1
|
Siravo E. Editorial for "Generalizing Diffusion Tensor Imaging of the Physis and Metaphysis". J Magn Reson Imaging 2024. [PMID: 38795378 DOI: 10.1002/jmri.29459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/27/2024] Open
|
2
|
Santos L, Hsu HY, Nelson RR, Sullivan B, Shin J, Fung M, Lebel MR, Jambawalikar S, Jaramillo D. Impact of Deep Learning Denoising Algorithm on Diffusion Tensor Imaging of the Growth Plate on Different Spatial Resolutions. Tomography 2024; 10:504-519. [PMID: 38668397 PMCID: PMC11054892 DOI: 10.3390/tomography10040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/29/2024] Open
Abstract
To assess the impact of a deep learning (DL) denoising reconstruction algorithm applied to identical patient scans acquired with two different voxel dimensions, representing distinct spatial resolutions, this IRB-approved prospective study was conducted at a tertiary pediatric center in compliance with the Health Insurance Portability and Accountability Act. A General Electric Signa Premier unit (GE Medical Systems, Milwaukee, WI) was employed to acquire two DTI (diffusion tensor imaging) sequences of the left knee on each child at 3T: an in-plane 2.0 × 2.0 mm2 with section thickness of 3.0 mm and a 2 mm3 isovolumetric voxel; neither had an intersection gap. For image acquisition, a multi-band DTI with a fat-suppressed single-shot spin-echo echo-planar sequence (20 non-collinear directions; b-values of 0 and 600 s/mm2) was utilized. The MR vendor-provided a commercially available DL model which was applied with 75% noise reduction settings to the same subject DTI sequences at different spatial resolutions. We compared DTI tract metrics from both DL-reconstructed scans and non-denoised scans for the femur and tibia at each spatial resolution. Differences were evaluated using Wilcoxon-signed ranked test and Bland-Altman plots. When comparing DL versus non-denoised diffusion metrics in femur and tibia using the 2 mm × 2 mm × 3 mm voxel dimension, there were no significant differences between tract count (p = 0.1, p = 0.14) tract volume (p = 0.1, p = 0.29) or tibial tract length (p = 0.16); femur tract length exhibited a significant difference (p < 0.01). All diffusion metrics (tract count, volume, length, and fractional anisotropy (FA)) derived from the DL-reconstructed scans, were significantly different from the non-denoised scan DTI metrics in both the femur and tibial physes using the 2 mm3 voxel size (p < 0.001). DL reconstruction resulted in a significant decrease in femorotibial FA for both voxel dimensions (p < 0.01). Leveraging denoising algorithms could address the drawbacks of lower signal-to-noise ratios (SNRs) associated with smaller voxel volumes and capitalize on their better spatial resolutions, allowing for more accurate quantification of diffusion metrics.
Collapse
Affiliation(s)
- Laura Santos
- Radiology Department, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Hao-Yun Hsu
- Radiology Department, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ronald R. Nelson
- Radiology Department, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Brendan Sullivan
- Radiology Department, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | | | | | - Sachin Jambawalikar
- Radiology Department, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Diego Jaramillo
- Radiology Department, Columbia University Irving Medical Center, New York, NY 10032, USA
| |
Collapse
|
3
|
Duong PT, Santos L, Hsu HY, Jambawalikar S, Mutasa S, Nguyen MK, Guariento A, Jaramillo D. Deep Learning-Assisted Diffusion Tensor Imaging for Evaluation of the Physis and Metaphysis. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:756-765. [PMID: 38321313 PMCID: PMC11031540 DOI: 10.1007/s10278-024-00993-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024]
Abstract
Diffusion tensor imaging of physis and metaphysis can be used as a biomarker to predict height change in the pediatric population. Current application of this technique requires manual segmentation of the physis which is time-consuming and introduces interobserver variability. UNET Transformers (UNETR) can be used for automatic segmentation to optimize workflow. Three hundred and eighty-five DTI scans from 191 subjects with mean age of 12.6 years ± 2.01 years were retrospectively used for training and validation. The mean Dice correlation coefficient was 0.81 for the UNETR model and 0.68 for the UNET. Manual extraction and segmentation took 15 min per volume, whereas both deep learning segmentation techniques took < 1 s per volume and were deterministic, always producing the same result for a given input. Intraclass correlation coefficient (ICC) for ROI-derived femur diffusion metrics was excellent for tract count (0.95), volume (0.95), and FA (0.97), and good for tract length (0.87). The results support the hypothesis that a hybrid UNETR model can be trained to replace the manual segmentation of physeal DTI images, therefore automating the process.
