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Chen S, Guo L, Zhao H, Wan X, Zang J. Quantitative measurements of dual-energy CT parameters in the diagnosis of osteoporosis - a highly sensitive and specific technique: An observational study. Medicine (Baltimore) 2024; 103:e38559. [PMID: 38968500 PMCID: PMC11224864 DOI: 10.1097/md.0000000000038559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/22/2024] [Indexed: 07/07/2024] Open
Abstract
With the aging of the population in our society, osteoporosis (OP) has become one of the chronic diseases that seriously threaten the physical health of the elderly, leading to a heavy burden on healthcare. In recent years, with the continuous development of dual-energy CT (DECT) technology, quantitative measurements of DECT parameters, which is highly sensitive to OP, provides accurate results, is convenient and cost-effective, and is expected to be widely used in bone density testing. This study was aimed to explore the value of quantitative measurements of DECT parameters in diagnosing OP, in order to better guide clinical judgments and treatment. A total of 187 patients who underwent dual-energy X-ray and DECT examinations at Tianjin hospital between January 2022 and June 2023 were included as participants in this study. The bone mineral density (BMD) values of the lumbar spine (L1-L4) were determined using dual-energy X-ray absorptiometry. Simultaneously, CT scans of the lumbar spine (L1-L4) were conducted to measure the CT values of contrast media (CM), mixed-energy image CT values (regular CT value [rCT]), calcium concentration (CaD), as well as fat fraction (FF). Pearson correlation analysis was used to examine the relationship between the quantitative measurements of L1 to L4 vertebral bodies obtained from DECT and BMD. The values of CM, rCT, and CaD in the OP group were all lower than those in the non-OP group with statistical significance (P < .001). Conversely, the fat fraction parameter value in the OP group was significantly higher in contrast with the non-OP group (P = .004); there was a positive correlation between CM, rCT, CaD, and BMD values (R = 0.579, P < .001; R = 0.604, P < .001; R = 0.563, P < .001); CM, rCT, and CaD had high diagnostic value for OP, as evidenced by AUCs of 0.935 (95% CI: 0.900-0.971), 0.956 (95% CI: 0.925-0.987), and 0.926 (95% CI: 0.858-0.954), respectively, all with P values < .001. Quantitative measurement of DECT parameters showed a high sensitivity as well as a high specificity in the diagnosis of OP. It is also highly feasible and holds significant clinical diagnostic value, making it a suitable candidate for widespread application.
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Affiliation(s)
- Si Chen
- Radiology Department, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lin Guo
- Radiology Department, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Hui Zhao
- Radiology Department, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xin Wan
- Ultrasonic Department, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jiacheng Zang
- Department of Hip, Tianjin Hospital, Tianjin University, Tianjin, China
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Yang Y, Hou J, Niu Y, Zhang Y, Luo T, Lu Q, Fu Y, Wang Y, Yu X. Correlation between vertebral bone mineral density and multi-level virtual non-calcium imaging parameters from dual-layer spectral detector computed tomography. Quant Imaging Med Surg 2024; 14:3803-3815. [PMID: 38846313 PMCID: PMC11151250 DOI: 10.21037/qims-23-1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/16/2024] [Indexed: 06/09/2024]
Abstract
Background Virtual non-calcium (VNCa) imaging based on dual-energy computed tomography (CT) plays an increasingly important role in diagnosing spinal diseases. However, the utility of VNCa technology in the measurement of vertebral bone mineral density (BMD) is limited, especially the VNCa CT value at multiple calcium suppression levels and the slope of VNCa curve. This retrospective cross-sectional study aimed to explore the correlation between vertebral BMD and new VNCa parameters from dual-layer spectral detector CT. Methods The dual-layer spectral detector CT and quantitative CT (QCT) data of 4 hydroxyapatite (HAP) inserts and 667 vertebrae of 234 patients (132 male and 102 female) who visited a university teaching hospital between April and May 2023 were retrospectively analyzed. The BMD values of 3 vertebrae (T12, L1, and L2) and inserts were measured using QCT, defined as QCT-BMD. The VNCa CT values and the slope λ of the VNCa attenuation curve of vertebrae and inserts were recorded. The correlations between VNCa parameters (VNCa CT value, slope λ) and QCT-BMD were analyzed. Results For the vertebrae, the correlation coefficient ranged from -0.904 to 0.712 (all P<0.05). As the calcium suppression index (CaSI) increased, the correlation degree exhibited a decrease first and then increased, with the best correlation (r=-0.904, P<0.001) observed at the index of 25%. In contrast, the correlation coefficient for the inserts remained relatively stable (r=-0.899 to -1, all P<0.05). For the vertebrae, the values of 3 slopes λ (λ1, λ2, and λ3) derived from the VNCa attenuation curve were 6.50±1.99, 3.75±1.15, and 2.04±0.62, respectively. Regarding the inserts, the λ1, λ2, and λ3 values were 11.56 [interquartile range (IQR): 2.40-22.62], 6.68 (IQR: 1.39-13.49), and 3.63 (IQR: 0.75-7.8), respectively. For the vertebrae, all 3 correlation coefficients between 3 slopes λ and QCT-BMD were 0.956 (all P<0.05). For the inserts, the 3 correlation coefficients were 0.996, 0.998, and 1 (all P<0.05), respectively. Conclusions A promising correlation was detected between VNCa CT parameters and QCT-BMD in vertebrae, warranting further investigation to explore the possibility of VNCa imaging to assess BMD.
