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Castagnoli F, Donners R, Tunariu N, Messiou C, Koh DM. Relative fat fraction of malignant bone lesions from breast cancer, prostate cancer and myeloma are significantly lower than normal bone marrow and shows excellent interobserver agreement. Br J Radiol 2023; 96:20230240. [PMID: 37750943 PMCID: PMC10646620 DOI: 10.1259/bjr.20230240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES To compare relative fat fraction (rFF) of active bone lesions from breast, prostate and myeloma malignancies and normal bone marrow; to assess its inter-reader agreement. METHODS Patients with breast (n = 26), myeloma (n = 32) and prostate cancer (n = 52) were retrospectively evaluated. 110 baseline rFF maps from whole-body MRI were reviewed by two radiologists. Regions of interest for up to four focal active lesions in each patient were drawn on rFF maps, one each at the cervicothoracic spine, lumbosacral spine, pelvis and extremity. The mean and standard deviation of rFF were recorded. The rFF of normal marrow was measured in the pelvis for patients without diffuse bone disease (n = 88). We compared the rFF of malignant bone lesions and normal marrow using Mann-Whitney test. Interobserver agreement was assessed by interclass correlation coefficient. RESULTS Malignant bone lesions showed significantly lower median rFF (13.87%) compared with normal marrow (89.76%) with little overlap (p < 0.0001). There was no significant difference in the median rFF of malignant lesions from breast (14.46%), myeloma (13.12%) and prostate cancer (13.67%) (p > 0.017, Bonferroni correction) and in the median rFF of bone disease according to their anatomical locations (p > 0.008, Bonferroni correction). There was excellent interobserver agreement (0.95). CONCLUSION The low rFF of active bone lesions in breast, prostate and myeloma malignancies provides high image contrast relative to normal marrow that may be used to detect bone metastases. ADVANCES IN KNOWLEDGE This study shows the importance of rFF towards detecting bone metastases.
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Gan C, Robertson PL, Lai JKC, Szer J. Fat fraction quantification of bone marrow in the lumbar spine using the LiverLab assessment tool in healthy adult volunteers and patients with Gaucher disease. Intern Med J 2023; 53:1163-1169. [PMID: 35762150 DOI: 10.1111/imj.15858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Magnetic Resonance Imaging is used for evaluation of bone in Gaucher disease (GD), but a widely available quantitative scoring method remains elusive. AIMS The study purpose was to assess the reproducibility of the LiverLab tool for assessing bone marrow fat fraction (FF) and determine whether it could differentiate GD patients from healthy subjects. METHODS Ten healthy volunteers and 18 GD patients were prospectively recruited. FF was calculated at L3, L4 and L5. GD patient bone marrow burden (BMB) score assessed by one observer. Inter and intra-rater agreement assessed with Bland-Altman data plots. Differences in FF between healthy volunteers versus GD patients and between subjects treated versus not treated assessed using two-sample t-tests. In GD patients, the relationship between FF, BMB and glucosylsphingosine was determined using the Pearson's correlation coefficient. RESULTS Healthy volunteer mean FF was 0.36, standard deviation (SD) 0.10 (range 0.20-0.57). Intra and inter-rater SD were both 0.02. GD patient mean FF was 0.40, SD 0.13 (range 0.09-0.57). No statistical difference was shown between healthy volunteers and GD patients (P = 0.447) or between GD patients whether on enzyme replacement therapy or not (P = 0.090). No significant correlation between mean FF and total BMB (r = -0.525, P = 0.253) or between FF and glucosylsphingosine levels (r = 0.287, P = 0.248). CONCLUSION Excellent reproducibility of LiverLab FF measurements across studies and observers is comparable to Dixon quantitative chemical shift imaging (QCSI). Lack of statistical difference between GD patients and controls may be explained by limited patient numbers, active treatment or mild disease severity in untreated patients.
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Affiliation(s)
- Calvin Gan
- Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patricia L Robertson
- Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey K C Lai
- Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeff Szer
- Clinical Haematology at Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Valero-Tena E, Roca-Espiau M, Verdú-Díaz J, Diaz-Manera J, Andrade-Campos M, Giraldo P. Advantages of digital technology in the assessment of bone marrow involvement in Gaucher's disease. Front Med (Lausanne) 2023; 10:1098472. [PMID: 37250646 PMCID: PMC10213682 DOI: 10.3389/fmed.2023.1098472] [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: 11/16/2022] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Gaucher disease (GD) is a genetic lysosomal disorder characterized by high bone marrow (BM) involvement and skeletal complications. The pathophysiology of these complications is not fully elucidated. Magnetic resonance imaging (MRI) is the gold standard to evaluate BM. This study aimed to apply machine-learning techniques in a cohort of Spanish GD patients by a structured bone marrow MRI reporting model at diagnosis and follow-up to predict the evolution of the bone disease. In total, 441 digitalized MRI studies from 131 patients (M: 69, F:62) were reevaluated by a blinded expert radiologist who applied a structured report template. The studies were classified into categories carried out at different stages as follows: A: baseline; B: between 1 and 4 y of follow-up; C: between 5 and 9 y; and D: after 10 years of follow-up. Demographics, genetics, biomarkers, clinical data, and cumulative years of therapy were included in the model. At the baseline study, the mean age was 37.3 years (1-80), and the median Spanish MRI score (S-MRI) was 8.40 (male patients: 9.10 vs. female patients: 7.71) (p < 0.001). BM clearance was faster and deeper in women during follow-up. Genotypes that do not include the c.1226A>G variant have a higher degree of infiltration and complications (p = 0.017). A random forest machine-learning model identified that BM infiltration degree, age at the start of therapy, and femur infiltration were the most important factors to predict the risk and severity of the bone disease. In conclusion, a structured bone marrow MRI reporting in GD is useful to standardize the collected data and facilitate clinical management and academic collaboration. Artificial intelligence methods applied to these studies can help to predict bone disease complications.