Collapse
Affiliation(s)
- Phuong T Duong
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Laura Santos
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Hao-Yun Hsu
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Michael K Nguyen
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Diego Jaramillo
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
4
|
Raya JG, Duarte A, Wang N, Mazzoli V, Jaramillo D, Blamire AM, Dietrich O. Applications of Diffusion-Weighted MRI to the Musculoskeletal System. J Magn Reson Imaging 2024; 59:376-396. [PMID: 37477576 DOI: 10.1002/jmri.28870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is an established MRI technique that can investigate tissue microstructure at the scale of a few micrometers. Musculoskeletal tissues typically have a highly ordered structure to fulfill their functions and therefore represent an optimal application of DWI. Even more since disruption of tissue organization affects its biomechanical properties and may indicate irreversible damage. The application of DWI to the musculoskeletal system faces application-specific challenges on data acquisition including susceptibility effects, the low T2 relaxation time of most musculoskeletal tissues (2-70 msec) and the need for sub-millimetric resolution. Thus, musculoskeletal applications have been an area of development of new DWI methods. In this review, we provide an overview of the technical aspects of DWI acquisition including diffusion-weighting, MRI pulse sequences and different diffusion regimes to study tissue microstructure. For each tissue type (growth plate, articular cartilage, muscle, bone marrow, intervertebral discs, ligaments, tendons, menisci, and synovium), the rationale for the use of DWI and clinical studies in support of its use as a biomarker are presented. The review describes studies showing that DTI of the growth plate has predictive value for child growth and that DTI of articular cartilage has potential to predict the radiographic progression of joint damage in early stages of osteoarthritis. DTI has been used extensively in skeletal muscle where it has shown potential to detect microstructural and functional changes in a wide range of muscle pathologies. DWI of bone marrow showed to be a valuable tool for the diagnosis of benign and malignant acute vertebral fractures and bone metastases. DTI and diffusion kurtosis have been investigated as markers of early intervertebral disc degeneration and lower back pain. Finally, promising new applications of DTI to anterior cruciate ligament grafts and synovium are presented. The review ends with an overview of the use of DWI in clinical routine. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.
Collapse
Affiliation(s)
- José G Raya
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Alejandra Duarte
- Division of Musculoskeletal Radiology, Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Nian Wang
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana, USA
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, Indiana, USA
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Andrew M Blamire
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Olaf Dietrich
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
5
|
Kvist O, Santos LA, De Luca F, Jaramillo D. Can diffusion tensor imaging unlock the secrets of the growth plate? BJR Open 2024; 6:tzae005. [PMID: 38558926 PMCID: PMC10978376 DOI: 10.1093/bjro/tzae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
"How tall will I be?" Every paediatrician has been asked this during their career. The growth plate is the main site of longitudinal growth of the long bones. The chondrocytes in the growth plate have a columnar pattern detectable by diffusion tensor imaging (DTI). DTI shows the diffusion of water in a tissue and whether it is iso- or anisotropic. By detecting direction and magnitude of diffusion, DTI gives information about the microstructure of the tissue. DTI metrics include tract volume, length, and number, fractional anisotropy (FA), and mean diffusivity. DTI metrics, particularly tract volume, provide quantitative data regarding skeletal growth and, in conjunction with the fractional anisotropy, be used to determine whether a growth plate is normal. Tractography is a visual display of the diffusion, depicting its direction and amplitude. Tractography gives a more qualitative visualization of cellular orientation in a tissue and reflects the activity in the growth plate. These two components of DTI can be used to assess the growth plate without ionizing radiation or pain. Further refinements in DTI will improve prediction of post-imaging growth and growth plate closure, and assessment of the positive and negative effect of treatments like cis-retinoic acid and growth hormone administration.