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Affiliation(s)
- Yanhui Yang
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jing Hou
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yue Niu
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yi Zhang
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Tao Luo
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qiang Lu
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yi Fu
- Medical Department, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Xiaoping Yu
- Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Yang Q, Wang Z, Han H, Zhang H, Yu W. Optimal scanning parameters of lumbar bone density measured by fast kilovoltage-switching dual-energy computed tomography (DECT). Quant Imaging Med Surg 2024; 14:4041-4053. [PMID: 38846294 PMCID: PMC11151259 DOI: 10.21037/qims-23-1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/15/2024] [Indexed: 06/09/2024]
Abstract
Background The technological innovation of fast kilovoltage (KV)-switching dual-energy computed tomography (DECT) has enabled the accurate measurement of vertebral bone density; however, it does not account for the effects of abdominal fat and ribs on the vertebral body. In our study, a European spine phantom (ESP) was used to establish an abdominal phantom for normal weight and obese people, and to explore the best scanning parameters for DECT to measure the bone mineral density (BMD) of the human lumbar spine. Methods Revolution CT was used to conduct energy spectrum scanning for each body mode. A total of 20 sets of energy spectrum scans was conducted and each set of conditions was scanned 10 times. The data conformed to a normal distribution, and the differences between the measured and actual values of ESP L1-3 vertebrae were compared using a one-sample t-test, and quantitative data were described byx ¯ ± s . A P value <0.05 was considered statistically significant. Relative error (RE) and root mean square error (RMSE) of BMD measurements were calculated for different scanning conditions in normal and obese populations. Results When simulating the upper abdominal condition (L1-2 level, fat area 140 cm2, with rib influence) in a normal weight population, there was no statistical difference (P>0.05) in BMD measurements for each vertebra at 0.8 s/rotation (rot) with different tube currents, the smallest RE at 0.8 s/rot, 190 mA condition, and the smallest RMSE for L1 and 2 vertebral BMD measurements at 190 mA; when simulating the abdominal condition at the L4 level in a normal weight population (fat area of 240 cm2, no rib influence), there were no statistical differences between the measurements at 0.8 s/rot, 190 and 275 mA conditions (P>0.05), and the RE and RMSE in the 190 mA condition was smaller than that in the 275 mA condition. Simulating the upper abdominal condition in the obese population (L1-2 level, fat area 340 cm2, with rib influence), there were no statistical difference between the measurements in the 0.8 s/rot, 315 and 355 mA conditions (P>0.05), the RE and RMSE in the 315 mA condition was less than those in the 355 mA; simulated obese abdominal condition at the L4 level in the population (fat area 450 cm2, no rib influence) resulted in 0.8 s/rot, no statistical difference in measurements between 315 mA (P>0.05), RE in 315 mA conditions were L1: 3.75%, L2: -1.06%, L3: 0.42%, and the RMSE under 315 mA condition were L1: 2.13, L2: 1.21, L3: 1.66. Conclusions When using Revolution CT to measure lumbar spine bone density, 0.8 s/rot at 190 mA may be the best scanning parameter for a normal weight population, and 0.8 s/rot at 315 mA may be the best scanning parameter for an obese population.