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Affiliation(s)
- Esther Valero-Tena
- Departamento de Medicina Interna y Reumatología, Hospital MAZ, Zaragoza, Spain
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
| | - Mercedes Roca-Espiau
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
| | - Jose Verdú-Díaz
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jordi Diaz-Manera
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marcio Andrade-Campos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal de la SEHH (GEEDL), Madrid, Spain
- Grupo de Investigación en Hematología, Instituto de Investigación Hospital del Mar, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - Pilar Giraldo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal de la SEHH (GEEDL), Madrid, Spain
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Bus SA, Akkerman EM, Maas M. Changes in sub-calcaneal fat pad composition and their association with dynamic plantar foot pressure in people with diabetic neuropathy. Clin Biomech (Bristol, Avon) 2021; 88:105441. [PMID: 34365054 DOI: 10.1016/j.clinbiomech.2021.105441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/09/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetic foot disease is associated with physiological and biomechanical abnormalities in the foot that increase risk for ulceration. The objective was to assess MRI changes in the composition of sub-calcaneal fat pad tissue and its association with plantar pressure during walking. METHODS Fourteen people with diabetes and peripheral neuropathy and five age-matched healthy controls underwent T1-weighted sagittal plane spin-echo Dixon MRI of the rearfoot. Dixon Chemical Shift Imaging was used to create fat-only and water-only images from which the fat signal fraction in a defined ROI of the sub-calcaneal fat pad was calculated. Barefoot plantar pressure distribution during walking was assessed and associated with fat pad outcomes. FINDINGS Mean ± SD fat signal fraction was significantly lower in the neuropathic subjects than in the healthy controls (0.55 ± 0.11 vs. 0.72 ± 0.03, p < 0.005), and was explained by a lowering in fat signal (R2 0.87), more than an increase in water signal (R2 0.32). Mean ± SD peak pressure at the heel was 391 ± 119 kPa for the neuropathic subjects and 325 ± 53 kPa for the healthy controls (non-significantly different). Fat signal fraction and peak pressure were significantly inversely correlated (r = -0.59, p < 0.01). INTERPRETATION Dixon chemical shift MRI showed a reduced fat signal fraction in sub-calcaneal fat pad tissue in people with diabetic neuropathy. Both neuropathic and non-neuropathic factors may be attributed to this outcome. Fat pad function also seems to be compromised, as indicated by an associated increase in peak plantar pressures. This may increase risk for foot ulceration.
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Affiliation(s)
- Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Erik M Akkerman
- Amsterdam UMC, University of Amsterdam, Department of Radiology, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Mario Maas
- Amsterdam UMC, University of Amsterdam, Department of Radiology, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Ahn GY, Koo BS, Joo KB, Kim TH, Lee S. Use of Quantitative Vertebral Bone Marrow Fat Fraction to Assess Disease Activity and Chronicity in Patients with Ankylosing Spondylitis. Korean J Radiol 2021; 22:1671-1679. [PMID: 34402239 PMCID: PMC8484149 DOI: 10.3348/kjr.2020.0953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 11/15/2022] Open
Abstract
Objective We quantitatively measured the fat fraction (FF) in the vertebrae of patients with ankylosing spondylitis (AS) using magnetic resonance imaging (MRI) and investigated the role of FF as an indicator of both active inflammation and chronicity. Materials and Methods A total of 52 patients with AS who underwent spinal MRI were retrospectively evaluated. The FF values of the anterosuperior and anteroinferior corners of the bone marrow in the L1-S1 spine were assessed using the modified Dixon technique. AS activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), AS Disease Activity Score (ASDAS), and serum inflammatory marker levels. AS disease chronicity was assessed by AS disease duration and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Univariable and multivariable regression analyses were conducted to investigate the correlation between FF and other clinical characteristics. Results The mean FF ± standard deviation of the total lumbar spine was 43.0% ± 11.3%. At univariable analysis, spinal FF showed significant negative correlation with BASDAI (β = −0.474, p = 0.002) and ASDAS with C-reactive protein (ASDAS-CRP; β = −0.478, p = 0.002) and a significant positive correlation with AS disease duration (β = 0.440, p = 0.001). After adjusting for patient age, sex, and total mSASSS score, spinal FF remained significantly negatively correlated with BASDAI (β = −0.543, p < 0.001), ASDAS-CRP (β = −0.568, p < 0.001), and ASDAS with erythrocyte sedimentation rate (β = −0.533, p = 0.001). Spinal FF was significantly lower in patients with very high disease activity (ASDAS-CRP > 3.5) than in those with only high disease activity (2.1 ≤ ASDAS-CRP ≤ 3.5) (p = 0.010). Conclusion Spinal FF may help assess both AS disease activity and chronicity.
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Affiliation(s)
- Ga Young Ahn
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Bon San Koo
- Division of Rheumatology, Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Kyung Bin Joo
- Departments of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Seunghun Lee
- Departments of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
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Beekman KM, Akkerman EM, Streekstra GJ, Veldhuis‐Vlug AG, Acherman Y, Gerdes VE, den Heijer M, Maas M, Bravenboer N, Bisschop PH. The Effect of Roux-en-Y Gastric Bypass on Bone Marrow Adipose Tissue and Bone Mineral Density in Postmenopausal, Nondiabetic Women. Obesity (Silver Spring) 2021; 29:1120-1127. [PMID: 33951317 PMCID: PMC8359834 DOI: 10.1002/oby.23171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/07/2021] [Accepted: 03/03/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study aimed to determine the effect of bariatric surgery-induced weight loss on bone marrow adipose tissue (BMAT) and bone mineral density (BMD) in postmenopausal, nondiabetic women. METHODS A total of 14 postmenopausal, nondiabetic women with obesity who were scheduled for laparoscopic Roux-en-Y gastric bypass surgery (RYGB) were included in this study. Vertebral bone marrow fat signal fraction was determined by quantitative chemical shift magnetic resonance imaging, and vertebral volumetric BMD (vBMD) was determined by quantitative computed tomography before surgery and 3 and 12 months after surgery. Data were analyzed by linear mixed model. RESULTS Body weight [mean (SD)] decreased after surgery from 108 (13) kg at baseline to 89 (12) kg at 3 months and 74 (11) kg at 12 months (P < 0.001). BMAT decreased after surgery from 51% (8%) at baseline to 50% (8%) at 3 months and 46% (7%) at 12 months (P = 0.004). vBMD decreased after surgery from 101 (26) mg/cm3 at baseline to 94 (28) mg/cm3 at 3 months (P = 0.003) and 94 (28) mg/cm3 at 12 months (P = 0.035). Changes in BMAT and vBMD were not correlated (ρ = -0.10 and P = 0.75). Calcium and vitamin D concentrations did not change after surgery. CONCLUSIONS RYGB decreases both BMAT (after 12 months) and vBMD (both after 3 months and 12 months) in postmenopausal, nondiabetic women. Changes in BMAT and vBMD were not correlated. These findings suggest that BMAT does not contribute to bone loss following RYGB.
