (ICC ≥0.955 between sessions). The mean intersession CV was lower within a short-term interval (2.97 %) than within sessions 1 and 3 (4.80 %) or sessions 3 and 2 (4.44 %). The overall mean CV for the reproducibility of FF measured with mDixon imaging over the short- and midterm was 4.09 % (95 % CI, 3.79-4.40 %). CONCLUSION mDixon is a reproducible method for FF quantification over short- and midterm intervals up to 6 months in healthy postmenopausal women. Our results also provide data by which a power analysis can be optimized when designing studies involving the use of FF derived from similar mDixon sequences.
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Affiliation(s)
- Guanwu Li
- Department of Radiology, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Hongkou District, Shanghai, 200437, China.
| | - Zheng Xu
- Xinzhuang Community Health Center, Shanghai, 201199, China
| | - Wei Yuan
- Department of Spinal Disease Unit, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Shixin Chang
- Department of Radiology, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Hongkou District, Shanghai, 200437, China
| | - Yongsheng Chen
- Department of Radiology, Wayne State University, Detroit, 48202, MI, USA
| | - Horea Calimente
- Department of Radiology, Wayne State University, Detroit, 48202, MI, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, 48202, MI, USA
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Yoo HJ, Hong SH, Kim DH, Choi J, Chae HD, Jeong BM, Ahn JM, Kang HS. Measurement of fat content in vertebral marrow using a modified dixon sequence to differentiate benign from malignant processes. J Magn Reson Imaging 2016; 45:1534-1544. [DOI: 10.1002/jmri.25496] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hye Jin Yoo
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Sung Hwan Hong
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Institute of Radiation MedicineSeoul National University Medical Research CenterSeoul Korea
| | - Dong Hyun Kim
- Department of RadiologySeoul National University HospitalSeoul Korea
| | - Ja‐Young Choi
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Hee Dong Chae
- Department of RadiologySeoul National University HospitalSeoul Korea
- Department of RadiologySeoul National University College of MedicineSeoul Korea
| | - Bo Mi Jeong
- Department of RadiologySeoul National University HospitalSeoul Korea
| | - Joong Mo Ahn
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Department of RadiologySeoul National University Bundang HospitalGyeongi‐Do Korea
| | - Heung Sik Kang
- Department of RadiologySeoul National University College of MedicineSeoul Korea
- Institute of Radiation MedicineSeoul National University Medical Research CenterSeoul Korea
- Department of RadiologySeoul National University Bundang HospitalGyeongi‐Do Korea
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89
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To assess differential features of marrow adiposity between postmenopausal women with osteoarthritis and osteoporosis using water/fat MRI. Menopause 2016; 24:105-111. [PMID: 27648658 DOI: 10.1097/gme.0000000000000732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the differential features of marrow adiposity between osteoarthritis (OA) and osteoporosis (OP) in postmenopausal women using water/fat MRI. METHODS This cross-sectional study included 97 postmenopausal women (OA [n = 25], OA + osteopenia [n = 27], OA + OP [n = 23], and OP groups [n = 22]). Water/fat MRI, dual-energy x-ray absorptiometry and biochemical analysis were performed to assess vertebral marrow fat fraction, bone mineral density, and bone biomarkers, respectively. Harris Hip Score was recorded to evaluate hip function. RESULTS There were significant differences in marrow fat content among the OA, OA + osteopenia, and OA + OP groups, between OP and OA participants with normal bone mass or osteopenia (all P < 0.05); no significant difference was observed between OA + OP and OP groups. Serum levels of leptin and β-Crosslaps in OA with normal bone mass and osteopenic OA groups were higher than in OP group. Marrow fat fraction was inversely correlated with Harris Hip Score (r = -0.371, P = 0.013), bone mineral density (r = -0.554, P = 0.009) and leptin levels (r = -0.610, P < 0.001). In multivariate regression analysis, marrow fat fraction was found to have a consistent and unchanged inverse association with leptin levels (Sβ = -0.311, P = 0.002) and bone mineral density (Sβ = -0.265, P = 0.006) after adjusting for age, years since menopause, and body mass index. CONCLUSIONS Postmenopausal OA with OP have a phenotype with higher marrow adiposity. OA and OP could coexist, for the presence of a specific subgroup of OA with increased marrow fat accumulation and high risk of developing OP.