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Affiliation(s)
- Qiushi Yang
- Department of Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Zeguo Wang
- Department of Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Heli Han
- Department of Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Han Zhang
- Department of Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Wanjiang Yu
- Department of Radiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
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Meng Z, Xiong A, Liu M, Guo Y, Zhu X, Luo T, Tian X, Meng X, Li X, Lin X, Wang X, Qin J. Quantitative evaluation of disc degeneration using dual-energy CT: advantages of R-VH, D-VH values and the IVNCa + CT model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2022-2030. [PMID: 38431753 DOI: 10.1007/s00586-024-08176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 12/21/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the correlation between dual-energy CT (DECT) virtual calcium free (VNCA), CT attenuation, the ratio and difference of VNCA to CT attenuation, and Pfirrmann grading of lumbar disc degeneration. METHODS A retrospective analysis on 135 intervertebral discs from 30 patients who underwent DECT and MR. Discs was graded using the Pfirrmann system. ROIs on the sagittal plane assessed HU value, VNCA value, Rho value, Z value, R-VH value, and D-VH value. Correlation, grade differences, and multivariate regression models were assessed. Diagnostic performance and cut-off values were determined using AUC. RESULTS VNCA (r = 0.589, P < 0.001), R-VH (r = 0.622, P < 0.001), and D-VH (r = 0.613, P < 0.001) moderately correlated with Pfirrmann grading. HU (r = 0.388, P < 0.001), Rho (r = 0.142, P = 0.102), and Z (r = -0.125, P = 0.153) showed a weak correlation. R-VH, D-VH, and VNCA had significantly higher correlation than HU. Statistically significant differences were observed in P values of VNCA, HU, R-VH, and D-VH in relative groups (P < 0.05), but not in Rho and Z values (P > 0.05). R-VH and D-VH had significant differences between Pfirrmann grades 1 and 2, and grades 2 and 3 (early stage) (P < 0.05). AUC readings of R-VH and D-VH (≥2, ≥3, ≥4) were higher. The multivariate model IVNCa + CT had the highest AUC. CONCLUSION The new quantitative indices R-VH value and D-VH value of DECT have advantages over VNCA value and HU value in evaluating early-stage disc degeneration (≥2 grades, ≥3 grades). The multivariate model IVNCa + CT has the best AUC values for evaluating disc degeneration at all stages.
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Affiliation(s)
- Zhanao Meng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Anni Xiong
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Mengmeng Liu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Yahao Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xuan Zhu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Tao Luo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiangjie Tian
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiangbo Meng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiaolei Li
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xue Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China
| | - Xiaohong Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China.
| | - Jie Qin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe District, Tianhe Road 600, Guangzhou, 510620, China.
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Reschke P, Gotta J, Stahl A, Koch V, Mader C, Martin SS, Scholtz JE, Booz C, Yel I, Hescheler DA, Gruber-Rouh T, Eichler K, Vogl TJ, Gruenewald LD. Value of Dual-Energy CT-Derived Metrics for the Prediction of Bone Non-union in Distal Radius Fractures. Acad Radiol 2024:S1076-6332(24)00063-1. [PMID: 38461052 DOI: 10.1016/j.acra.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
RATIONALE AND OBJECTIVES Bone non-union is a serious complication of distal radius fractures (DRF) that can result in functional limitations and persistent pain. However, no accepted method has been established to identify patients at risk of developing bone non-union yet. This study aimed to compare various CT-derived metrics for bone mineral density (BMD) assessment to identify predictive values for the development of bone non-union. MATERIALS AND METHODS CT images of 192 patients with DRFs who underwent unenhanced dual-energy CT (DECT) of the distal radius between 03/2016 and 12/2020 were retrospectively identified. Available follow-up imaging and medical health records were evaluated to determine the occurrence of bone non-union. DECT-based BMD, trabecular Hounsfield unit (HU), cortical HU and cortical thickness ratio were measured in normalized non-fractured segments of the distal radius. RESULTS Patients who developed bone non-union were significantly older (median age 72 years vs. 54 years) and had a significantly lower DECT-based BMD (median 68.1 mg/cm3 vs. 94.6 mg/cm3, p < 0.001). Other metrics (cortical thickness ratio, cortical HU, trabecular HU) showed no significant differences. ROC and PR curve analyses confirmed the highest diagnostic accuracy for DECT-based BMD with an area under the curve (AUC) of 0.83 for the ROC curve and an AUC of 0.46 for the PR curve. In logistic regression models, DECT-based BMD was the sole metric significantly associated with bone non-union. CONCLUSION DECT-derived metrics can accurately predict bone non-union in patients who sustained DRF. The diagnostic performance of DECT-based BMD is superior to that of HU-based metrics and cortical thickness ratio.