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Affiliation(s)
- Kerensa M. Beekman
- Department of Radiology and Nuclear MedicineAmsterdam Movement SciencesAmsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
- Department of EndocrinologyAmsterdam Movement SciencesAmsterdam University Medical CenterVrije University, AmsterdamAmsterdamthe Netherlands
| | - Erik M. Akkerman
- Department of Radiology and Nuclear MedicineAmsterdam Movement SciencesAmsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Geert J. Streekstra
- Department of Radiology and Nuclear MedicineAmsterdam Movement SciencesAmsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
- Department of Biomedical Engineering and PhysicsAmsterdam Movement SciencesAmsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Annegreet G. Veldhuis‐Vlug
- Department of Internal MedicineJan van Goyen Medical Center/Onze Lieve Vrouwe GasthuisAmsterdamthe Netherlands
- Department of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - Yair Acherman
- Department of SurgerySpaarne GasthuisHaarlemthe Netherlands
| | - Victor E. Gerdes
- Department of Vascular MedicineAmsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Martin den Heijer
- Department of EndocrinologyAmsterdam Movement SciencesAmsterdam University Medical CenterVrije University, AmsterdamAmsterdamthe Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear MedicineAmsterdam Movement SciencesAmsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Nathalie Bravenboer
- Department of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Clinical ChemistryResearch Laboratory Bone and Calcium MetabolismAmsterdam Movement SciencesAmsterdam University Medical CenterVrije University, AmsterdamAmsterdamthe Netherlands
| | - Peter H. Bisschop
- Department of EndocrinologyAmsterdam Movement SciencesAmsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
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Van Nieuwenhove S, Van Damme J, Padhani AR, Vandecaveye V, Tombal B, Wuts J, Pasoglou V, Lecouvet FE. Whole-body magnetic resonance imaging for prostate cancer assessment: Current status and future directions. J Magn Reson Imaging 2020; 55:653-680. [PMID: 33382151 DOI: 10.1002/jmri.27485] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
Over the past decade, updated definitions for the different stages of prostate cancer and risk for distant disease, along with the advent of new therapies, have remarkably changed the management of patients. The two expectations from imaging are accurate staging and appropriate assessment of disease response to therapies. Modern, next-generation imaging (NGI) modalities, including whole-body magnetic resonance imaging (WB-MRI) and nuclear medicine (most often prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/computed tomography [CT]) bring added value to these imaging tasks. WB-MRI has proven its superiority over bone scintigraphy (BS) and CT for the detection of distant metastasis, also providing reliable evaluations of disease response to treatment. Comparison of the effectiveness of WB-MRI and molecular nuclear imaging techniques with regard to indications and the definition of their respective/complementary roles in clinical practice is ongoing. This paper illustrates the evolution of WB-MRI imaging protocols, defines the current state-of-the art, and highlights the latest developments and future challenges. The paper presents and discusses WB-MRI indications in the care pathway of men with prostate cancer in specific key situations: response assessment of metastatic disease, "all in one" cancer staging, and oligometastatic disease.
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Affiliation(s)
- Sandy Van Nieuwenhove
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Julien Van Damme
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anwar R Padhani
- Mount Vernon Cancer Centre, Mount Vernon Hospital, London, UK
| | - Vincent Vandecaveye
- Department of Radiology and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joris Wuts
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Vassiliki Pasoglou
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Frederic E Lecouvet
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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Analysis of muscle, hip, and subcutaneous fat in osteoporosis patients with varying degrees of fracture risk using 3T Chemical Shift Encoded MRI. Bone Rep 2020; 12:100259. [PMID: 32322608 PMCID: PMC7163287 DOI: 10.1016/j.bonr.2020.100259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 02/08/2023] Open
Abstract
Osteoporosis (OP) is a major disease that affects 200 million people worldwide. Fatty acid metabolism plays an important role in bone health and plays an important role in bone quality and remodeling. Increased bone marrow fat quantity has been shown to be associated with a decrease in bone mineral density (BMD), which is used to predict fracture risk. Chemical-Shift Encoded magnetic resonance imaging (CSE-MRI) allows noninvasive and quantitative assessment of adipose tissues (AT). The aim of our study was to assess hip or proximal femoral bone marrow adipose tissue (BMAT), thigh muscle (MUS), and subcutaneous adipose tissue (SAT) in 128 OP subjects matched for age, BMD, weight and height with different degrees of fracture risk assessed through the FRAX score (low, moderate and high). Our results showed an increase in BMAT and in MUS in high compared to low fracture risk patients. We also assessed the relationship between fracture risk as assessed by FRAX and AT quantities. Overall, the results of this study suggest that assessment of adipose tissue via 3T CSE-MRI provides insight into the pathophysiology fracture risk by showing differences in the bone marrow and muscle fat content in subjects with similarly osteoporotic BMD as assessed by DXA, but with varying degrees of fracture risk as assessed by FRAX.
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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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Improved contrast for myeloma focal lesions with T2-weighted Dixon images compared to T1-weighted images. Diagn Interv Imaging 2019; 100:513-519. [PMID: 31130374 DOI: 10.1016/j.diii.2019.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/25/2019] [Accepted: 05/04/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was twofold. First, to compare the contrast between spinal multiple myeloma (MM) focal lesions and surrounding bone marrow obtained on T2-weighted Dixon fat-only MR images to that obtained on T1-weighted spin-echo images. Second, to search for correlation between bone marrow fat fraction assessed by T2-weighted Dixon sequence and International Myeloma Working Group myeloma defining events. MATERIALS AND METHODS A total of 39 patients with 112 focal MM lesions were included. There were 25 men and 14 women with a mean age of 68.8±9.8 [SD] years (range: 49-88 years). Contrast between focal MM lesions and surrounding bone marrow was calculated on T1-weighted spin-echo and T2-weighted Dixon (including water-only and fat-only) images. Contrast between focal MM lesions and bone marrow was compared using ANOVA and post-hoc Tukey tests. Correlation between bone marrow fat fraction and myeloma defining events was assessed using Spearman's correlation test. RESULTS MM lesion contrast was greater on T2-weighted Dixon (F (2;93)=35.10) than on T1-weighted images (P<0.0001). Greatest MM lesion contrast was achieved with T2-weighted Dixon fat-only (0.63±0.21 [SD]; range: 0.06-0.91) compared to T2-weighted Dixon water-only (0.45±0.20 [SD]; range: 0.07-0.8) (P=0.0003) and T1-weighted (0.23±0.19 [SD]; range: 0.04-0.87) (P<0.0001) images. There were no significant correlations between myeloma defining events and fat fraction. CONCLUSION T2-weighted Dixon fat-only images provide greater contrast between MM lesions and adjacent bone marrow than T1-weighted images. The usefulness of a T1-weighted sequence associated to a T2-weighted Dixon sequence has to be determined.