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90
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Di Pietro G, Capuani S, Manenti G, Vinicola V, Fusco A, Baldi J, Scimeca M, Hagberg G, Bozzali M, Simonetti G, Tarantino U. Bone Marrow Lipid Profiles from Peripheral Skeleton as Potential Biomarkers for Osteoporosis: A 1H-MR Spectroscopy Study. Acad Radiol 2016; 23:273-83. [PMID: 26774740 DOI: 10.1016/j.acra.2015.11.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 09/22/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES To characterize the lipidic profile of bone marrow in the calcaneus and femoral neck of healthy, osteopenic, and osteoporotic women, by using magnetic resonance spectroscopy (MRS) at 3T. The final goal was to identify specific metabolites with the potential ability to discriminate between healthy, osteopenic, and osteoporotic subjects. MATERIALS AND METHODS Sixty-two and thirty three postmenopausal women recruited to investigate calcaneus and femoral neck, respectively, underwent a bone mineral density (BMD) measurement to be classified as healthy subjects (n = 22), osteopenic (n = 45), or osteoporotic (n = 28) patients. MRS spectra were used to quantify and compare bone marrow fat resonances between the three BMD groups. Between-group differences were tested using a Welch analysis of variance. Multiple comparisons were made with the Games-Howell correction. Relationships between pairs of variables were assessed with linear correlation analysis. Reproducibility analysis was performed for all the lipid resonances in both sites. RESULTS The reproducibility was satisfactory. In femoral neck, methylene (L13), glycerol (L41, L43), and total lipid resonances were significantly lower in healthy as compared to osteoporotic subjects. On the other hand, in calcaneus, L13/glycerol significantly discriminated between osteopenic and osteoporotic subjects whereas L13/(unsaturated lipid) discriminated between healthy and osteopenic group. However, the reproducibility of both unsaturated lipid and glycerol resonances were less optimal. CONCLUSIONS MRS of bone marrow lipid profiles from peripheral skeletal sites may be a promising tool for screening of large population to identify individuals with or at risk for developing osteoporosis. Moreover, it provides information about the metabolic changes occurring in bone marrow with the development of osteoporosis, which are skeletal site dependent.
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91
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Baum T, Cordes C, Dieckmeyer M, Ruschke S, Franz D, Hauner H, Kirschke JS, Karampinos DC. MR-based assessment of body fat distribution and characteristics. Eur J Radiol 2016; 85:1512-8. [PMID: 26905521 DOI: 10.1016/j.ejrad.2016.02.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 12/14/2022]
Abstract
The assessment of body fat distribution and characteristics using magnetic resonance (MR) methods has recently gained significant attention as it further extends our pathophysiological understanding of diseases including obesity, metabolic syndrome, or type 2 diabetes mellitus, and allows more detailed insights into treatment response and effects of lifestyle interventions. Therefore, the purpose of this study was to review the current literature on MR-based assessment of body fat distribution and characteristics. PubMed search was performed to identify relevant studies on the assessment of body fat distribution and characteristics using MR methods. T1-, T2-weighted MR Imaging (MRI), Magnetic Resonance Spectroscopy (MRS), and chemical shift-encoding based water-fat MRI have been successfully used for the assessment of body fat distribution and characteristics. The relationship of insulin resistance and serum lipids with abdominal adipose tissue (i.e. subcutaneous and visceral adipose tissue), liver, muscle, and bone marrow fat content have been extensively investigated and may help to understand the underlying pathophysiological mechanisms and the multifaceted obese phenotype. MR methods have also been used to monitor changes of body fat distribution and characteristics after interventions (e.g. diet or physical activity) and revealed distinct, adipose tissue-specific properties. Lastly, chemical shift-encoding based water-fat MRI can detect brown adipose tissue which is currently the focus of intense research as a potential treatment target for obesity. In conclusion, MR methods reliably allow the assessment of body fat distribution and characteristics. Irrespective of the promising findings based on these MR methods the clinical usefulness remains to be established.