Collapse
Affiliation(s)
- Ola Kvist
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, 171 64, Sweden
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, 171 77, Sweden
| | - Laura A Santos
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY 100 32, United States
| | - Francesca De Luca
- Department of Radiology, Karolinska University Hospital, Stockholm, 171 64, Sweden
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, 171 65, Sweden
| | - Diego Jaramillo
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY 100 32, United States
| |
Collapse
|
6
|
Santos LA, Sullivan B, Kvist O, Jambawalikar S, Mostoufi-Moab S, Raya JM, Nguyen J, Marin D, Delgado J, Tokaria R, Nelson RR, Kammen B, Jaramillo D. Diffusion tensor imaging of the physis: the ABC's. Pediatr Radiol 2023; 53:2355-2368. [PMID: 37658251 DOI: 10.1007/s00247-023-05753-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
The physis, or growth plate, is the primary structure responsible for longitudinal growth of the long bones. Diffusion tensor imaging (DTI) is a technique that depicts the anisotropic motion of water molecules, or diffusion. When diffusion is limited by cellular membranes, information on tissue microstructure can be acquired. Tractography, the visual display of the direction and magnitude of water diffusion, provides qualitative visualization of complex cellular architecture as well as quantitative diffusion metrics that appear to indirectly reflect physeal activity. In the growing bones, DTI depicts the columns of cartilage and new bone in the physeal-metaphyseal complex. In this "How I do It", we will highlight the value of DTI as a clinical tool by presenting DTI tractography of the physeal-metaphyseal complex of children and adolescents during normal growth, illustrating variation in qualitative and quantitative tractography metrics with age and skeletal location. In addition, we will present tractography from patients with physeal dysfunction caused by growth hormone deficiency and physeal injury due to trauma, chemotherapy, and radiation therapy. Furthermore, we will delineate our process, or "DTI pipeline," from image acquisition to data interpretation.
Collapse
Affiliation(s)
- Laura A Santos
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA.
| | - Brendan Sullivan
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Ola Kvist
- Pediatric Radiology Department, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | | | - Jose M Raya
- New York University Langone Health, New York, NY, USA
| | - Jie Nguyen
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Marin
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Jorge Delgado
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rumana Tokaria
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Ronald R Nelson
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Bamidele Kammen
- University of California San Francisco, San Francisco, CA, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| |
Collapse
|
7
|
Kvist O, Dorniok T, Sanmartin Berglund J, Nilsson O, Flodmark CE, Diaz S. DTI assessment of the maturing growth plate of the knee in adolescents and young adults. Eur J Radiol 2023; 162:110759. [PMID: 36931119 DOI: 10.1016/j.ejrad.2023.110759] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To assess the growth plates of the knee in a healthy population of young adults and adolescents using DTI, and to correlate the findings with chronological age and skeletal maturation. METHODS A prospective, cross-sectional study to assess the tibial and femoral growth plates with DTI in 155 healthy volunteers aged between 14.0 and 21 years old. Echo-planar DTI with 15 directions and b value of 0 and 600 s/mm2 was performed on a 3 T whole-body scanner. RESULTS A relationship was observed between chronological age and most DTI metrics (fractional anisotropy, mean diffusivity, and radial diffusivity), tract length and volume. (No significant relationship could be seen for axonal diffusivity and tract length.) Subdivision according to skeletal maturation showed the greatest tract lengths and volumes seen in stage 4b and not 4a. The intra-observer agreement was significant (P = 0.01) for all the measured variables, but agreement varied (femur 0.53 - 0.98; tibia 0.58 - 0.98). Spearman's correlation showed a significant correlation for age (P = 0.05; P = 0.01) as well as for the fractional anisotropy value within all variables in both femur and tibia. Tract number and volume had a similar correlation with most variables, especially the DTI metrics, and would seem to be interchangeable. CONCLUSION The current study indicates that DTI metrics could be a tool to assess the skeletal maturation process of the growth plate and its activity. Tractography seems promising to assess the activity of the growth plate in a younger population but must be used with caution in the more mature growth plate.
Collapse
Affiliation(s)
- Ola Kvist
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
| | - Torsten Dorniok
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Ola Nilsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; School of Medical Sciences and Department of Paediatrics, Örebro University and University Hospital, Örebro, Sweden.
| | - Carl-Erik Flodmark
- Department of Clinical Sciences in Malmö, Lunds University, Lund, Sweden.
| | - Sandra Diaz
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Radiology, Lunds University, Lund, Sweden.