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Tate CJ, Mollee PN, Miles KA. Combination bone marrow imaging using positron emission tomography (PET)-MRI in plasma cell dyscrasias: correlation with prognostic laboratory values and clinicopathological diagnosis. BJR Open 2019; 1:20180020. [PMID: 33178915 PMCID: PMC7592407 DOI: 10.1259/bjro.20180020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 02/05/2023] Open
Abstract
Objective This prospective observational study of positron emission tomography (PET)-MRI findings in 16 consecutive newly diagnosed patients with a plasma cell dyscrasia describes and compares MRI-detected myeloma lesions with 18F-fludeoxyglucose PET-avid myeloma lesions, and correlates quantitative imaging findings to a range of biochemical and prognostic parameters. Methods Simultaneously acquired whole body PET and MRI images were evaluated qualitatively for the presence of focal or generalised abnormalities of bone marrow (BM) on either modality. Quantitative analysis comprised mean standardised uptake values (SUVmean) and fractional water content of the BM measured from PET and chemical shift MRI images of the second to fourth lumbar vertebrae. Results Final diagnoses comprised symptomatic myeloma (n = 10), asymptomatic myeloma (n = 4) and monoclonal gammopathy of uncertain significance (n = 2). 8/10 patients with symptomatic myeloma demonstrated BM abnormalities on qualitative assessment of MRI compared to 4/10 on PET. BM SUVmean inversely correlated with serum albumin (r = 0.57, p = 0.017). BM water fraction correlated with trephine cellularity and blood platelet count (r = 0.78, p = 0.00039 and r = 0.61, p = 0.0013 respectively). BM water fraction correlated with SUVmean in patients with low plasma cell burden (r = 0.91, p = 0.0015) but not in patients with high plasma cell burden (r = 0.18, p = 0.61). Conclusion PET-MRI shows promise in both morphological and functional multiparametric quantitative assessment of myeloma. Advances in knowledge For the first time, multiparametric imaging in myeloma has been shown to predict BM abnormalities and correlate with known biochemical prognostic markers, moving PET-MRI beyond simple diagnostic applications into potential prognostic and treatment selection applications.
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Affiliation(s)
- Courtney J Tate
- Princess Alexandra Hospital, Royal Brisbane and Women's Hospital, University of Queensland, QLD, Australia
| | - Peter N Mollee
- Institute of Nuclear Medicine, University College London, QLD, Australia
| | - Kenneth A Miles
- Princess Alexandra Hospital, University of Queensland, QLD, Australia
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12
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Zimran A, Dinur T, Revel-Vilk S, Akkerman EM, van Dussen L, Hollak CEM, Maayan H, Altarescu G, Chertkoff R, Maas M. Improvement in bone marrow infiltration in patients with type I Gaucher disease treated with taliglucerase alfa. J Inherit Metab Dis 2018; 41:1259-1265. [PMID: 30066229 PMCID: PMC6326976 DOI: 10.1007/s10545-018-0195-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
Abstract
Preliminary data suggest a positive effect of taliglucerase alfa on the bone marrow infiltration of Gaucher cells. In this investigator-initiated study, we report the impact of taliglucerase alfa on the bone marrow fat fraction (FF) in 26 patients assessed by quantitative chemical shift imaging (QCSI). Of 15 treatment-naïve patients (median age 48 [range 24-68] years), eight had baseline FF ≤ 0.3, six of those with a FF ≤ 0.23 ('bone at risk'). All significantly improved from a median baseline FF of 0.24 (0.15-0.32) to 1st year FF of 0.37 (0.25-0.54) and 2nd year FF of 0.42 (0.27-0.59) (p = 0.01). Among the 11 'switch-over' patients (median age 42 [range 33-69] years; median imiglucerase exposure 8 [range 1-17] years), eight had baseline FF ≤ 0.3, five of those with FF < 0.23. All, but one, significantly improved from a median baseline FF of 0.17 (0.08-0.28) to 1st year FF of 0.3 (0.05-0.34) and 2nd year FF of 0.34 (0.08-0.44) (p = 0.03). Two elderly female patients (age 43 and 58 years, with 17 years imiglucerase exposure) who remained at the same enzyme replacement therapy dose, increased from baseline FF of 0.13 and 0.19 to 0.26 at 1 year. Although the number of observations is small, we hypothesize that switching to taliglucerase may result in an improved bone marrow response. A larger study is needed to assess the early benefit of taliglucerase alfa in adult patients with type 1 Gaucher disease on the bone marrow compartment.
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Affiliation(s)
- Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with Hebrew-University Medical School, Jerusalem, Israel
| | - Tama Dinur
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with Hebrew-University Medical School, Jerusalem, Israel
| | - Shoshana Revel-Vilk
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with Hebrew-University Medical School, Jerusalem, Israel.
| | | | | | | | - Hannah Maayan
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with Hebrew-University Medical School, Jerusalem, Israel
| | | | | | - Mario Maas
- Academic Medical Centre, Amsterdam, Netherlands
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13
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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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Latifoltojar A, Hall-Craggs M, Bainbridge A, Rabin N, Popat R, Rismani A, D'Sa S, Dikaios N, Sokolska M, Antonelli M, Ourselin S, Yong K, Taylor SA, Halligan S, Punwani S. Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction. Eur Radiol 2017; 27:5325-5336. [PMID: 28656463 PMCID: PMC5674123 DOI: 10.1007/s00330-017-4907-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/13/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate whole-body MRI (WB-MRI) parameters significantly associated with treatment response in multiple myeloma (MM). METHODS Twenty-one MM patients underwent WB-MRI at diagnosis and after two cycles of chemotherapy. Scans acquired at 3.0 T included T2, diffusion-weighted-imaging (DWI) and mDixon pre- and post-contrast. Twenty focal lesions (FLs) matched on DWI and post-contrast mDixon were selected for each time point. Estimated tumour volume (eTV), apparent diffusion coefficient (ADC), enhancement ratio (ER) and signal fat fraction (sFF) were derived. Clinical treatment response to chemotherapy was assessed using conventional criteria. Significance of temporal parameter change was assessed by the paired t test and receiver operating characteristics/area under the curve (AUC) analysis was performed. Parameter repeatability was assessed by interclass correlation (ICC) and Bland-Altman analysis of 10 healthy volunteers scanned at two time points. RESULTS Fifteen of 21 patients responded to treatment. Of 254 FLs analysed, sFF (p < 0.0001) and ADC (p = 0.001) significantly increased in responders but not non-responders. eTV significantly decreased in 19/21 cases. Focal lesion sFF was the best discriminator of treatment response (AUC 1.0). Bone sFF repeatability was excellent (ICC 0.98) and better than bone ADC (ICC 0.47). CONCLUSION WB-MRI derived focal lesion sFF shows promise as an imaging biomarker of treatment response in newly diagnosed MM. KEY POINTS • Bone signal fat fraction using mDixon is a robust quantifiable parameter • Fat fraction and ADC significantly increase in myeloma lesions responding to treatment • Bone lesion fat fraction is the best discriminator of myeloma treatment response.