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Affiliation(s)
- Thomas Baum
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Christian Cordes
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans Hauner
- Else Kröner Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; ZIEL Research Center for Nutrition and Food Sciences, Technische Universität München, Germany
| | - Jan S Kirschke
- Section of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Singhal V, Miller KK, Torriani M, Bredella MA. Short- and long-term reproducibility of marrow adipose tissue quantification by 1H-MR spectroscopy. Skeletal Radiol 2016; 45:221-5. [PMID: 26563561 PMCID: PMC4864977 DOI: 10.1007/s00256-015-2292-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/26/2015] [Accepted: 11/03/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess short- and long-term reproducibility of marrow adipose tissue (MAT) quantification by 1H-MR spectroscopy. MATERIALS AND METHODS Our study was IRB-approved and HIPAA compliant. Written informed consent was obtained. We studied 20 overweight/obese but otherwise healthy subjects (12 female, 8 male) with a mean age of 37 ± 6 years. All subjects underwent proton magnetic resonance spectroscopy (1H-MRS) of the fourth lumbar vertebral body using a single-voxel point-resolved spatially localized spectroscopy sequence without water suppression at 3 T. Measurements were repeated after 6 weeks and 6 months using identical scanning protocols. The following clinical parameters were collected, weight, BMI, exercise status, and trabecular bone mineral density (BMD), by quantitative computed tomography. Short- (baseline, 6 weeks) and long-term (baseline, 6 months) reproducibility of MAT was assessed by the coefficient of variance (CV), standard deviation (SD), and interclass correlation coefficients (ICCs). Short- and long-term changes in clinical parameters were assessed by paired t-test. RESULTS For short-term reproducibility between baseline and 6-week scans, the CV was 9.9 %, SD was 0.08, and ICC was 0.97 (95 % CI 0.94-099). For long-term reproducibility between baseline and 6-month scans, the CV was 12.0 %, SD was 0.10, and ICC was 0.95 (95 % CI 0.88 to 0.98). There was no significant short- or long-term change in clinical parameters (weight, BMI, exercise status, BMD) (p > 0.2). CONCLUSION 1H-MRS is a reproducible method for short- and long-term quantification of MAT. Our results can guide sample size calculations for interventional and longitudinal studies.
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Affiliation(s)
- Vibha Singhal
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA,Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Karen K. Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Yang Y, Luo X, Xie X, Yan F, Chen G, Zhao W, Jiang Z, Fang C, Shen J. Influences of teriparatide administration on marrow fat content in postmenopausal osteopenic women using MR spectroscopy. Climacteric 2016; 19:285-91. [PMID: 26744910 DOI: 10.3109/13697137.2015.1126576] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Teriparatide could induce osteoblast differentiation of mesenchymal stem cells while inhibiting adipocyte differentiation. However, there are significant differences between ex vivo and in vivo models. We aimed to evaluate the impact of teriparatide on marrow and abdominal fat accumulation in postmenopausal osteopenic women. Methods Postmenopausal osteopenic women were randomly assigned to receive teriparatide or placebo for 12 months. Subcutaneous (SAT) and visceral adipose tissue (VAT), marrow fat fraction (MFF), bone density (BMD) and bone biomarkers were measured at baseline, 6 and 12 months. Results At 12 months, mean percentage changes in BMD from baseline were 3.51%, 2.21% and 1.80% at lumbar spine, total hip and femoral neck for the teriparatide group, respectively. Relative to baseline conditions, teriparatide reduced MFF (-3.54% at 6 months; -5.87% at 12 months, all p < 0.01). A significant difference in MFF, but not BMD, was first detected at 6 months (p = 0.012) between groups. MFF was negatively associated with SAT (r = -0.479) and positively associated with VAT (r = 0.531) and VAT/SAT (r = 0.415, all p < 0.05). Teriparatide treatment did not alter abdominal fat composition. Conclusion Teriparatide effectively lowers marrow adiposity but not abdominal fat accumulation in postmenopausal osteopenic women.