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Affiliation(s)
- Philipp Reschke
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adrian Stahl
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christoph Mader
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel A Hescheler
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
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Takatsu Y, Ohnishi H, Tateyama T, Miyati T. Usefulness of fat-containing agents: an initial study on estimating fat content for magnetic resonance imaging. Phys Eng Sci Med 2024; 47:339-350. [PMID: 38379016 DOI: 10.1007/s13246-023-01372-y] [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: 04/24/2023] [Accepted: 12/11/2023] [Indexed: 02/22/2024]
Abstract
This initial study aimed at testing whether fat-containing agents can be used for the fat mass estimation methods using magnetic resonance imaging (MRI). As an example for clinical application, fat-containing agents (based on soybean oil, 10% and 20%), 100% soybean oil, and saline as reference substances were placed outside the proximal femurs obtained from 14 participants and analyzed by 0.3 T MRI. Fat content was the estimated fat fraction (FF) based on signal intensity (SIeFF, %). The SIeFF values of the femoral bone marrow, including the femoral head, neck, shaft, and trochanter area, were measured. MRI data were compared in terms of bone mineral content (BMC) and bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) in the proximal femur. Twelve pig femurs were also used to confirm the correlation between FF by the DIXON method and SIeFF. According to Pearson's correlation coefficient, the SIeFF and total BMC and BMD data revealed strong and moderate negative correlations in the femoral head (r < - 0.74) and other sites (r = - 0.66 to - 0.45). FF and SIeFF showed a strong correlation (r = 0.96). This study was an initial investigation of a method for estimating fat mass with fat-containing agents and showed the potential for use in MRI. SIeFF and FF showed a strong correlation, and SIeFF and BMD and BMC showed correlation; however, further studies are needed to use SIeFF as a substitute for DXA.
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Affiliation(s)
- Yasuo Takatsu
- Molecular Imaging, School of Medical Sciences, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Hiroshi Ohnishi
- Department of Radiology, Geisei Ortho Clinic, 1495-1, Wajikikou, Geisei-Mura, Aki-Gun, Kochi, 781-5701, Japan
| | - Tomoko Tateyama
- Department of Intelligent Information Engineering, School of Medical Sciences, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
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Gruenewald LD, Booz C, Gotta J, Reschke P, Martin SS, Mahmoudi S, Bernatz S, Eichler K, D'Angelo T, Chernyak V, Sommer CM, Vogl TJ, Koch V. Incident fractures of the distal radius: Dual-energy CT-derived metrics for opportunistic risk stratification. Eur J Radiol 2024; 171:111283. [PMID: 38183896 DOI: 10.1016/j.ejrad.2023.111283] [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: 10/20/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Dual-energy CT (DECT)-derived bone mineral density (BMD) of the distal radius and other CT-derived metrics related to bone health have been suggested for opportunistic osteoporosis screening and risk evaluation for sustaining distal radius fractures (DRFs). METHODS The distal radius of patients who underwent DECT between 01/2016 and 08/2021 was retrospectively analyzed. Cortical Hounsfield Unit (HU), trabecular HU, cortical thickness, and DECT-based BMD were acquired from a non-fractured, metaphyseal area in all examinations. Receiver-operating characteristic (ROC) analysis was conducted to determine the area under the curve (AUC) values for predicting DRFs based on DECT-derived BMD, HU values, and cortical thickness. Logistic regression models were then employed to assess the associations of these parameters with the occurrence of DRFs. RESULTS In this study, 263 patients (median age: 52 years; interquartile range: 36-64; 132 women; 192 fractures) were included. ROC curve analysis revealed a higher area under the curve (AUC) value for DECT-derived BMD compared to cortical HU, trabecular HU, and cortical thickness (0.91 vs. 0.61, 0.64, and 0.69, respectively; p <.001). Logistic regression models confirmed the association between lower DECT-derived BMD and the occurrence of DRFs (Odds Ratio, 0.83; p <.001); however, no influence was observed for cortical HU, trabecular HU, or cortical thickness. CONCLUSIONS DECT can be used to assess the BMD of the distal radius without dedicated equipment such as calibration phantoms to increase the detection rates of osteoporosis and stratify the individual risk to sustain DRFs. In contrast, assessing HU-based values and cortical thickness does not provide clinical benefit.
