Magnetic susceptibility effects of trabecular bone on magnetic resonance imaging of bone marrow

Update on bone density measurements and their interpretation in children and adolescents

Following the increased awareness about the central role of the pediatric age in building bone for life, clinicians face more than ever the necessity of assessing bone health in pediatric subjects at risk for early bone mass derangements or in healthy children, in order to optimize their bone mass accrual and prevent osteoporosis. Although the diagnosis of osteoporosis is not made solely upon bone mineral density measurements during growth, such determination can be very useful in the follow-up of pediatric patients with primary and secondary osteoporosis. The ideal instrument would give information on the mineral content and density of the bone, and on its architecture. It should be able to perform the measurements on the skeletal sites where fractures are more frequent, and it should be minimally invasive, accurate, precise and rapid. Unfortunately, none of the techniques currently utilized fulfills all requirements. In the present review, we focus on the pediatric use of dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), peripheral QCT (pQCT), and magnetic resonance imaging (MRI), highlighting advantages and limits for their use and providing indications for bone densitometry interpretation and of vertebral fractures diagnosis in pediatric subjects.

Simultaneous Quantification of Bone Edema/Adiposity and Structure in Inflamed Bone Using Chemical Shift-Encoded MRI in Spondyloarthritis

Purpose

To evaluate proton density fat fraction (PDFF) and R2* as markers of bone marrow composition and structure in inflamed bone in patients with spondyloarthritis.

Methods

Phantoms containing fat, water, and trabecular bone were constructed with proton density fat fraction (PDFF) and bone mineral density (BMD) values matching those expected in healthy bone marrow and disease states, and scanned using chemical shift‐encoded MRI (CSE‐MRI) at 3T. Measured PDFF and R2* values in phantoms were compared with reference FF and BMD values. Eight spondyloarthritis patients and 10 controls underwent CSE‐MRI of the sacroiliac joints. PDFF and R2* in areas of inflamed bone and fat metaplasia in patients were compared with normal bone marrow in controls.

Results

In phantoms, PDFF measurements were accurate over the full range of PDFF and BMD values. R2* measurements were positively associated with BMD but also were influenced by variations in PDFF. In patients, PDFF was reduced in areas of inflammation and increased in fat metaplasia compared to normal marrow. R2* measurements were significantly reduced in areas of fat metaplasia.

Conclusion

PDFF measurements reflect changes in marrow composition in areas of active inflammation and structural damage and could be used for disease monitoring in spondyloarthritis. R2* measurements may provide additional information bone mineral density but also are influenced by fat content. Magn Reson Med 79:1031–1042, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Evaluation of Spinal Bone Changes in Patients with Chronic Renal Failure by CT and Mr Imaging with Pathologic Correlation

To investigate bone changes in patients with chronic renal failure (CRF), bone mineral density (BMD) and T1 relaxation times were measured with CT and MR imaging and the results were correlated to histology. Excised lumbar vertebrae from 25 autopsy cases of CRF (18 males and 7 females), including 12 cases in which the patients had been receiving hemodialysis were examined. BMD and T1 relaxation time values were associated with specific histologic findings for cellularity, trabeculae, and peritrabecular fibrosis. Three vertebrae with low BMD showed increased hematopoietic marrow content, a finding not observed in primary osteoporosis. The vertebrae with osteosclerosis showed prolonged T1 relaxation time, which was due to increased amount of hematopoietic marrow, and the presence of thickened or many small irregular trabeculae or peritrabecular fibrosis. These findings may be useful in the evaluation of bone changes in patients with CRF.

Noise Effects in Various Quantitative Susceptibility Mapping Methods

Various regularization methods have been proposed for single-orientation quantitative susceptibility mapping (QSM), which is an ill-posed magnetic field to susceptibility source inverse problem. Noise amplification, a major issue in inverse problems, manifests as streaking artifacts and quantification errors in QSM and has not been comparatively evaluated in these algorithms. In this paper, various QSM methods were systematically categorized for noise analysis. Six representative QSM methods were selected from four categories: two non-Bayesian methods with alteration or approximation of the dipole kernel to overcome the ill conditioning; four Bayesian methods using a general mathematical prior or a specific physical structure prior to select a unique solution, and using a data fidelity term with or without noise weighting. The effects of noise in these QSM methods were evaluated by reconstruction errors in simulation and image quality in 50 consecutive human subjects. Bayesian QSM methods with noise weighting consistently reduced root mean squared errors in numerical simulations and increased image quality scores in the human brain images, when compared to non-Bayesian methods and to corresponding Bayesian methods without noise weighting (p ≤ 0.001). In summary, noise effects in QSM can be reduced using Bayesian methods with proper noise weighting.

Proton-density fat fraction and simultaneous R2* estimation as an MRI tool for assessment of osteoporosis

OBJECTIVE

To investigate multi-echo chemical shift-encoded MRI-based mapping of proton density fat fraction (PDFF) and fat-corrected R2* in bone marrow as biomarkers for osteoporosis assessment.