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Affiliation(s)
- Y Yang
- a Department of Radiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China ;,b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - X Luo
- a Department of Radiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China ;,c Department of Radiology , Northern Jiangsu People's Hospital and Clinical Medical College of Yangzhou University , Yangzhou , China
| | - X Xie
- d Department of Radiology , First People's Hospital Affiliated to Shanghai Jiaotong University , Shanghai , China
| | - F Yan
- a Department of Radiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - G Chen
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - W Zhao
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - Z Jiang
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - C Fang
- e Department of Endocrinology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - J Shen
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
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Abstract
CLINICAL ISSUE Diabetic bone diseases are more than just osteoporosis in patients with diabetes mellitus (DM): a relatively high bone mineral density is paired with a paradoxically high risk of fragility fractures. Diabetics exhibit low bone turnover, osteocyte dysfunction, relative hypoparathyroidism and an accumulation of advanced glycation end products in the bone matrix. Besides typical insufficiency fractures, diabetics show a high risk for peripheral fractures of the lower extremities (e.g. metatarsal fractures). The correct interdisciplinary assessment of fracture risks in patients with DM is therefore a clinical challenge. STANDARD RADIOLOGICAL METHODS There are two state of the art imaging methods for the quantification of fracture risks: dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). Radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are suitable for the detection of insufficiency fractures. METHODICAL INNOVATIONS AND PERFORMANCE Novel research imaging techniques, such as high-resolution peripheral quantitative computed tomography (HR-pQCT) provide non-invasive insights into bone microarchitecture of the peripheral skeleton. Using MR spectroscopy, bone marrow composition can be studied. Both methods have been shown to be capable of discriminating between type 2 diabetic patients with and without prevalent fragility fractures and thus bear the potential of improving the current standard of care. Currently both methods remain limited to clinical research applications. PRACTICAL RECOMMENDATIONS DXA and HR-pQCT are valid tools for the quantification of bone mineral density and assessment of fracture risk in patients with DM, especially if interpreted in the context of clinical risk factors. Radiography, CT and MRI are suitable for the detection of insufficiency fractures.
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Cordes C, Baum T, Dieckmeyer M, Ruschke S, Diefenbach MN, Hauner H, Kirschke JS, Karampinos DC. MR-Based Assessment of Bone Marrow Fat in Osteoporosis, Diabetes, and Obesity. Front Endocrinol (Lausanne) 2016; 7:74. [PMID: 27445977 PMCID: PMC4921741 DOI: 10.3389/fendo.2016.00074] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022] Open
Abstract
Bone consists of the mineralized component (i.e., cortex and trabeculae) and the non-mineralized component (i.e., bone marrow). Most of the routine clinical bone imaging uses X-ray-based techniques and focuses on the mineralized component. However, bone marrow adiposity has been also shown to have a strong linkage with bone health. Specifically, multiple previous studies have demonstrated a negative association between bone marrow fat fraction (BMFF) and bone mineral density. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) are ideal imaging techniques for non-invasively investigating the properties of bone marrow fat. In the present work, we first review the most important MRI and MRS methods for assessing properties of bone marrow fat, including methodologies for measuring BMFF and bone marrow fatty acid composition parameters. Previous MRI and MRS studies measuring BMFF and fat unsaturation in the context of osteoporosis are then reviewed. Finally, previous studies investigating the relationship between bone marrow fat, other fat depots, and bone health in patients with obesity and type 2 diabetes are presented. In summary, MRI and MRS are powerful non-invasive techniques for measuring properties of bone marrow fat in osteoporosis, obesity, and type 2 diabetes and can assist in future studies investigating the pathophysiology of bone changes in the above clinical scenarios.
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Affiliation(s)
- Christian Cordes
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- *Correspondence: Christian Cordes,
| | - Thomas Baum
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Maximilian N. Diefenbach
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans Hauner
- Else Kröner Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S. Kirschke
- Section of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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96
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Barber QM, Yahya A. Aspects of spinal bone marrow fat to water quantification with magnetic resonance spectroscopy at 3 T. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/4/047001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Karampinos DC, Melkus G, Baum T, Bauer JS, Rummeny EJ, Krug R. Bone marrow fat quantification in the presence of trabecular bone: initial comparison between water-fat imaging and single-voxel MRS. Magn Reson Med 2015; 71:1158-65. [PMID: 23657998 DOI: 10.1002/mrm.24775] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of the present study was to test the relative performance of chemical shift-based water-fat imaging in measuring bone marrow fat fraction in the presence of trabecular bone, having as reference standard the single-voxel magnetic resonance spectroscopy (MRS). METHODS Six-echo gradient echo imaging and single-voxel MRS measurements were performed on the proximal femur of seven healthy volunteers. The bone marrow fat spectrum was characterized based on the magnitude of measurable fat peaks and an a priori knowledge of the chemical structure of triglycerides, in order to accurately extract the water peak from the overlapping broad fat peaks in MRS. The imaging-based fat fraction results were then compared to the MRS-based results both without and with taking into consideration the presence of short T2* water components in MRS. RESULTS There was a significant underestimation of the fat fraction using the MRS model not accounting for short T2* species with respect to the imaging-based fat fraction. A good equivalency was observed between the fat fraction using the MRS model accounting for short T2* species and the imaging-based fat fraction (R(2) = 0.87). CONCLUSION The consideration of the short T2* water species effect on bone marrow fat quantification is essential when comparing MRS-based and imaging-based fat fraction results.