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Affiliation(s)
- Leon D Gruenewald
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Christian Booz
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Jennifer Gotta
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Philipp Reschke
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Simon S Martin
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Simon Bernatz
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Katrin Eichler
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Christof M Sommer
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Thomas J Vogl
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - Vitali Koch
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
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Gruenewald LD, Koch V, Yel I, Eichler K, Gruber-Rouh T, Alizadeh LS, Mahmoudi S, D'Angelo T, Wichmann JL, Wesarg S, Vogl TJ, Booz C. Association of Phantomless Dual-Energy CT-based Volumetric Bone Mineral Density with the Prevalence of Acute Insufficiency Fractures of the Spine. Acad Radiol 2023; 30:2110-2117. [PMID: 36577605 DOI: 10.1016/j.acra.2022.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the bone mineral density (BMD) of the lumbar spine derived from dual-energy CT (DECT)-based volumetric material decomposition and its association with acute insufficiency fractures of the thoracolumbar spine. MATERIALS AND METHODS L1 of 160 patients (77 men, 83 women; mean age 64.3 years, range, 22-94 years) who underwent third-generation dual-source DECT between January 2016 and December 2021 due to suspected insufficiency fractures was retrospectively analyzed. All depicted vertebrae were examined for signs of recent fractures. A dedicated DECT postprocessing software using material decomposition was applied for phantomless BMD assessment. Receiver-operating characteristic (ROC) analysis identified optimal BMD thresholds. Associations of BMD, sex, and age with the occurrence of insufficiency fractures were examined with logistic regression models. RESULTS A DECT-derived BMD threshold of 120.40 mg/cm³ yielded 90.1% specificity and 59.32% sensitivity to differentiate patients with at least one insufficiency fracture from patients without fracture. No patient without fracture had a DECT-derived BMD below 85 mg/cm3. Lower DECT-derived bone mineral density was associated with an increased risk of insufficiency fractures (Odds ratio of 0.93, 95% CI, 0.91-0.96, p < 0.001). Overall ROC-derived AUC was 0.82 (p < 0.0001) for the differentiation of patients that sustained an insufficiency fracture from the control group. CONCLUSION Dual-Energy CT-based BMD assessment can accurately differentiate patients with acute insufficiency fractures of the thoracolumbar spine from patients without fracture. This algorithm can be used for phantomless risk stratification of patients undergoing routine CT to sustain insufficiency fractures of the thoracolumbar spine The identified cut-off value of 120.4 mg/cm³ is in line with current American College of Radiology (ACR) recommendations to differentiate healthy individuals from those with reduced bone mineral density.
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Affiliation(s)
- Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Leona S Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, ME, Italy
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | | | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, HE, Germany.
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Liu Z, Huang D, Jiang Y, Ma X, Zhang Y, Chang R. Correlation of R2* with fat fraction and bone mineral density and its role in quantitative assessment of osteoporosis. Eur Radiol 2023; 33:6001-6008. [PMID: 37017704 PMCID: PMC10415514 DOI: 10.1007/s00330-023-09599-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES To investigate the correlation of R2* with vertebral fat fraction (FF) and bone mineral density (BMD), and to explore its role in the quantitative assessment of osteoporosis (OP). METHODS A total of 83 patients with low back pain (59.77 ± 7.46 years, 30 males) were enrolled, which underwent lumbar MRI in IDEAL-IQ sequences and quantitative computed tomography (QCT) scanning within 48h. The FF, R2*, and BMD of all 415 lumbar vertebrae were respectively measured. According to BMD, all vertebrae were divided into BMD normal, osteopenia, and OP groups, and the difference of FF and R2* among groups was analyzed by one-way ANOVA. The correlation between R2*, FF, and BMD was analyzed by Pearson's test. Taking BMD as the gold standard, the efficacies for FF and R2* in diagnosis of OP and osteopenia were assessed by receiver operating characteristic curve, and their area under the curve (AUC) was compared with DeLong's test. RESULTS The FF and R2* were statistically different among groups (F values of 102.521 and 11.323, both p < 0.05), and R2* were significantly correlated with FF and BMD, respectively (r values of -0.219 and 0.290, both p < 0.05). In diagnosis of OP and osteopenia, the AUCs were 0.776 and 0.778 for FF and 0.638 and 0.560 for R2*, and the AUCs of R2* were lower than those of FF, with Z values of 4.030 and 4.087, both p < 0.001. CONCLUSION R2* is significantly correlated with FF and BMD and can be used as a complement to FF and BMD for quantitative assessment of OP. KEY POINTS • R2* based on IDEAL-IQ sequences has a definite but weak linear relationship with FF and BMD. • FF is significantly correlated with BMD and can effectively evaluate BMAT. • R2* can be used as a complement to FF and BMD for fine quantification of bone mineral loss and bone marrow fat conversion.