METHODS

Fifty-one patients (28 female; mean age 69.7 ± 9.0 years) underwent dual energy X-ray absorptiometry (DXA). On the basis of the t score, 173 valid vertebrae bodies were divided into three groups (healthy, osteopenic and osteoporotic). Three echo chemical shift-encoded MRI sequences were acquired at 3 T. PDFF and R2* with correction for multiple-peak fat (R2*MP) were measured for each vertebral body. Kruskal-Wallis test and post hoc analysis were performed to evaluate differences between groups. Further, the area under the curve (AUC) for each technique was calculated using logistic regression analysis.

RESULTS

On the basis of DXA, 92 samples were normal (53 %), 47 osteopenic (27 %) and 34 osteoporotic (20 %). PDFF was increased in osteoporosis compared with healthy (P = 0.007). R2*MP showed significant differences between normal and osteopenia (P = 0.004), and between normal and osteoporosis (P < 0.001). AUC to differentiate between normal and osteoporosis was 0.698 for R2*MP, 0.656 for PDFF and 0.74 for both combined.

CONCLUSION

PDFF and R2*MP are moderate biomarkers for osteoporosis. PDFF and R2*MP combination might improve the prediction in differentiating healthy subjects from those with osteoporosis.

Quantitative MRI for the assessment of bone structure and function

Osteoporosis is the most common degenerative disease in the elderly. It is characterized by low bone mass and structural deterioration of bone tissue, leading to morbidity and increased fracture risk in the hip, spine and wrist-all sites of predominantly trabecular bone. Bone densitometry, currently the standard methodology for diagnosis and treatment monitoring, has significant limitations in that it cannot provide information on the structural manifestations of the disease. Recent advances in imaging, in particular MRI, can now provide detailed insight into the architectural consequences of disease progression and regression in response to treatment. The focus of this review is on the emerging methodology of quantitative MRI for the assessment of structure and function of trabecular bone. During the past 10 years, various approaches have been explored for obtaining image-based quantitative information on trabecular architecture. Indirect methods that do not require resolution on the scale of individual trabeculae and therefore can be practiced at any skeletal location, make use of the induced magnetic fields in the intertrabecular space. These fields, which have their origin in the greater diamagnetism of bone relative to surrounding marrow, can be measured in various ways, most typically in the form of R2', the recoverable component of the total transverse relaxation rate. Alternatively, the trabecular network can be quantified by high-resolution MRI (micro-MRI), which requires resolution adequate to at least partially resolve individual trabeculae. Micro-MRI-based structure analysis is therefore technically demanding in terms of image acquisition and algorithms needed to extract the structural information under conditions of limited signal-to-noise ratio and resolution. Other requirements that must be met include motion correction and image registration, both critical for achieving the reproducibility needed in repeat studies. Key clinical applications targeted involve fracture risk prediction and evaluation of the effect of therapeutic intervention.

Osteoporosis imaging

Because osteoporotic fractures may be prevented, diagnostic techniques are essential in the assessment of osteoporosis. Conventional radiographs of the spine are not suited for diagnosing early osteoporosis, but they show fractures that may have no clinical symptoms. The radiologist should be aware of the enormous significance of these fractures for future osteoporotic fractures. Bone mass measurements are standard techniques in the diagnosis of osteoporosis, which are the basis of the WHO definition of osteoporosis. In this article the authors presented these standard techniques and newer diagnostic techniques that provide insights in the structure of trabecular bone.

Comparison of DXA and MRI methods for interpreting femoral neck bone mineral density

The aim of the study was to improve the practical implementation of the dual X-ray absorptiometry (DXA) by converting the areal bone mineral density BMD (BMD(areal)) to volumetric BMD using magnetic resonance (MR) imaging (MRI) because a failure to control for the femoral neck size can lead to erroneous interpretation of BMD values. We also evaluated the feasibility of MR T2* relaxation time in assessing bone mineral status of the femoral neck. Twenty-eight randomly selected 47- to 64-yr-old healthy men were studied. The men had neither unilateral nor bilateral hip osteoarthritis according to radiographs. Bone width, mineral content (BMC), BMD(areal), and apparent volumetric BMD (BMD(vol)) of the right femoral neck were measured with DXA. The BMD(vol) was calculated by approximating the femoral neck to be cylindrical with a circular cross-section (Vol(dxa)). Volumetric measurements from MR (Vol(mri)) images of the femoral neck were also used to create a BMD measure that was corrected for the femoral neck volume (BMD(mri)). T2* measurements were performed with a 1.5-T scanner (Siemens Magnetom 63SP, Erlangen, Germany). A single 10-mm-thick coronal slice was generated on the femur with a repetition time of 60 ms, and nine echo times (4-20 ms) were used to derive T2* values. Vol(mri) correlated positively (r = 0.828, p < 0.001) with Vol(dxa). However, the Vol(mri) of the femoral neck was 18% lower than the Vol(dxa). Similarly, the BMD(mri) was related to the BMD(vol) (r = 0.737, p < 0.001). Because of the difference in the volumetric measures, the BMD(mri) of the femoral neck was 21% higher than the BMD(vol) (p < 0.001). T2* relaxation time showed a significant negative correlation with BMC, BMD(areal), BMD(vol), and BMD(mri) (r = -0.423 to -0.757, p < 0.05-0.001). In conclusion, these results are evidence that DXA-derived volume approximations by the cylinder with circular cross-section geometry may lead to lower DXA-derived BMD(vol) values, as compared to true MRI-derived volumetric bone mineral density. Thus, the BMD(vol) may not be an accurate method to calculate the true volumetric BMD in the femoral neck. Our results also suggest that the MRI-derived T2* method may be used to approximate the BMD in the proximal femur.