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Affiliation(s)
- Dimitrios C Karampinos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA; Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
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98
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Yang Y, Luo X, Yan F, Jiang Z, Li Y, Fang C, Shen J. Effect of zoledronic acid on vertebral marrow adiposity in postmenopausal osteoporosis assessed by MR spectroscopy. Skeletal Radiol 2015; 44:1499-505. [PMID: 26130070 DOI: 10.1007/s00256-015-2200-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/02/2015] [Accepted: 06/11/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Zoledronic acid (ZOL) has a suppressive effect on marrow adiposity in ovariectomized rats. Currently, however, data on the effect of ZOL on marrow fat in humans are unavailable. The purpose of this work was to determine the in vivo effect of ZOL on bone remodeling and marrow adipogenesis in postmenopausal osteoporosis. MATERIALS AND METHODS In a 12-month, randomized, double-blind, placebo-controlled trial, we studied 100 postmenopausal women with osteoporosis who were randomly given either a single dose of intravenous infusion of ZOL (5 mg) or placebo. All subjects received adequate dietary calcium and vitamin D3. Main outcome measures included bone mineral density by dual-energy X-ray absorptiometry, vertebral marrow fat content by proton MR spectroscopy, serum markers of bone turnover by biochemical analysis. RESULTS Ninety percent of the participants completed the 12-month follow-up. With respect to baselines, marrow fat content reduced by 8.1% in the ZOL-treated women and increased by 3.0% in the controls (all p < 0.05). In addition, there were significant increases of bone mineral density by 2.8, 2.0, and 1.7% in the lumbar spine, femoral neck, and total hip, respectively, in the ZOL group compared with the placebo group. Serum levels of bone resorption marker CTX and bone formation marker BALP decreased by 33 and 18% in postmenopausal women receiving ZOL. CONCLUSIONS In postmenopausal women with osteoporosis, a single dose of ZOL therapy significantly reduced marrow adiposity. MR spectroscopy of vertebral marrow fat may therefore serve as a novel tool for BMD-independent efficacy assessment.
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Affiliation(s)
- Yi Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, China
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99
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Breitkreutz DY, Fallone BG, Yahya A. Effect of J coupling on 1.3-ppm lipid methylene signal acquired with localised proton MRS at 3 T. NMR IN BIOMEDICINE 2015; 28:1324-1331. [PMID: 26314546 DOI: 10.1002/nbm.3387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/10/2015] [Accepted: 07/30/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this work was to investigate the effect of J-coupling interactions on the quantification and T2 determination of 1.3-ppm lipid methylene protons at 3 T. The response of the 1.3-ppm protons of hexanoic, heptanoic, octanoic, linoleic and oleic acid was measured as a function of point-resolved spectroscopy (PRESS) and stimulated echo acquisition mode (STEAM) TE. In addition, a narrow-bandwidth refocusing PRESS sequence designed to rewind J-coupling evolution of the 1.3-ppm protons was applied to the five fatty acids, to corn oil and to tibial bone marrow of six healthy volunteers. Peak areas were plotted as a function of TE, and data were fitted to monoexponentially decaying functions to determine Mo (the extrapolated area for TE = 0 ms) and T2 values. In phantoms, rewinding J-coupling evolution resulted in 198%, 64%, 44%, 20% and 15% higher T2 values for heptanoic, octanoic, linoleic and oleic acid, and corn oil, respectively, compared with those obtained with standard PRESS. The narrow-bandwidth PRESS sequence also resulted in significant changes in Mo , namely -77%, -22%, 28%, 23% and 28% for heptanoic, octanoic, linoleic and oleic acid, and corn oil, respectively. T2 values obtained with STEAM were closer to the values measured with narrow-bandwidth PRESS. On average, in tibial bone marrow (six volunteers) rewinding J-coupling evolution resulted in 21% ± 3% and 9 % ± 1% higher Mo and T2 values, respectively. This work demonstrates that the consequence of neglecting to consider scalar coupling effects on the quantification of 1.3-ppm lipid methylene protons and their T2 values is not negligible. The linoleic and oleic acid T2 results indicate that T2 measures of lipids with standard MRS techniques are dependent on lipid composition.