| |
Collapse
|
8
|
Jaramillo D, Duong P, Nguyen JC, Mostoufi-Moab S, Nguyen MK, Moreau A, Barrera CA, Hong S, Raya JG. Diffusion Tensor Imaging of the Knee to Predict Childhood Growth. Radiology 2022; 303:655-663. [PMID: 35315716 PMCID: PMC9131176 DOI: 10.1148/radiol.210484] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 12/15/2021] [Accepted: 01/19/2022] [Indexed: 01/16/2023]
Abstract
Background Accurate and precise methods to predict growth remain lacking. Diffusion tensor imaging (DTI) depicts the columnar structure of the physis and metaphyseal spongiosa and provides measures of tract volume and length that may help predict growth. Purpose To validate physeal DTI metrics as predictors of height velocity (1-year height gain from time of MRI examination) and total height gain (height gain from time of MRI examination until growth stops) and compare the prediction accuracy with bone age-based models. Materials and Methods Femoral DTI studies (b values = 0 and 600 sec/mm2; directions = 20) of healthy children who underwent MRI of the knee between February 2012 and December 2016 were retrospectively analyzed. Children with height measured at MRI and either 1 year later (height velocity) or after growth cessation (total height gain, mean = 34 months from MRI) were included. Physeal DTI tract volume and length were correlated with height velocity and total height gain. Multilinear regression was used to assess the potential of DTI metrics in the prediction of both parameters. Bland-Altman plots were used to compare root mean square error (RMSE) and bias in height prediction using DTI versus bone age methods. Results Eighty-nine children (mean age, 13 years ± 3 [SD]; 47 boys) had height velocity measured, and 70 (mean age, 14 years ± 1; 36 girls) had total height gain measured. Tract volumes correlated with height velocity (r2 = 0.49) and total height gain (r2 = 0.46) (P < .001 for both) after controlling for age and sex. Tract volume was the strongest predictor for height velocity and total height gain. An optimal multilinear model including tract volume improved prediction of height velocity (R2 = 0.63, RMSE = 1.7 cm) and total height gain (R2 = 0.59, RMSE = 1.8 cm) compared with bone age-based methods (height velocity: R2 = 0.32, RMSE = 2.9 cm; total height gain: R2 = 0.42, RMSE = 5.0 cm). Conclusion Models using tract volume derived from diffusion tensor imaging may perform better than bone age-based models in children for the prediction of height velocity and total height gain. © RSNA, 2022.
Collapse
Affiliation(s)
- Diego Jaramillo
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - Phuong Duong
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - Jie C. Nguyen
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - Sogol Mostoufi-Moab
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - Michael K. Nguyen
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - Andrew Moreau
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - Christian A. Barrera
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - Shijie Hong
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| | - José G. Raya
- From the Department of Radiology, Columbia University Medical Center,
630 W 168th St, MC 28, New York, NY 10032 (D.J., P.D.); Department of Radiology
(J.C.N., M.K.N., S.H.) and Division of Oncology (S.M.M., A.M.),
Children’s Hospital of Philadelphia, Philadelphia, Pa; Department of
Radiology, Massachusetts General Hospital, Boston, Mass (C.A.B.); and Department
of Radiology, NYU Grossman School of Medicine, New York, NY (J.G.R.)
| |
Collapse
|
9
|
Shen Q, Wang X, Bai H, Tan X, Liu X. Effects of high-dose all-trans retinoic acid on longitudinal bone growth of young rats. Growth Horm IGF Res 2022; 62:101446. [PMID: 35149382 DOI: 10.1016/j.ghir.2022.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/15/2022] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The signaling axis consisting of GH-IGF1-IGFBP3 is the primary signal taht acts prepubertally to influence height development. Growth plate thinning and even premature closure have been reported in children with tumors treated with retinoid chemotherapy, resulting in long bone dysplasia. Growth failure may occur despite received GH treatment, but the reason is unknown. This study investigate the effect of high-dose all-trans retinoic acid (ATRA) on the development of long bones in growing SD rats. METHODS A total of 20 three-week-old male SD rats were randomly divided into a control group and an experimental group (n = 10). Rats were treated by gavage with or without high-dose ATRA for 10 days. The body weights of the rats were recorded daily. At the end of the experiment, we measured the length of nose-tail and tibia, stained the tibia and liver for pathological tissue and RT-PCR reaction, and measured the levels of serum GH, IGF1 and IGFBP3, and so on. RESULTS Compared with controls, experimental rats exhibited reduced body weight and shortened nasal-tail and radial tibial length. Cyp26b1 enzyme activity in the liver was elevated, and histopathological staining revealed that the cartilaginous epiphyseal plate was narrowed, the medullary cavity of trabecular bone was sparse, the number of trabecular bones was decreased, trabecular separation was increased, bone marrow mineralization was enhanced, osteoclastic activity was increased, and circulating GH-IGF1-IGFBP3 levels were decreased. However, RT-PCR reaction results of localized proximal tibiae showed upregulation of IGF1 and downregulation of IGFBP3. CONCLUSIONS High-dose ATRA intake over a short period of time can reduce GH-IGF1-IGFBP3 levels, affect cartilage and bone homeostasis, and inhibit bone growth in developing animals.