Cross-sectional study of osteopenia with quantitative MR imaging and bone densitometry

PURPOSE

To evaluation the cancellous bone-induced intravoxel spin dephasing rate (R2') and its relationship to bone mineral density and marrow fat and to examine these parameters as predictors of vertebral fracture status.

MATERIALS AND METHODS

R2' and R2, the rate constants for reversible and irreversible spin dephasing, and marrow fat fraction were measured in the lumbar vertebrae and proximal femur. One hundred thirty-nine subjects (mean age, 62.4 years +/- 11.4 [SD]; 33 men, 106 women) had spinal dual-energy x-ray absorptiometric bone mineral density (BMD) T scores ranging from +3 to -5. R2', BMD, and bone marrow composition as determinants of vertebral fracture status were examined.

RESULTS

Strongest single predictors of fracture status for BMD and R2' were the Ward triangle (r(2) = 0.48) and trochanter (r(2) = 0.37), respectively. Combined, the two parameters and sites increased fracture prediction (r(2) = 0. 62), whereas the combination of multiple BMD sites did not. Multivariate regression involving marrow fat fraction further improved fracture status prediction. R2' was correlated with BMD at all sites, although slopes differed by a factor of up to 2.5, which reflected differences in trabecular orientation relative to the static field. R2, the true transverse relaxation rate, was negatively correlated with marrow fat fraction. A non-age-related increase in marrow fat fraction in osteoporosis parallels earlier findings in animal models.

CONCLUSION

Cancellous bone marrow R2' measured in the proximal femur provides information, which, with BMD, improves prediction of vertebral fracture status.

High-speed spectroscopic imaging for cancellous bone marrow R(2)* mapping and lipid quantification

In this work an interleaved multiple-gradient-echo chemical shift imaging (IMGE-CSI) technique was designed, implemented and evaluated at 1.5 and 4T for high-resolution lipid quantification and R(2)* measurement in-vivo. The method is analogous to echo planar CSI but utilizes conventional gradient echoes, exploiting the principle of spectroscopic bandwidth extension by interleaving temporally offset gradient-echo trains. It is shown that IMGE-CSI is able to measure true fat volume fraction in oil/water mixtures with high accuracy, not possible with Dixon-type methods which approximate the spectrum as consisting of only two spectral components. Correlation of the CSI- derived volume fractions with volumetry afforded r(2) > 0.99 with a slope of 0.98. The method is shown to be able to quantify regional variations in bone marrow composition in vivo with a spatial resolution of 2.5 x 2.5 x 5 mm(3.) R(2)* was obtained by multi-line spectral curve fitting. For the measurement of R(2)* in cancellous bone marrow the method is shown to agree well with time-domain fitting techniques but is superior in instances where the marrow has both hematopoietic and fatty constituents. Finally, excellent inter-scan reproducibility (1% coefficient of variation for global means and medians) was achieved, yielding r(2) = 0.98 of the test-retest correlation for three scans in four test subjects. In conclusion, IMGE-CSI is found to enable highly accurate lipid quantification and measurement of cancellous bone marrow R(2)* at spatial resolutions and scan times typical of standard clinical protocols.

R'2 measured in trabecular bone in vitro: relationship to trabecular separation

Measurement of key parameters of the microstructure of trabecular bone is critical to the study of osteoporosis and bone strength. Density based methods cannot provide this information, and give only the total amount of bone present, and not its arrangement. Magnetic resonance imaging has shown the potential to provide information related to the microarchitecture of the trabecular bone matrix. Twelve samples (8 x 8 x 8 mm3 bone cubes) were cut from sheep vertebrae such that the trabeculae ran either parallel or perpendicular to each face. Detailed measurements of the structure of these bone cubes were made by histomorphometry, and compared to R'2 and R*2 measured with a spin and gradient-echo sequence, Partially Refocused Interleaved Multiple Echo, at 1.5 Tesla. The precision of the R'2 measurement (% coefficient of variation) was 8.7+/-5.1, and 7.7+/-4.3 for R*2. Uncorrected values of R'2 and R*2 were significantly correlated to density measured by quantitative computed tomography (r = 0.87, p = 0.0005, and r = 0.90, p = 0.0002, respectively), and trabecular bone area measured by histomorphometry (r = 0.80, p = 0.002, and r = 0.83, p = 0.0008, respectively). Density correction was effected by imaging the same slice of bone in two orientations (90 degrees and 0 degrees ) to the main magnetic field. For both R'2 and R*2 there was a significant difference between measurements in the 90 degrees and 0 degrees orientations (p < 0.01). The difference between the two values was used, and termed R'2net or R*2net. The net parameters were independent of bone mass. R'2net and R*2net were significantly correlated to trabecular separation (p < 0.05) with r = -0.58 and r = -0.62, respectively. These results demonstrate the ability of magnetic resonance imaging to characterize a key measure of the trabecular microstucture. An increase in trabecular separation has important biomechanical consequences in osteoporosis. This result also strengthens the hypothesis that the sensitivity of R'2 to osteoporosis-related bone changes is due to magnetic susceptibility effects in which rapid transitions between bone and marrow create local magnetic field inhomogeneities that result in an increase in R'2 values.