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Affiliation(s)
- Zhenghua Liu
- Department of Radiology, Honghui Hospital Affiliated Xi'an Jiaotong University, No. 555, Youyi East Road, Xi'an 710054, China
| | - Dageng Huang
- Department of Spinal Surgery, Honghui Hospital Affiliated Xi'an Jiaotong University, No. 555, Youyi East Road, Xi'an 710054, China
| | - Yonghong Jiang
- Department of Radiology, Honghui Hospital Affiliated Xi'an Jiaotong University, No. 555, Youyi East Road, Xi'an 710054, China.
| | - Xiaowen Ma
- Department of Radiology, Honghui Hospital Affiliated Xi'an Jiaotong University, No. 555, Youyi East Road, Xi'an 710054, China.
| | - Yuting Zhang
- Department of Radiology, Honghui Hospital Affiliated Xi'an Jiaotong University, No. 555, Youyi East Road, Xi'an 710054, China
| | - Rong Chang
- Department of Radiology, Honghui Hospital Affiliated Xi'an Jiaotong University, No. 555, Youyi East Road, Xi'an 710054, China
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10
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Gruenewald LD, Koch V, Martin SS, Yel I, Mahmoudi S, Bernatz S, Eichler K, Gruber-Rouh T, Pinto Dos Santos D, D'Angelo T, Wesarg S, Herrmann E, Golbach R, Handon M, Vogl TJ, Booz C. Dual-Energy CT-based Opportunistic Volumetric Bone Mineral Density Assessment of the Distal Radius. Radiology 2023; 308:e223150. [PMID: 37552067 DOI: 10.1148/radiol.223150] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background In patients with distal radius fractures (DRFs), low bone mineral density (BMD) is associated with bone substitute use during surgery and bone nonunion, but BMD information is not regularly available. Purpose To evaluate the feasibility of dual-energy CT (DECT)-based BMD assessment from routine examinations in the distal radius and the relationship between the obtained BMD values, the occurrence of DRFs, bone nonunion, and use of surgical bone substitute. Materials and Methods Scans in patients who underwent routine dual-source DECT in the distal radius between January 2016 and December 2021 were retrospectively acquired. Phantomless BMD assessment was performed using the delineated trabecular bone of a nonfractured segment of the distal radius and both DECT image series. CT images and health records were examined to determine fracture severity, surgical management, and the occurrence of bone nonunion. Associations of BMD with the occurrence of DRFs, bone nonunion, and bone substitute use at surgical treatment were examined with generalized additive models and receiver operating characteristic analysis. Results This study included 263 patients (median age, 52 years; IQR, 36-64 years; 132 female patients), of whom 192 were diagnosed with fractures. Mean volumetric BMD was lower in patients who sustained a DRF (93.9 mg/cm3 vs 135.4 mg/cm3; P < .001), required bone substitutes (79.6 mg/cm3 vs 95.5 mg/cm3; P < .001), and developed bone nonunion (71.1 mg/cm3 vs 96.5 mg/cm3; P < .001). Receiver operating characteristic curve analysis identified these patients with an area under the curve of 0.71-0.91 (P < .001). Lower BMD increased the risk to sustain DRFs, develop bone nonunion, and receive bone substitutes at surgery (P < .001). Conclusion DECT-based BMD assessment at routine examinations is feasible and could help predict surgical bone substitute use and the occurrence of bone nonunion in patients with DRFs. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Carrino in this issue.
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Affiliation(s)
- Leon D Gruenewald
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Vitali Koch
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Simon S Martin
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Ibrahim Yel
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Scherwin Mahmoudi
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Simon Bernatz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Katrin Eichler
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Tatjana Gruber-Rouh
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Daniel Pinto Dos Santos
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Tommaso D'Angelo
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Stefan Wesarg
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Eva Herrmann
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Rejane Golbach
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Marlin Handon
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Thomas J Vogl
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
| | - Christian Booz
- From the Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology (L.D.G., V.K., S.S.M., I.Y., C.B.), Department of Diagnostic and Interventional Radiology (S.M., S.B., K.E., T.G.R., D.P.D.S., M.H., T.J.V.), and Department of Biostatistics and Mathematical Modeling (E.H., R.G.), University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy (T.D.); Department of Radiology and Nuclear Medicine, Erasmus Medical College, Rotterdam, the Netherlands (T.D.); and Fraunhofer IGD, Darmstadt, Germany (S.W.)