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Affiliation(s)
- Arash Latifoltojar
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Margaret Hall-Craggs
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospital, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospital, London, UK
| | - Ali Rismani
- Department of Haematology, University College London Hospital, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
| | - Nikolaos Dikaios
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Magdalena Sokolska
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Michela Antonelli
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospital, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE.
- Department of Radiology, University College London Hospital, London, UK.
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15
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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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16
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Matcuk GR, Siddiqi I, Cen S, Hagiya A, Isaacson R, Brynes R. Bone marrow cellularity MRI calculation and correlation with bone marrow biopsy. Clin Imaging 2016; 40:392-7. [DOI: 10.1016/j.clinimag.2015.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/15/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
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17
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Luker GD, Nguyen HM, Hoff BA, Galbán CJ, Hernando D, Chenevert TL, Talpaz M, Ross BD. A Pilot Study of Quantitative MRI Parametric Response Mapping of Bone Marrow Fat for Treatment Assessment in Myelofibrosis. ACTA ACUST UNITED AC 2016; 2:67-78. [PMID: 27213182 PMCID: PMC4872873 DOI: 10.18383/j.tom.2016.00115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Myelofibrosis (MF) is a hematologic neoplasm arising as a primary disease or secondary to other myeloproliferative neoplasms (MPNs). Both primary and secondary MF are uniquely associated with progressive bone marrow fibrosis, displacing normal hematopoietic cells from the marrow space and disrupting normal production of mature blood cells. Activation of the JAK2 signaling pathway in hematopoietic stem cells commonly causes MF, and ruxolitinib, a drug targeting this pathway, is the treatment of choice for many patients. However, current measures of disease status in MF do not necessarily predict response to treatment with ruxolitinib or other drugs in MF. Bone marrow biopsies are invasive and prone to sampling error, while measurements of spleen volume only indirectly reflect bone marrow status. Toward the goal of developing an imaging biomarker for treatment response in MF, we present preliminary results from a prospective clinical study evaluating parametric response mapping (PRM) of quantitative Dixon MRI bone marrow fat fraction maps in four MF patients treated with ruxolitinib. PRM allows for the voxel-wise identification of significant change in quantitative imaging readouts over time, in this case the bone marrow fat content. We identified heterogeneous response patterns of bone marrow fat among patients and within different bone marrow sites in the same patient. We also observed discordance between changes in bone marrow fat fraction and reductions in spleen volume, the standard imaging metric for treatment efficacy. This study provides initial support for PRM analysis of quantitative MRI of bone marrow fat to monitor response to therapy in MF, setting the stage for larger studies to further develop and validate this method as a complementary imaging biomarker for this disease.
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Affiliation(s)
- Gary D Luker
- Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Huong Marie Nguyen
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A Hoff
- Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Craig J Galbán
- Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas L Chenevert
- Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Moshe Talpaz
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian D Ross
- Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Biological Chemistry, University of Michigan, Ann Arbor, MI, USA
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18
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Limonard EJ, Veldhuis-Vlug AG, van Dussen L, Runge JH, Tanck MW, Endert E, Heijboer AC, Fliers E, Hollak CE, Akkerman EM, Bisschop PH. Short-Term Effect of Estrogen on Human Bone Marrow Fat. J Bone Miner Res 2015; 30:2058-66. [PMID: 25982922 DOI: 10.1002/jbmr.2557] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/30/2015] [Accepted: 05/09/2015] [Indexed: 12/13/2022]
Abstract
Bone marrow fat, an unique component of the bone marrow cavity increases with aging and menopause and is inversely related to bone mass. Sex steroids may be involved in the regulation of bone marrow fat, because men have higher bone marrow fat than women and clinical observations have suggested that the variation in bone marrow fat fraction is greater in premenopausal compared to postmenopausal women and men. We hypothesized that the menstrual cycle and/or estrogen affects the bone marrow fat fraction. First, we measured vertebral bone marrow fat fraction with Dixon Quantitative Chemical Shift MRI (QCSI) twice a week during 1 month in 10 regularly ovulating women. The vertebral bone marrow fat fraction increased 0.02 (95% CI, 0.00 to 0.03) during the follicular phase (p = 0.033), and showed a nonsignificant decrease of 0.02 (95% CI, -0.01 to 0.04) during the luteal phase (p = 0.091). To determine the effect of estrogen on bone marrow fat, we measured vertebral bone marrow fat fraction every week for 6 consecutive weeks in 6 postmenopausal women before, during, and after 2 weeks of oral 17-β estradiol treatment (2 mg/day). Bone marrow fat fraction decreased by 0.05 (95% CI, 0.01 to 0.09) from 0.48 (95% CI, 0.42 to 0.53) to 0.43 (95% CI, 0.34 to 0.51) during 17-β estradiol administration (p < 0.001) and increased again after cessation. During 17-β estradiol administration the bone formation marker procollagen type I N propeptide (P1NP) increased (p = 0.034) and the bone resorption marker C-terminal crosslinking telopeptides of collagen type I (CTx) decreased (p < 0.001). In conclusion, we described the variation in vertebral bone marrow fat fraction among ovulating premenopausal women. And among postmenopausal women, we demonstrated that 17-β estradiol rapidly reduces the marrow fat fraction, suggesting that 17-β estradiol regulates bone marrow fat independent of bone mass.
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Affiliation(s)
- Eelkje J Limonard
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annegreet G Veldhuis-Vlug
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura van Dussen
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jurgen H Runge
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael W Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik Endert
- Department of Clinical Chemistry, Laboratory of Endocrinology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke C Heijboer
- VU University Medical Center, Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam, the Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Carla E Hollak
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik M Akkerman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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van Dussen L, Akkerman EM, Hollak CEM, Nederveen AJ, Maas M. Evaluation of an imaging biomarker, Dixon quantitative chemical shift imaging, in Gaucher disease: lessons learned. J Inherit Metab Dis 2014; 37:1003-11. [PMID: 24924293 DOI: 10.1007/s10545-014-9726-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/09/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
Gaucher disease (GD) is the first lysosomal storage disorder for which specific therapy became available. The infiltration of bone marrow by storage cells plays an important part in the pathophysiology of skeletal complications and can be quantified by measurements of bone marrow fat fraction (Ff). Ff measurements by Dixon quantitative chemical shift imaging (QCSI) are standard for the follow-up care of GD patients at the Academic Medical Center. Several criteria should be met in order for these measurements to qualify as an imaging biomarker. These include: 1) The presence of the imaging biomarker is closely coupled or linked to the presence of the target disease or condition; 2) The detection and/or quantitative measurement of the biomarker is accurate, reproducible, and feasible over time, and; 3) The changes measured over time in the imaging biomarker are closely coupled, or linked, to the success or failure of the therapeutic effect and the true end point for the medical therapy being evaluated. This review assesses the use of Ff measurements by QCSI as a biomarker for GD in light of these criteria. In addition potential pitfalls are discussed including: degenerative disc disease; vertebral collapse and infection; haematological malignancies; focal fatty deposits; age; menopause; phase and repositioning errors, and; fat surrounding the basivertebral vein.QCSI measurements of Ff can be used as an imaging biomarker for GD taking these pitfalls into account. It is one of the first biomarkers, in particular imaging biomarkers, for GD that has been systematically evaluated and could be a valuable tool in clinical trials comparing different treatments or dosing regimens.