Adaptation of the human calcaneus to variations of impact forces during running

OBJECTIVE

The influence of varied forces under the heel induced by changes in midsole hardness on adaptations of the human calcaneus during running training was investigated.

DESIGN

A longitudinal study was conducted over a period of 20 weeks with subjects training for 50 km per week on average.

BACKGROUND

The skeletal systems' metabolism acts highly dynamic, governed by mechanical factors. The amount of running training has been shown to increase the bone mineral density in the calcaneus. Mechanical factors have not been controlled in former investigations.

METHODS

Bone quality parameters were determined before and after the training by use of an ultrasound system and quantitative MRI while the mechanics of foot-ground contact were controlled. The total group of 26 subjects was divided into three subgroups based upon different magnitude of forces under the heel inside the shoe.

RESULTS

The biomechanical testing demonstrate no relationship between midsole hardness and external or in-shoe impacts. Bone parameters showed specific differences for all groups which are pronounced in runners with intermediate impacts.

CONCLUSIONS

The observed variations reflect metabolic changes in bone marrow which appear to be effected by the impact magnitude and cannot be characterised as negative.

RELEVANCE

The current data imply that no negative changes of impacts on calcaneal bone were produced by high amounts of training in distance running. The mechanical testing indicates that the potential of modifying calcaneal adaptation directly by varying midsole hardness is limited.

Computer simulations for the optimization of magnetic resonance phase imaging applied in the study of trabecular bone

A new technique for the evaluation of bone trabeculation using magnetic resonance (MR) phase images has been recently presented. This technique calculates the phase variance in a region of interest (ROI) on the phase images of a gradient echo sequence. In this study, a computer program was developed which simulates the phase distribution in gradient echo acquired phase images of a structure that mimics trabecular bone, consisting of a three-dimensional connected network of orthogonal bone struts. Several tests were performed in order to assess the influence of imaging parameters such as the echo time, the pixel size and the slice width on phase variance. The results from this work show that with selection of appropriate imaging parameters, phase variance strongly reflects variations in trabecular bone density. Representative MR experiments were performed in the distal radius to verify the simulation results.

CT and MR assessment of osteoporosis

Over the past decades there has been remarkable progress in the development and application of non-invasive radiological methods for assessing the skeletal bone mass and status. It is possible to evaluate the peripheral or axial entire skeleton as well as the trabecular bone or cortical bone envelopes with a high degree of accuracy and precision, and with a reasonable capacity for determining bone strength and predicting fracture risk. Cross sectional imaging methods such as CT and MR yield significant advantages for these applications since they are the only techniques which allow for accurate three dimensional localization of tissue and for true isolation of the trabecular and the cortical bone compartment. Both methods can be applied to practically every anatomic location in the human body.

Effects of trabecular bone on marrow relaxation in the tibia

The effects of bone on marrow relaxation in the trabecular volume of the most proximal 3 cm in the left tibia were studied with a RF-spoiled gradient echo MRI protocol on a 1.0 T MR unit. The MR measurements were performed on six healthy volunteers, and repeated within one month in order to assess the precision of the method. In the same subjects, the area bone mineral density (BMD, g/cm2) was measured at the left proximal femur using dual-energy X-ray absorptiometry. The calcaneus of the same side was examined with quantitative ultrasound. The marrow T2* relaxation deviated from a mono-exponential decay, and resembled the decay of subcutaneous fat. The shape of the relaxation curve reflected the presence of several spectral components in bone marrow, and was further influenced by the amount and structure of the surrounding trabecular bone. The bone marrow decays showed substantially reduced inter-subject variability after normalisation of the marrow data fit parameters to corresponding values for s.c. fat. This suggests the use of an internal adipose tissue reference in order to correct for diet-related variations of marrow T2* estimates. The mean relative precision of the MR measurements was between 5% and 10% depending on the data fit model. Moderate-to-strong correlations between DXA BMD indices in the proximal femur and MR parameters were found (r(max)=-0.96; p < 0.01), while ultrasound-derived measures of bone strength measured on the calcaneus demonstrated significantly weaker correlations to the MR parameters (r(max)=-0.78; p > 0.05). The method employed in this study showed reasonable precision and a moderate to good correlation compared to other bone parameters derived at the same extremity, and is a promising tool for the use on patients.

Validation of object-induced MR distortion correction for frameless stereotactic neurosurgery

Spatial fidelity is a paramount issue in image guided neurosurgery. Until recently, three-dimensional computed tomography (3D CT) has been the primary modality because it provides fast volume capture with pixel level (1 mm) accuracy. While three-dimensional magnetic resonance (3D MR) images provide superior anatomic information, published image capture protocols are time consuming and result in scanner- and object-induced magnetic field inhomogeneities which raise inaccuracy above pixel size. Using available scanner calibration software, a volumetric algorithm to correct for object-based geometric distortion, and a Fast Low Angle SHot (FLASH) 3D MR-scan protocol, we were able to reduce mean CT to MR skin-adhesed fiducial marker registration error from 1.36 to 1.09 mm. After dropping the worst one or two of six fiducial markers, mean registration error dropped to 0.62 mm (subpixel accuracy). Three dimensional object-induced error maps present highest 3D MR spatial infidelity at the tissue interfaces (skin/air, scalp/skull) where frameless stereotactic fiducial markers are commonly applied. The algorithm produced similar results in two patient 3D MR-scans.