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Beekman KM, Duque G, Corsi A, Tencerova M, Bisschop PH, Paccou J. Osteoporosis and Bone Marrow Adipose Tissue. Curr Osteoporos Rep 2023; 21:45-55. [PMID: 36534306 DOI: 10.1007/s11914-022-00768-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review focuses on the recent findings regarding bone marrow adipose tissue (BMAT) concerning bone health. We summarize the variations in BMAT in relation to age, sex, and skeletal sites, and provide an update on noninvasive imaging techniques to quantify human BMAT. Next, we discuss the role of BMAT in patients with osteoporosis and interventions that affect BMAT. RECENT FINDINGS There are wide individual variations with region-specific fluctuation and age- and gender-specific differences in BMAT content and composition. The Bone Marrow Adiposity Society (BMAS) recommendations aim to standardize imaging protocols to increase comparability across studies and sites. Water-fat imaging (WFI) seems an accurate and efficient alternative for spectroscopy (1H-MRS). Most studies indicate that greater BMAT is associated with lower bone mineral density (BMD) and a higher prevalence of vertebral fractures. The proton density fat fraction (PDFF) and changes in lipid composition have been associated with an increased risk of fractures independently of BMD. Therefore, PDFF and lipid composition could potentially be future imaging biomarkers for assessing fracture risk. Evidence of the inhibitory effect of osteoporosis treatments on BMAT is still limited to a few randomized controlled trials. Moreover, results from the FRAME biopsy sub-study highlight contradictory findings on the effect of the sclerostin antibody romosozumab on BMAT. Further understanding of the role(s) of BMAT will provide insight into the pathogenesis of osteoporosis and may lead to targeted preventive and therapeutic strategies.
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Affiliation(s)
- Kerensa M Beekman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gustavo Duque
- Department of Medicine and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michaela Tencerova
- Molecular Physiology of Bone, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Peter H Bisschop
- Department of Endocrinology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Julien Paccou
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, University Lille, Lille, France.
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Quantitative Study of Vertebral Body and Paravertebral Muscle Degeneration Based on Dual-Energy Computed Tomography: Correlation With Bone Mineral Density. J Comput Assist Tomogr 2023; 47:86-92. [PMID: 36668981 PMCID: PMC9869939 DOI: 10.1097/rct.0000000000001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aimed to quantify the degeneration of the vertebral body and paravertebral muscles using dual-energy computed tomography (DECT) and study its relationship with osteoporosis. METHODS A total of 130 patients with chronic low back pain were included in this study, and DECT scanning of the lumbar region was undertaken prospectively. By placing a standard quantitative computed tomography corrected phantom under the waist during the DECT procedure, bone mineral density (BMD) and the following quantitative parameters were obtained: calcium density (CaD), vertebral fat fraction (VFF), psoas major area, psoas major fat fraction, erector spinalis area, and erector spinalis fat fraction (ESFF). Independent sample t test and 1-way analysis of variance were used between different age-BMD groups. Pearson test was applied to determine correlations for all measurements, and a mathematical model of BMD was established through regression analysis. RESULTS Calcium density, VFF, psoas major area, psoas major fat fraction, erector spinalis area, and ESFF were significantly different among the age-BMD groups (P < 0.05), and BMD was significantly correlated with these parameters (P < 0.05). Calcium density, VFF, and ESFF were included in the BMD regression equation: BMD = 69.062 + 11.637 × CaD - 1.018 × VFF - 0.726 × ESFF (R2 = 0.860, F = 125.979, P < 0.001). CONCLUSIONS Degeneration of the vertebral body and paravertebral muscles can be quantitatively analyzed using DECT, and CaD, VFF, and ESFF were independent influencing factors of BMD.
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Liu Z, Huang D, Zhang Y, Chang R, Zhang X, Jiang Y, Ma X. Accuracy and applicability of dual-energy computed tomography in quantifying vertebral bone marrow adipose tissue compared with magnetic resonance imaging. Insights Imaging 2022; 13:181. [DOI: 10.1186/s13244-022-01326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/03/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Objectives
To evaluate the accuracy of dual-energy computed tomography (DECT) in quantifying bone marrow adipose tissue (BMAT) and its applicability in the study of osteoporosis (OP).
Methods
A total of 83 patients with low back pain (59.77 ± 7.46 years, 30 males) were enrolled. All patients underwent lumbar DECT and magnetic resonance imaging (MRI) scanning within 48 h, and the vertebral fat fraction (FF) was quantitatively measured, recorded as DECT-FF and MRI-FF. A standard quantitative computed tomography (QCT) phantom was positioned under the waist during DECT procedure to realize the quantization of bone mineral density (BMD). The intraclass correlation coefficient (ICC) and Bland–Altman method was used to evaluate the agreement between DECT-FF and MRI-FF. The Pearson test was used to study the correlation between DECT-FF, MRI-FF, and BMD. With BMD as a gold standard, the diagnostic efficacy of DECT-FF and MRI-FF in different OP degrees was compared by receiver operating characteristic (ROC) curve and DeLong test.