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Affiliation(s)
- L van Dussen
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands,
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Simpson WL, Hermann G, Balwani M. Imaging of Gaucher disease. World J Radiol 2014; 6:657-668. [PMID: 25276309 PMCID: PMC4176783 DOI: 10.4329/wjr.v6.i9.657] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/09/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
Gaucher disease is the prototypical lysosomal storage disease. It results from the accumulation of undegraded glucosylceramide in the reticuloendothelial system of the bone marrow, spleen and liver due to deficiency of the enzyme glucocerebrosidase. This leads to hematologic, visceral and skeletal maifestions. Build up of glucosylceramide in the liver and spleen results in hepatosplenomegaly. The normal bone marrow is replaced by the accumulating substrate leading to many of the hematologic signs including anemia. The visceral and skeletal manifestations can be visualized with various imaging modalities including radiography, computed tomography, magnetic resonance imaging (MRI) and radionuclide scanning. Prior to the development of enzyme replacement therapy, treatment was only supportive. However, once intravenous enzyme replacement therapy became available in the 1990s it quickly became the standard of care. Enzyme replacement therapy leads to improvement in all manifestations. The visceral and hematologic manifestations respond more quickly usually within a few months or years. The skeletal manifestations take much longer, usually several years, to show improvement. In recent years newer treatment strategies, such as substrate reduction therapy, have been under investigation. Imaging plays a key role in both initial diagnosis and routine monitoring of patient on treatment particularly volumetric MRI of the liver and spleen and MRI of the femora for evaluating bone marrow disease burden.
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Taliglucerase alfa leads to favorable bone marrow responses in patients with type I Gaucher disease. Blood Cells Mol Dis 2013. [DOI: 10.1016/j.bcmd.2012.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hemke R, Maas M. Diseases of the Reticuloendothelial System. MAGNETIC RESONANCE IMAGING OF THE BONE MARROW 2013:177-192. [DOI: 10.1007/174_2012_717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Correlation of MRI-Based bone marrow burden score with genotype and spleen status in Gaucher's disease. AJR Am J Roentgenol 2008; 191:115-23. [PMID: 18562733 DOI: 10.2214/ajr.07.3550] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to correlate skeletal pathologic findings quantified by MRI-based bone marrow burden score with genotype and spleen status and other clinical parameters, including liver size and duration of enzyme replacement therapy, in patients with Gaucher's disease. MATERIALS AND METHODS Two radiologists retrospectively reviewed MR images of 47 patients with Gaucher's disease and determined bone marrow burden scores by consensus on the basis of previously published criteria. The bone marrow burden scores were correlated with genotype, liver volume, spleen status, age, and cumulative duration of enzyme replacement therapy. RESULTS Subjects with compound heterozygous N370S alleles had significantly higher overall, lumbar spinal, and femoral bone marrow burden scores than did N370S homozygotes. There was a significant positive correlation between an enlarged or surgically absent spleen and bone marrow burden score. There were no significant associations between bone marrow burden score and liver volume, age, cumulative duration of enzyme replacement therapy, or cumulative duration of untreated disease. Femoral and lumbar spinal bone marrow burden scores had a weak but significant positive correlation across all patients. CONCLUSION Skeletal pathologic findings in Gaucher's disease encapsulated as bone marrow burden score correlate significantly with the number of copies of the N370S allele, which has an ameliorative effect on bone marrow disease. Splenectomy or splenomegaly is associated with greater risk of bone marrow disease. Femoral and lumbar spinal bone marrow burden scores, although only weakly correlated, independently illustrated both the protective role of the N370S allele and the unfavourable implication of splenectomy. This finding suggests that axial and appendicular bone marrow burdens are related but distinct and justifies multiple-compartment evaluation in Gaucher's disease.
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van Breemen MJ, de Fost M, Voerman JSA, Laman JD, Boot RG, Maas M, Hollak CEM, Aerts JM, Rezaee F. Increased plasma macrophage inflammatory protein (MIP)-1α and MIP-1β levels in type 1 Gaucher disease. Biochim Biophys Acta Mol Basis Dis 2007; 1772:788-96. [PMID: 17499484 DOI: 10.1016/j.bbadis.2007.04.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 04/03/2007] [Accepted: 04/03/2007] [Indexed: 11/25/2022]
Abstract
Pancytopenia, hepatosplenomegaly and skeletal complications are hallmarks of Gaucher disease. Monitoring of the outcome of therapy on skeletal status of Gaucher patients is problematic since currently available imaging techniques are expensive and not widely accessible. The availability of a blood test that relates to skeletal manifestations would be very valuable. We here report that macrophage inflammatory protein (MIP)-1alpha and MIP-1beta, both implicated in skeletal complications in multiple myeloma (MM), are significantly elevated in plasma of Gaucher patients. Plasma MIP-1alpha of patients (median 78 pg/ml, range 21-550 pg/ml, n=48) is elevated (normal median 9 pg/ml, range 0-208 pg/ml, n=39). Plasma MIP-1beta of patients (median 201 pg/ml, range 59-647 pg/ml, n=49) is even more pronouncedly increased (normal median 17 pg/ml, range 1-41 pg/ml, n=39; one outlier: 122 pg/ml). The increase in plasma MIP-1beta levels of Gaucher patients is associated with skeletal disease. The plasma levels of both chemokines decrease upon effective therapy. Lack of reduction of plasma MIP-1beta below 85 pg/ml during 5 years of therapy was observed in patients with ongoing skeletal disease. In conclusion, MIP-1alpha and MIP-1beta are elevated in plasma of Gaucher patients and remaining high levels of MIP-1beta during therapy seem associated with ongoing skeletal disease.