Quantitation of intrinsic magnetic susceptibility-related effects in a tissue matrix. Phantom study

A theoretical background and experimental method that allows a separation of intrinsic, tissue-matrix-specific magnetic-field inhomogeneity effects from both macroscopic (large compared with voxel dimensions) and microscopic (on the order of molecular dimensions) inhomogeneities is proposed. Such separation allows one to take full advantage of these tissue-matrix-specific magnetic field inhomogeneity effects to extract information about tissue structure. A method to measure the volume fraction occupied by the susceptibility-perturbing component in a tissue matrix, the R2' relaxation rate constant, and the susceptibility difference between the bulk component and the susceptibility-perturbing component in a tissue matrix has been developed and tested on phantoms. This method offers the potential to assess a variety of tissue parameters, including cerebral blood volume, blood volume and blood oxygenation-level changes in functional MRI, the structure of trabecular bone, and other physiologically important issues.

Comparison of computer simulated and phantom measured phase variance in the study of trabecular bone

A new method using magnetic resonance phase images for the assessment of trabecular bone structure has recently been proposed. To test this method, a mathematical model is developed which calculates the phase distribution in gradient echo acquired phase images of a structure of Pyrex glass rods immersed in a copper sulfate solution. Several experiments were performed using a phantom built in the same way as the structure used in the mathematical model. The results from the model are compared with those from the phantom tests, and the influence of resolution and bone area fraction on the phase dispersion is studied. The good correlation between theoretical and experimental results shows that phase variance increases with increasing resolution and bone density. However, the dependence of variance on bone density is less prominent for large pixel sizes.

How can we measure bone quality?

Osteoporosis is a systematic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue. This leads to diminished biomechanical competence of the skeleton and is associated with low-trauma or atraumatic fractures. In the past decade, considerable progress has been made in the development of methods for assessing the skeleton non-invasively, so that osteoporosis can be better managed. While dual X-ray absorptiometry (DXA) is still the preferred methodology, several limitations will be addressed. Another densitometric technique which is widely accepted for diagnosis of spinal osteoporosis is single energy QCT. Measurements of vertebral trabecular bone mineral density (BMD) demonstrate larger percentage decrements between vertebrally-fractured subjects and normal controls, and confer higher relative risks for vertebral fracture than either anteroposterior or lateral DXA measurements. As an emerging alternative to photon absorptiometry techniques, there is a growing interest in the use of quantitative ultrasound (QUS) measurements for the non-invasive assessment of osteoporotic fracture risk in the management of osteoporosis. The attractiveness of QUS lies in the fact that indirect and in vitro experience has suggested that ultrasound may give information not only about BMD but also about architecture and elasticity. Whether or not combining QUS and DXA improve fracture prediction is still unclear and needs further analysis. Due to the growing evidence supporting the use of QUS in osteoporosis and the large number of QUS devices already on the market, a general clinical consensus on the application of QUS is urgently needed. Other techniques that are less widely used for the management of osteoporosis. For example, peripheral quantitative computed tomography, quantitative magnetic resonance (QMR) and magnetic resonance microscopy are promising tools for the evaluation of the skeleton. For example, the ability of QMR and high resolution magnetic resonance imaging has been explored and shows promise as a technique for assessing trabecular bone structure in osteoporosis.

Experimental correlation between T2* and ultimate compressive strength in lumbar porcine vertebrae

RATIONALE AND OBJECTIVES

The authors used magnetic resonance (MR) imaging to investigate the correlation between T2* measurements of trabecular bone and the ultimate compressive strength of lumbar porcine vertebrae.

METHODS

Five pigs that weighted 25-32 kg were sacrificed and imaged with a 1.5-T MR system. T2* of the lumbar vertebrae was measured from gradient-echo images. The vertebrae were individually compressed at a fixed speed in the direction of the spine until crushed. The maximum load a vertebra could resist was recorded.

RESULTS

T2* ranged from 7.1 to 14.5 msec. T2* determined from 5-mm coronal sections differed from that determined from axial and sagittal sections (P < .05). Between 2.9 and 5.4 kN of force (296-550 kg) was needed to crush a vertebra. A linear correlation between the ultimate compressive strength and T2* of all vertebrae was observed for all imaging planes and section thicknesses (P < .001, except for 10-mm sagittal images, for which P < .002). The T2* determined for the axial plane showed the best correlation with the ultimate compressive strength (r = -0.83).

CONCLUSION

The correlation between T2* values and vertebral strength indicates that MR imaging may potentially be used to predict fracture risks in patients.