Collapse
Affiliation(s)
- Qin Shen
- Department of Orthopedic of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xia Wang
- Department of Orthopedic of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Haodi Bai
- Department of Orthopedic of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xin Tan
- Department of Orthopedic of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xing Liu
- Department of Orthopedic of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
| |
Collapse
|
10
|
Koh KN, Jeon JY, Park SS, Im HJ, Kim H, Kang MS. Physeal Abnormalities in Children With High-risk Neuroblastoma Intensively Treated With/Without 13-Cis-Retinoic Acid. J Pediatr Orthop 2021; 41:e841-e848. [PMID: 34387230 DOI: 10.1097/bpo.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to investigate the presence of physeal abnormality and its effect on growth in children with high-risk neuroblastoma treated by intensive multimodal treatment with/without 13-cis-retinoic acid (13-CRA). METHODS Fifteen patients diagnosed with high-risk neuroblastomas at the age of 1 to 10 years, who received treatment such as high-dose chemotherapy and autologous stem cell transplantation with/without 13-CRA, and with complete data during their >2-year follow-up were retrospectively reviewed. The physeal abnormalities were investigated by whole-body magnetic resonance imaging, serially performed every 3 to 6 months. The patients' height growth was also investigated and compared with that of age-and-sex-matched patients with brain tumors who also underwent high-dose chemotherapy and autologous stem cell transplantation. RESULTS Six of 15 patients presented multifocal physeal abnormalities during follow-up, and all lesions occurred in patients with 13-CRA use. The lesions in 3 patients completely resolved spontaneously without any adverse effect on growth, but some lesions in the other 3 patients progressed to disturb the bony growth. Height growth of matched patients with brain tumors were not significantly different, and none of the matched controls showed definite bony deformity during the follow-up. CONCLUSIONS Some children who were treated for high-risk neuroblastomas experienced multifocal physeal insults, probably due to the use of 13-CRA. Most lesions resolved spontaneously, but some led to bony deformity. If the lesions are not followed by premature physeal closure, there seems to be no further adverse effect of 13-CRA on leg length growth. Routine periodic screening for physeal status is needed for the patients with high-risk neuroblastomas using 13-CRA. LEVEL OF EVIDENCE Level IV-prognostic study.
Collapse
Affiliation(s)
- Kyung-Nam Koh
- Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Soo-Sung Park
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul
| | - Ho Joon Im
- Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - Hyery Kim
- Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - Michael Seungcheol Kang
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul
| |
Collapse
|
11
|
Guo M, Zemel BS, Hawkes CP, Long J, Kelly A, Leonard MB, Jaramillo D, Mostoufi-Moab S. Sarcopenia and preserved bone mineral density in paediatric survivors of high-risk neuroblastoma with growth failure. J Cachexia Sarcopenia Muscle 2021; 12:1024-1033. [PMID: 34184837 PMCID: PMC8350210 DOI: 10.1002/jcsm.12734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/21/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Survival from paediatric high-risk neuroblastoma (HR-NBL) has increased, but cis-retinoic acid (cis-RA), the cornerstone of HR-NBL therapy, can cause osteoporosis and premature physeal closure and is a potential threat to skeletal structure in HR-NBL survivors. Sarcopenia is associated with increased morbidity in survivors of paediatric malignancies. Low muscle mass may be associated with poor prognosis in HR-NBL patients but has not been studied in these survivors. The study objective was to assess bone density, body composition and muscle strength in HR-NBL survivors compared with controls. METHODS This prospective cross-sectional study assessed areal bone mineral density (aBMD) of the whole body, lumbar spine, total hip, femoral neck, distal 1/3 and ultradistal radius and body composition (muscle and fat mass) using dual-energy X-ray absorptiometry (DXA) and lower leg muscle strength using a dynamometer. Measures expressed as sex-specific standard deviation scores (Z-scores) included aBMD (adjusted for height Z-score), bone mineral apparent density (BMAD), leg lean mass (adjusted for leg length), whole-body fat mass index (FMI) and ankle dorsiflexion peak torque adjusted for leg length (strength-Z). Muscle-specific force was assessed as strength relative to leg lean mass. Outcomes were compared between HR-NBL survivors and controls using Student's t-test or Mann-Whitney U test. Linear regression models examined correlations between DXA and dynamometer outcomes. RESULTS We enrolled 20 survivors of HR-NBL treated with cis-RA [13 male; mean age: 12.4 ± 1.6 years; median (range) age at therapy initiation: 2.6 (0.3-9.1) years] and 20 age-, sex- and race-matched controls. Height-Z was significantly lower in HR-NBL survivors compared with controls (-1.73 ± 1.38 vs. 0.34 ± 1.12, P < 0.001). Areal BMD-Z, BMAD-Z, FMI-Z, visceral adipose tissue and subcutaneous adipose tissue were not significantly different in HR-NBL survivors compared with controls. Compared with controls, HR-NBL survivors had lower leg lean mass-Z (-1.46 ± 1.35 vs. - 0.17 ± 0.84, P < 0.001) and strength-Z (-1.13 ± 0.86 vs. - 0.15 ± 0.71, P < 0.001). Muscle-specific force was lower in HR-NBL survivors compared with controls (P < 0.05). CONCLUSIONS Bone mineral density and adiposity are not severely impacted in HR-NBL survivors with growth failure, but significant sarcopenia persists years after treatment. Future studies are needed to determine if sarcopenia improves with muscle-specific interventions in this population of cancer survivors.
Collapse
Affiliation(s)
- Michelle Guo
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Babette S Zemel
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin P Hawkes
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jin Long
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Stanford, CA, USA
| | - Andrea Kelly
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary B Leonard
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Diego Jaramillo
- Department of Radiology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
12
|
Duong P, Mostoufi-Moab S, Raya JG, Jaimes C, Delgado J, Jaramillo D. Imaging Biomarkers of the Physis: Cartilage Volume on MRI vs. Tract Volume and Length on Diffusion Tensor Imaging. J Magn Reson Imaging 2020; 52:544-551. [PMID: 32039525 DOI: 10.1002/jmri.27076] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Current methods to predict height and growth failure are imprecise. MRI measures of physeal cartilage are promising biomarkers for growth. PURPOSE In the physis, to assess how 3D MRI volume measurements, and diffusion tensor imaging (DTI) measurements (tract volume and length) correlate with growth parameters and detect differences in growth. We compared patients exposed to cis-retinoic acid, which causes physeal damage and growth failure, with normal subjects. STUDY TYPE Case-control. POPULATION Twenty pediatric neuroblastoma survivors treated with cis-retinoic acid and 20 age- and sex-matched controls. FIELD STRENGTH/SEQUENCE 3T; DTI and 3D double-echo steady-state (DESS) sequences. ASSESSMENT On distal femoral MR studies, physeal 3D volume and DTI tract measurements were calculated and compared to height. STATISTICAL TESTS We used partial Spearman correlation, analysis of covariance, logistic regression, Wald test, and the intraclass correlation coefficient (ICC). RESULTS The height percentile correlated most strongly with DTI tract volumes (r = 0.74), followed by mean tract length (r = 0.53) and 3D volume (r = 0.40) (all P < 0.02). Only tract volumes and lengths correlated with annualized growth velocity. Relative to controls, patients showed smaller tract volumes (8.00 cc vs. 13.71 cc, P < 0.01), shorter tract lengths (5.92 mm vs 6.99 mm, P = 0.03), and smaller ratios of 3D cartilage volume to tract length; but no difference (4.51 cc vs 4.85 cc) in 3D MRI volumes. The 10 patients with the lowest height percentiles had smaller tract volumes (5.07 cc vs. 10.93 cc, P < 0.01), but not significantly different 3D MRI volumes. Tract volume is associated with abnormal growth, with an accuracy of 75%. DATA CONCLUSION DTI tract volume of the physis/metaphysis predicts abnormal growth better than physeal cartilage volumetric measurement and correlates best with height percentile and growth velocity. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2 J. Magn. Reson. Imaging 2020;52:544-551.
Collapse
Affiliation(s)
- Phuong Duong
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Sogol Mostoufi-Moab
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - José G Raya
- Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jorge Delgado
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| |
Collapse
|