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Affiliation(s)
- Mariëlle J van Breemen
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
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Elstein D, Hollak C, Aerts JMFG, van Weely S, Maas M, Cox TM, Lachmann RH, Hrebicek M, Platt FM, Butters TD, Dwek RA, Zimran A. Sustained therapeutic effects of oral miglustat (Zavesca, N-butyldeoxynojirimycin, OGT 918) in type I Gaucher disease. J Inherit Metab Dis 2004; 27:757-66. [PMID: 15505381 DOI: 10.1023/b:boli.0000045756.54006.17] [Citation(s) in RCA: 196] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
It has been shown that treatment with miglustat (Zavesca, N-butyldeoxynojirimycin, OGT 918) improves key clinical features of type I Gaucher disease after 1 year of treatment. This study reports longer-term efficacy and safety data. Patients who had completed 12 months of treatment with open-label miglustat (100-300 mg three times daily) were enrolled to continue with therapy in an extension study. Data are presented up to month 36. Liver and spleen volumes measured by CT or MRI were scheduled every 6 months. Biochemical and haematological parameters, including chitotriosidase activity (a sensitive marker of Gaucher disease activity) were monitored every 3 months. Safety data were also collected every 3 months. Eighteen of 22 eligible patients at four centres entered the extension phase and 14 of these completed 36 months of treatment with miglustat. After 36 months, there were statistically significant improvements in all major efficacy endpoints. Liver and spleen organ volumes were reduced by 18% and 30%, respectively. In patients whose haemoglobin value had been below 11.5 g/dl at baseline, mean haemoglobin increased progressively from baseline by 0.55 g/dl at month 12 (NS), 1.28 g/dl at month 24 (p =0.007), and 1.30 g/dl at month 36 (p =0.013). The mean platelet count at month 36 increased from baseline by 22 x 10(9)/L. No new cases of peripheral neuropathy occurred since previously reported. Diarrhoea and weight loss, which were frequently reported during the initial 12-month study, decreased in magnitude and prevalence during the second and third years. Patients treated with miglustat for 3 years show significant improvements in organ volumes and haematological parameters. In conclusion, miglustat was increasingly effective over time and showed acceptable tolerability in patients who continued with treatment for 3 years.
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Affiliation(s)
- D Elstein
- Shaare Zedek Medical Centre, Jerusalem, Israel
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Maas M, van Kuijk C, Stoker J, Hollak CEM, Akkerman EM, Aerts JFMG, den Heeten GJ. Quantification of bone involvement in Gaucher disease: MR imaging bone marrow burden score as an alternative to Dixon quantitative chemical shift MR imaging--initial experience. Radiology 2003; 229:554-61. [PMID: 14526090 DOI: 10.1148/radiol.2292020296] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To develop a semiquantitative magnetic resonance (MR) imaging bone marrow burden (BMB) score with inclusion of both axial and peripheral bone marrow in Gaucher disease as an alternative to MR imaging with the Dixon quantitative chemical shift imaging (QCSI) technique. MATERIALS AND METHODS Two experienced musculoskeletal radiologists with no experience in evaluating Gaucher disease blindly analyzed MR images of lumbar spines and femora. Interobserver and intraobserver variability were tested. In addition, the BMB score was determined as a parameter to evaluate bone marrow response to enzyme supplementation therapy. Finally, the BMB score was compared with fat fraction measurements obtained with Dixon QCSI. Differences between groups were analyzed by using the nonparametric Mann-Whitney test. A P value of less than.05 was considered to represent significance. Correlation was calculated by using two-tailed nonparametric rank correlation (Spearman rho). RESULTS In 30 patients (mean age, 39.3 years; age range, 12-71 years) the mean fat fraction was 0.20 (range, 0.08-0.40). The BMB score range was 3-13 points. A significant correlation was found between the two observers when using BMB (rho = 0.91, P <.001). The intraobserver variation showed a significant correlation (rho = 0.99, P <.001). There was a significant correlation between BMB and QCSI (rho = -0.78, P <.001). Although BMB was less sensitive than Dixon QCSI, it showed enough sensitivity to allow detection of bone marrow response to enzyme supplementation therapy. CONCLUSION BMB is a reproducible semiquantitative scoring system that is easy to use. It combines MR imaging of both axial and peripheral bone marrow and shows a significant correlation with QCSI.
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Affiliation(s)
- Mario Maas
- Department of Radiology, Academic Medical Center, Meibergdreef 9, Suite G1-231, 1105 AZ Amsterdam, the Netherlands.
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Maas M, Poll LW, Terk MR. Imaging and quantifying skeletal involvement in Gaucher disease. Br J Radiol 2002; 75 Suppl 1:A13-24. [PMID: 12036829 DOI: 10.1259/bjr.75.suppl_1.750013] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radiological imaging is used in patients with Gaucher disease to estimate the disease burden, to evaluate the presence of specific skeletal complications and to track response to therapy. MRI is currently the best technique for assessing bone marrow involvement in Gaucher disease. Gaucher cell infiltrated bone marrow is characterized by an abnormal low signal intensity on conventional T1- and T2-weighted spin echo sequences, owing to a reduction in fat marrow, which gives a high signal intensity. Enzyme replacement therapy results in a degradation of Gaucher cell deposits with a reconversion of marrow fat and consequently an increased signal on T(1)-weighted images. Conventional MRI also detects other skeletal complications in Gaucher disease, including oedema resulting from acute bone infarction, infection and trauma, avascular necrosis, pathological fractures and vertebral compression. The main drawback of conventional MRI is that it is not quantitative. Quantitative chemical shift imaging is the most sensitive quantitative method for evaluating bone marrow but is not widely available. Alternative MRI-based methods include calculation of the T1 relaxation constant and proton spectroscopy. Scoring of imaging changes detected on conventional MRI may be useful in estimating disease burden and risk of complications. Dual-energy X-ray absorptiometry (DXA) is sensitive to generalized osteopenia and changes in bone mineral density with extended enzyme replacement therapy. However, DXA is insensitive to local changes and cannot yet be used to predict fracture risk in these patients. Until the ideal quantitative technique is developed, conventional MRI will remain the best diagnostic modality for assessing skeletal complications in Gaucher disease and monitoring response to enzyme replacement therapy.