Magnetic resonance imaging of the bone marrow in lymphomas and leukemias

This article reviews MRI techniques and results in the assessment of bone marrow in patients with lymphoma. MRI is more sensitive than blind biopsy (BB) in detecting bone marrow invasion. False-negative results have been reported in low-grade non Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia. Bone marrow imaging is particularly indicated in patients with Hodgkin's disease, high grade NHL or myelocytic leukemia, with a negative BB and abnormal clinical (stage B, bone pains) or biochemical data (elevated alkaline phosphatase) and who have relapsed. During treatment. MR imaging is a valuable tool for the evaluation of response and the diagnosis of benign bone marrow complications. Knowledge of post-therapeutic patterns is essential to avoid misinterpretations. The main drawback with this technique is its inability to differentiate residual lesions from fibrosis and needle guided-biopsy is mandatory if treatment decision-making relies on the MR result, alone.

Quantitation of T2' anisotropic effects on magnetic resonance bone mineral density measurement

In this paper, the authors quantitate the anisotropy of susceptibility effects in an uniaxial trabecular bone model and show its relevance to clinical MR bone mineral density measurements. A physical model is described that quantitates the anisotropic MR behavior of uniaxial trabecular bone. To test the model; a phantom of parallel polyethylene filaments was scanned every 15 degrees between 0 degrees and 90 degrees with respect to the system's main magnetic field (B0). The distal radial metaphysis of a healthy female volunteer was scanned in orthogonal projections. The signal from each phantom image and each radial image was separated in a pixel-wise fashion into R2 and R2' maps. As predicted, R2' relaxation showed anisotropic behavior and changed according to sin2 (theta), confirming that columnar structures parallel with B0 will cause no MR susceptibility effects. Scans of the distal radius showed that R2' relaxation was twice as great with the forearm perpendicular to B0 as when it was parallel to it, demonstrating different contributions from struts and columns. For both phantom and radial bone scans, R2 relaxation was isotropic and did not change with object orientation.

Gradient-echo magnetic resonance signal decay in a porcine vertebral body model: influence of chemical shift

RATIONALE AND OBJECTIVES

This study investigates how magnetic resonance (MR) signal and T2* of trabecular bone are affected by chemical shift.

METHODS

Five pigs were sacrificed, and 150 gradient-echo MR images with increasing echo times (TEs) were obtained of the lumbar spine. Two vertebrae were excised, defatted, and imaged. Commercial fat-protein emulsions with 40%, 27%, and 15% concentrations of fat were studied. Regions of interest in subcutaneous fat (n = 3), bladder (n = 4), vertebral body (n = 10), and defatted vertebral body (n = 10) were used to study decay of signal intensity.

RESULTS

MR signal intensity of the vertebrae decreased with a superimposed modulation. The periodicity was 4.65 msec (range, 4.60-4.68 msec). At a TE of 0 msec, a phase shift of 24 degrees (range, 14 degrees-37 degrees), which corresponds to a shift in TE of 0.31 msec at 1.5 T, was present. In the fat-protein emulsions, the amplitude of the modulation increased with the amount of fat.

CONCLUSION

Chemical shift and the amount of fat affects T2* measurements.

Optimizing joint imaging: MR imaging techniques

For optimizing MR imaging of the joints, a sophisticated knowledge of MR system hard- and software conditions and coil technologies, sequence and contrast preparation techniques, and the use of paramagnetic contrast agents is necessary. This review article discusses the basic principles of the appropriate use of surface coils as well as the different conventional and fast imaging sequences, including three-dimensional (3D) MR imaging. In addition, the applications of contrast agents as well as the most important contrast preparation techniques are reviewed.

Magnetic resonance imaging of the calcaneus: preliminary assessment of trabecular bone-dependent regional variations in marrow relaxation time compared with dual X-ray absorptiometry

RATIONALE AND OBJECTIVES

Marrow transverse relaxation time (T2*) in magnetic resonance (MR) imaging may be related to the density and structure of the surrounding trabecular network. We investigated regional variations of T2* in the human calcaneus and compared the findings with bone mineral density (BMD), as measured by dual X-ray absorpiometry (DXA). Short- and long-term precisions were evaluated first to determine whether MR imaging would be useful for the clinical assessment of disease status and progression in osteoporosis.

METHODS

Gradient-recalled echo MR images of the calcaneus were acquired at 1.5 T from six volunteers. Measurements of T2* were compared with BMD and (for one volunteer) conventional radiography.

RESULTS

T2* values showed significant regional variation; they typically were shortest in the superior region of the calcaneus. There was a linear correlation between MR and DXA measurements (r = .66 for 1/T2* versus BMD). Differences in T2* attributable to variations in analysis region-of-interest placement were not significant for five of the six volunteers. Sagittal MR images had short- and long-term precision errors of 4.2% and 3.3%, respectively. For DXA, the precision was 1.3% (coefficient of variation).

CONCLUSION

MR imaging may be useful for trabecular bone assessment in the calcaneus. However, given the large regional variations in bone density and structure, the choice of an ROI is likely to play a major role in the accuracy, precision, and overall clinical efficacy of T2* measurements.