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Affiliation(s)
| | - B Gino Fallone
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
| | - Atiyah Yahya
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Physics, Cross Cancer Institute, Edmonton, AB, Canada
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100
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Paccou J, Hardouin P, Cotten A, Penel G, Cortet B. The Role of Bone Marrow Fat in Skeletal Health: Usefulness and Perspectives for Clinicians. J Clin Endocrinol Metab 2015; 100:3613-21. [PMID: 26244490 DOI: 10.1210/jc.2015-2338] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT There is growing interest in the relationship between bone marrow fat (BMF), bone mineral density (BMD), and fractures. Moreover, BMF might be influenced by metabolic diseases associated with bone loss and fractures, such as type 2 diabetes mellitus (T2DM), anorexia nervosa (AN), and obesity. METHODS The primary-source literature for this review was acquired using a PubMed search for articles published between January 2000 and April 2015. Search terms included BMF, BMD, fractures, T2DM, AN, and obesity. The titles and abstracts of all articles were reviewed for relevant subjects. RESULTS Magnetic resonance imaging, with or without spectroscopy, was used to noninvasively quantify BMF in humans. A negative relationship was found between BMD and BMF in both healthy and osteopenic/osteoporotic populations. Data are lacking on the relationship between BMF and fractures. Studies in populations of individuals with metabolic diseases such as T2DM, AN, and obesity have shown BMF abnormalities. CONCLUSIONS We conclude that most human data demonstrate an inverse relationship between BMF and BMD, but data on the relationship with fractures are inconsistent and need further study. In daily practice, the usefulness for clinicians of assessing BMF using magnetic resonance imaging is still limited. However, the perspectives are exciting, particularly in terms of improving the diagnosis and management of osteoporosis.
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Affiliation(s)
- Julien Paccou
- Université de Lille (J.P., A.C., G.P., B.C.), Faculté de Chirurgie Dentaire, Place de Verdun, 59000 Lille, France; Service de Rhumatologie (J.P., B.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France; Université du Littoral Côte (P.H.), 62327 Boulogne-sur-Mer, France; and Service d'Imagerie Musculo-Squelettique (A.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France
| | - Pierre Hardouin
- Université de Lille (J.P., A.C., G.P., B.C.), Faculté de Chirurgie Dentaire, Place de Verdun, 59000 Lille, France; Service de Rhumatologie (J.P., B.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France; Université du Littoral Côte (P.H.), 62327 Boulogne-sur-Mer, France; and Service d'Imagerie Musculo-Squelettique (A.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France
| | - Anne Cotten
- Université de Lille (J.P., A.C., G.P., B.C.), Faculté de Chirurgie Dentaire, Place de Verdun, 59000 Lille, France; Service de Rhumatologie (J.P., B.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France; Université du Littoral Côte (P.H.), 62327 Boulogne-sur-Mer, France; and Service d'Imagerie Musculo-Squelettique (A.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France
| | - Guillaume Penel
- Université de Lille (J.P., A.C., G.P., B.C.), Faculté de Chirurgie Dentaire, Place de Verdun, 59000 Lille, France; Service de Rhumatologie (J.P., B.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France; Université du Littoral Côte (P.H.), 62327 Boulogne-sur-Mer, France; and Service d'Imagerie Musculo-Squelettique (A.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France
| | - Bernard Cortet
- Université de Lille (J.P., A.C., G.P., B.C.), Faculté de Chirurgie Dentaire, Place de Verdun, 59000 Lille, France; Service de Rhumatologie (J.P., B.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France; Université du Littoral Côte (P.H.), 62327 Boulogne-sur-Mer, France; and Service d'Imagerie Musculo-Squelettique (A.C.), Centre Hospitalier Régional Universitaire, 59000 Lille, France
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