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Affiliation(s)
- M Maas
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
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Poll LW, Maas M, Terk MR, Roca-Espiau M, Bembi B, Ciana G, Weinreb NJ. Response of Gaucher bone disease to enzyme replacement therapy. Br J Radiol 2002; 75 Suppl 1:A25-36. [PMID: 12036830 DOI: 10.1259/bjr.75.suppl_1.750025] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In Gaucher disease, enzyme replacement therapy usually reduces liver and spleen volumes and improves haematological abnormalities within 1 year. In contrast, skeletal manifestations of Gaucher disease are thought to respond more slowly. For example, decreased bone marrow glycolipid infiltration and increased bone mineral density have been reported to take up to 3-4 years of treatment. In this report, we present recent studies using T1- and T2-weighted MRI and quantitative chemical shift imaging that demonstrate decreases in abnormal glucocerebroside infiltration and increases in normal fat content of bone marrow within the first year of treatment. There was no obvious relationship between age, gender, splenectomy status or genotype and the response of bone marrow to therapy. Although the dose of enzyme replacement therapy may be related to bone marrow response, no significant relationship was demonstrated in this report. Long-term enzyme replacement therapy induces continued degradation of Gaucher cell deposits, reconversion of fat marrow and increased bone mineral density. This treatment is also associated with improved or non-progressive bone symptoms and functional status in most adult patients, and it prevents the new occurrence of bone pain and bone crisis in nearly all patients. The development of more sensitive, quantitative imaging methods will help to evaluate disease severity better and to assess the response to therapy.
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Affiliation(s)
- L W Poll
- Institute of Diagnostic Radiology, Heinrich Heine University, Düsseldorf, Germany.
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Maas M, Hollak CEM, Akkerman EM, Aerts JMFG, Stoker J, Den Heeten GJ. Quantification of skeletal involvement in adults with type I Gaucher's disease: fat fraction measured by Dixon quantitative chemical shift imaging as a valid parameter. AJR Am J Roentgenol 2002; 179:961-5. [PMID: 12239046 DOI: 10.2214/ajr.179.4.1790961] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The objective of our study was to determine the merit of the fat fraction of axial bone marrow measured by Dixon quantitative chemical shift imaging (Dixon QCSI) as a clinical parameter to quantitatively assess the extent of skeletal involvement in type 1 Gaucher's disease. MATERIALS AND METHODS Dixon QCSI was performed in 30 adult patients (age range, 18-69 years; mean, 39 years) with type 1 Gaucher's disease who were untreated. The relationship between the mean value of the fat fraction in vertebrae L3, L4, and L5 and the presence, absence, and severity of clinical bone complications (chronic bone pain, bone crisis, fracture, avascular necrosis, and joint replacement) as well as the conventional MR imaging of bone marrow involvement were studied. Also the relationship of fat fraction to sex, age, and other disease parameters (history of splenectomy, liver and spleen volume, plasma chitotriosidase, hemoglobin level, and platelet count) was evaluated. Our results were compared with the fat fraction of healthy volunteers. RESULTS The fat fraction measured in patients with Gaucher's disease ranged from 0.08 to 0.40 (mean, 0.20). Bone complications occurred primarily in patients with a fat fraction of less than 0.23. Univariate logistic regression analysis indicated that for every decrease of 0.1 of the fat fraction, the risk of bone complications increased 85% (p < 0.05). The fat fraction was correlated with liver size, but no correlation with other disease parameters was found. In the patient population, the fat fraction was significantly lower than in the healthy population (range, 0.27-0.55; mean, 0.37; p < 0.001). CONCLUSION The fat fraction of the lumbar spine when measured with Dixon QCSI is associated with the occurrence of bone complications. It may, therefore, be a clinically useful parameter.
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Affiliation(s)
- Mario Maas
- Department of Radiology, Academic Medical Center, Meibergdreef 9, G1-231, 1105 AZ Amsterdam, The Netherlands
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30
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Vlieger EJP, Maas M, Akkerman EM, Hollak CEM, Den Heeten GJ. Vertebra disc ratio as a parameter for bone marrow involvement and its application in Gaucher disease. J Comput Assist Tomogr 2002; 26:843-8. [PMID: 12439326 DOI: 10.1097/00004728-200209000-00031] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish the vertebra disc ratio (VDR), the ratio of the average T1-weighted gray value of disc L3 and intervertebral disc L3/L4, as a parameter for bone marrow involvement. To explore its value as alternative for bone marrow fat fraction measured with Dixon Quantitative Chemical Shift Imaging (Ff) in Gaucher disease (GD). METHODS Age dependency and normal value for the VDR were determined in 46 controls. The VDR in untreated GD (n = 22) and long-treated GD (7.5 years; n = 19) were compared with it. The changes in VDR in treated (n = 33) and untreated (n = 8) GD were calculated. The correlation between VDR and Ff was determined. RESULTS Age dependency was small. The normal VDR was 1.90 +/- 0.30, both untreated GD (1.29 +/- 0.31) and long-treated GD (1.70 +/- 0.33) differed significantly from normal. Changes in treated GD were significant in the first four treatment years, in untreated GD they were not. The correlation with Ff was 0.86. CONCLUSIONS The VDR is a useful parameter for evaluation of bone marrow of patients with GD. The VDR correlates very well with Ff, so applicability is expected in diseases in which Ff has proven to be useful.
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Affiliation(s)
- Erik-Jan P Vlieger
- Department of Radiology, Academic Medical Center, Meibergdreef 9, G1-209, 1105 AZ Amsterdam, The Netherlands.
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Hollak C, Maas M, Akkerman E, den Heeten A, Aerts H. Dixon quantitative chemical shift imaging is a sensitive tool for the evaluation of bone marrow responses to individualized doses of enzyme supplementation therapy in type 1 Gaucher disease. Blood Cells Mol Dis 2001; 27:1005-12. [PMID: 11831867 DOI: 10.1006/bcmd.2001.0474] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Type 1 Gaucher disease can be effectively treated with enzyme supplementation therapy. Bone disease is a debilitating feature of the disorder and results from infiltration of the bone marrow by Gaucher cells. The effect of treatment on bone marrow infiltration is difficult to measure, necessitating the development of sensitive techniques to allow adequate dosing. Dixon quantitative chemical shift imaging (Dixon-QCSI) is a MRI technique to measure displacement of fatty marrow by Gaucher cells. Low bone marrow fat fractions have been found in Gaucher disease. We studied the effect of individualized low doses of enzyme therapy on the fat fractions of the lumbar spine in 12 adult Gaucher disease patients before and during treatment and in 9 untreated Gaucher controls. Fat fractions were decreased in 9/12 patients (median 0.20, range 0.08-0.40) and equally low in the untreated Gaucher controls compared to age-matched healthy volunteers (normal values 0.27-0.43, P < 0.01). During treatment, fat fractions increased significantly already after 1 year in 11/12 patients (P = 0.007). After 4 to 5 years, fat fractions normalized in 11/12 patients. Fat fractions remained low in the untreated Gaucher controls (P = 0.5 and 0.6 at 1 and 2 years, respectively). Six of 11 patients had a dose increase, which did not clearly affect fat fractions. Dixon-QCSI is a sensitive tool for the measurement of the response of bone marrow to enzyme therapy.
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Affiliation(s)
- C Hollak
- Department of Hematology, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
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