Assessment of the magnetic field distribution in yellow and red bone marrow by the MAGSUS technique

The MAGSUS imaging technique has been shown to provide insights into the distribution of the macroscopic and microscopic static magnetic field without requiring further data processing. Applications of the MAGSUS technique on bone marrow are reported in more detail in this article. Effects of the superposition of water and lipid signals and of considerable transverse relaxation on MAGSUS imaging are demonstrated, and adapted imaging parameters are presented. Examples of applications on marrow with different physiological and pathological compositions and different locations are shown. Appropriate adjustments for a reliable estimation of the trabecular density in peripheral yellow marrow and for an assessment of the field distribution in hemopoietic red marrow are reported. Osteoporotic peripheral marrow with reduced amount of trabecular structures and alterations due to osteodystrophia deformans can be simply revealed by this method. An estimation of the trabecular density can also be performed by MAGSUS in vertebral bodies of hematologically unaffected persons, but the interindividually differing amount of paramagnetic depositions in the marrow (e.g., hemosiderin) must be taken into account.

An in vivo automated shimming method taking into account shim current constraints

Many in vivo imaging techniques require magnetic field homogeneity in the volume of interest. Shim coils of the second and third order spherical harmonics have been used successfully to compensate for complicated field variations caused by the human anatomy itself. The available currents of these coils are invariably limited. In this note we demonstrate that these limits significantly affect the optimal shim condition. We propose an automated in vivo shimming method for arbitrary volumes of interest using 3-dimensional (3D) field maps. This method is a modification of previous works using least-squares criteria. The main difference is that a constrained optimization is performed in vivo under the current limits of the shim coils, which improved the field homogeneity significantly over simple truncations of the least-squares solutions. This shimming method was used with head scans of five normal volunteers on a 4.0 tesla scanner. A fast double-echo sequence was used to obtain field maps, and a new field uniformity measure was derived for this method. The field mapping sequence was tested against a standard single-echo Dixon sequence used by previous investigators, and the stability of the shimming method was tested by repeated studies on the same subject.

Osteoarthritis and magnetic resonance imaging: potential and problems

To date, MRI has primarily been used to study anatomical changes, and at a resolution that makes detailed analysis of focal change difficult. This is primarily because cost limits the development and use of tailor made research systems. The detailed analysis of soft tissue, cartilage, and bone marrow images should provide a fruitful non-invasive method to study OA. However, the development of MRI methods to study movement, diffusion and perfusion, and the spatial localisation of spectroscopic information, promises a revolution in the study of the living joint in man.

A review of the recent advances in magnetic resonance imaging in the assessment of osteoporosis

Osteoporosis is a common metabolic disorder with considerable associated morbidity and mortality. The loss of bone mineral integrity and the resultant occurrence of atraumatic fractures are typically symptomatic of the disease. Currently skeletal status is commonly assessed using non-invasive conventional radiography and scintigraphy as well as densitometric techniques such as quantitative computed tomography and dual-energy X-ray absorptiometry. But, apart from gross bone mineral density, the fine structure of trabecular bone also plays an important role in defining the biomechanical competence of the skeleton. Recently attention has been focused on deriving measures that provide information about not only trabecular bone density but also microstructure. Magnetic resonance imaging (MRI) is one such new technique which potentially may provide information pertaining to bone density and structure as well as to occult fracture detection. Cortical bone produces a signal void in MR images, due to the fact that it contains very few mobile protons that give rise to a signal in MRI; also the MR relaxation time T2 of these protons is very short which produces a very fast decay of the MR signal during image acquisition. However, the trabecular bone network affects the MR properties of bone marrow. The difference in the magnetic properties of trabecular bone and bone marrow generates local imperfections in the magnetic field. The MR signal from bone marrow is modified due to these imperfections and the MR relaxation time T2 of marrow is shortened. The extent of relaxation time shortening and hence loss of signal intensity is proportional to the density of trabecular bone and marrow interfaces and their spatial architecture. Recent investigation in this area include studies aimed at quantifying marrow relaxation times and establishing their relationship to trabecular bone density and structure. In addition, with advances in imaging software and hardware, MR images at in-plane resolutions of 78-200 microns may be obtained. The trabecular bone structure is clearly revealed in such images and studies aimed at the development of high-resolution MRI techniques combined with quantitative image analysis techniques are currently under way. These potentially useful techniques for assessing osteoporosis and predicting fracture risk are reviewed in this paper.

Localized MR 1H spectroscopy reveals alterations of susceptibility in bone marrow with hemosiderosis

A noninvasive investigation of the structure of hemopoietic bone marrow is based on the determination of the magnetic field distribution within small volume elements in vertebral bodies by localized 1H MR spectroscopy. In patients with hematological diseases the status of the bone marrow was found to considerably influence the homogeneity of the magnetic field in trabecular bone in vivo. The line widths of the 1H signals were evaluated in follow-up studies during initial chemotherapy of eight patients with leukemia. Intraindividual comparison revealed significant broadening of the field distribution after a few weeks of cytotoxic treatment in five of the patients. Additionally, 19 patients after bone marrow transplantation showed significantly broader field distributions in the lipid signals than 13 matched healthy volunteers. These alterations of the microscopic field homogeneity were not caused by trabecular density effects. Iliac crest biopsies revealed high amounts of hemosiderin in the cases with broadened line widths. Ten of the 19 patients after bone marrow transplantation showed high amounts of hemosiderin and broad lines in the spectra. The content of hemosiderin of the other patients was not significantly increased.

Characterization of spatial distortion in magnetic resonance imaging and its implications for stereotactic surgery

The different sources of spatial distortion in magnetic resonance images are reviewed from the point of view of stereotactic target localization. The extents of the two most complex sources of spatial distortion, gradient field nonlinearities and magnetic field inhomogeneities, are discussed both qualitatively and quantitatively. Several ways by which the spatial distortion resulting from these sources can be minimized are discussed. The clinical relevance of the spatial distortion along with some strategies to minimize the localization errors in magnetic resonance-guided stereotaxy are presented.

MR susceptibility misregistration correction

The authors present a new in vivo method to correct the nonlinear, object-shape-dependent and material-dependent spatial distortion in magnetic resonance (MR) images caused by magnetic susceptibility variations. This distortion across the air/tissue interface before and after the correction is quantified using a phantom. The results are compared to the distortion-free computed tomography (CT) images of the same phantom by fusing CT and MR images using fiducials, with a registration accuracy of better than a millimeter. The distortion at the bone/tissue boundary is negligible compared to the typical MRI (MR imaging) resolution of 1 mm, while that at the air/tissue boundary creates displacements of about 2 mm (for G(x) 3.13 mT/m). This is a significant value if MRI is to provide highly accurate geometric measurements, as in the case of target localization for stereotaxic surgery. The correction scheme provides MR images with accuracy similar to that of CT: 1 mm. A new method to estimate the magnetic susceptibility of materials from MR images is presented. The magnetic susceptibility of cortical bone is measured using a SQUID magnetometer, and is found to be -8.86 ppm (with respect to air), which is quite similar to that of tissue (-9 ppm).

Leukemic red bone marrow changes assessed by magnetic resonance imaging and localized 1H spectroscopy

Red bone marrow of healthy persons has considerable contents of water and lipids. The cellularity and the corresponding fat-water ratio within the marrow show clear changes in hematological diseases. Magnetic resonance (MR) methods use the signals of the protons of water and lipids. This paper gives a comparison between different standard MR techniques and recently developed fat- and water-selective imaging methods, addressing their sensitivity to bone marrow changes in leukemia. Additionally, 1H results of spectroscopic methods are presented. The results and conclusions are based on the examination of 26 healthy volunteers and 106 patients with general or focal bone marrow alterations. Standard T1-weighted images did not distinguish bone marrow of young healthy volunteers with relatively high cellularity from acute leukemia. Using fat- and water-selective methods, patients with untreated leukemia showed only water proton signals and no lipid signals from red bone marrow of vertebral bodies and the pelvis. This phenomenon was never observed in healthy volunteers. Following chemotherapy, lipid and water contents normalize in successfully treated patients. Nonresponders did not show significant changes of the fat-water ratio after up to 3 weeks of therapy. Phase contrast imaging provides information about the difference between fat and water fractions within the bone marrow, but quantitative determination of the absolute fat and water fractions requires acquisition of several images and suffers from the susceptibility effects in trabecular bone marrow. The fat-water ratio and additional qualities of water and lipid protons (relaxation times) can be evaluated by volume-selective MR spectroscopy. Typical results of spectra from small-volume elements in hypercellular vertebral bone marrow of leukemic patients before cytotoxic treatment and of normocellular or hypocellular marrow after therapy are demonstrated.

Quantitation of the susceptibility difference between trabecular bone and bone marrow: experimental studies

In this study we quantify the effects of different relaxation mechanisms on the signal intensity in gradient-echo images of tissue such as bone marrow in the presence of trabecular bone. The susceptibility difference between trabecular bone and soft tissue produces distortions in the magnetic lines of force which induce strong inhomogeneities in the static magnetic field. Diffusion of tissue protons in such magnetic field gradients produce a shortening of the transverse relaxation time T2, while the dephasing of the transverse magnetization due to susceptibility differences produces a shortening of the apparent relaxation time T2* as demonstrated in gradient-echo images. We have used specimens of dried human vertebrae with different bone densities immersed in either saline to simulate tissue water or an emulsion of oil and water to simulate bone marrow to quantify these relaxation mechanisms in vitro. We have measured the MR relaxation times T1, T2, and T2* of protons within the trabecular spaces and correlated their variations with trabecular bone density. We have found that in vitro, at 1.5 T, the relaxation times T1 and T2 do not show significant variations with bone density and there are no significant contributions to the transverse relaxation rate due to the diffusion of tissue water in the magnetic field gradients. However, the relaxation rate, 1/T2*, of saline in the presence of trabecular bone increases at a rate of 0.2 s-1/mg/cc due to the dephasing of the transverse magnetization in the magnetic field inhomogeneities. Similar bone density-related T2* variations were observed for fat protons within the trabeculae where the chemical-shift-induced modulations of signal intensity in an oil-water emulsion have been separated from the susceptibility-induced relaxation effects. In addition, we have verified these effects in vivo and quantified in vivo variations in fat and water relaxation rates of bone marrow in the epiphysis and diaphysis in the appendicular skeleton of normal volunteers and found that both fat and water T2* are shorter in the epiphysis compared to the diaphysis, which correlates well with previous observations.