Results
The values of DECT-FF and MRI-FF agreed well (ICC = 0.918). DECT-FF and MRI-FF correlated with BMD, with r values of −0.660 and −0.669, respectively (p < 0.05). In the diagnosis of OP and osteopenia, the areas under curve (AUC) of DECT-FF was, respectively, 0.791 and 0.710, and that of MRI-FF was 0.807 and 0.708, and there was no significant difference between AUCs of two FF values (with Z values of 0.503 and 0.066, all p > 0.05).
Conclusion
DECT can accurately quantify the BMAT of vertebrae and has the same applicability as MRI in the study of OP.
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Wang YP, Khelifi N, Halleux CD, Ung RV, Samson F, Gagnon C, Mac-Way F. Bone Marrow Adiposity, Bone Mineral Density and Wnt/β-catenin Pathway Inhibitors Levels in Hemodialysis Patients. J Bone Metab 2022; 29:113-122. [PMID: 35718928 PMCID: PMC9208902 DOI: 10.11005/jbm.2022.29.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background Marrow adipose tissue (MAT) is known to accumulate in patients with chronic kidney disease. This pilot study aimed to evaluate bone mineral density (BMD), MAT, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) using computed tomography (CT) scans and to explore correlations between bone parameters, circulating Wnt/β-catenin pathway inhibitor levels, and adipose tissue parameters. Methods Single-center cross-sectional pilot study conducted in hemodialysis patients at the Centre Universitaire de Québec, Hôtel-Dieu de Québec hospital, Canada. CT-scan slices were acquired at the levels of the hip, L3 vertebra, and tibia. Volumetric and areal BMD, tibia cortical thickness, VAT and SAT area, and fat marrow index (FMI) were analyzed using the Mindways QCT Pro software. Blood levels of sclerostin, dickkopf-related protein 1 (DKK1), fibroblast growth factor 23, and α-Klotho were assessed. Spearman’s rho test was used to evaluate correlations. Results Fifteen hemodialysis patients (median age, 75 [66–82] years; 80% male; dialysis vintage, 39.3 [27.4–71.0] months) were included. While inverse correlations were obtained between L3 FMI and BMD, positive correlations were found between proximal tibial FMI and vertebral and tibial BMD, as well as with tibial (proximal and distal) cortical thickness. VAT had a positive correlation with α-Klotho levels, whereas L3 FMI had a negative correlation with DKK1 levels. Conclusions CT-scan allows simultaneous evaluation of bone and marrow adiposity in dialysis patients. Correlations between MAT and BMD vary depending on the bone site evaluated. DKK1 and α-Klotho levels correlate with adipose tissue accumulation in dialysis patients.
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Affiliation(s)
- Yue-Pei Wang
- Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Université Laval, Quebec, Canada
| | - Nada Khelifi
- Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Université Laval, Quebec, Canada
| | - Cyrille de Halleux
- Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Université Laval, Quebec, Canada
| | - Roth-Visal Ung
- Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Université Laval, Quebec, Canada
| | - France Samson
- Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Université Laval, Quebec, Canada
| | - Claudia Gagnon
- Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Université Laval, Quebec, Canada
| | - Fabrice Mac-Way
- Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Université Laval, Quebec, Canada
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15
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Yao Q, Liu M, Yuan K, Xin Y, Qiu X, Zheng X, Li C, Duan S, Qin J. Radiomics nomogram based on dual-energy spectral CT imaging to diagnose low bone mineral density. BMC Musculoskelet Disord 2022; 23:424. [PMID: 35524240 PMCID: PMC9074261 DOI: 10.1186/s12891-022-05389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background Osteoporosis is associated with a decrease of bone mineralized component as well as a increase of bone marrow fat. At present, there are few studies using radiomics nomogram based fat-water material decomposition (MD) images of dual-energy spectral CT as an evaluation method of abnormally low Bone Mineral Density (BMD). This study aims to establish and validate a radiomics nomogram based the fat-water imaging of dual-energy spectral CT in diagnosing low BMD. Methods Ninety-five patients who underwent dual-energy spectral CT included T11-L2 and dual x-ray absorptiometry (DXA) were collected. The patients were divided into two groups according to T-score, normal BMD(T ≥ -1) and abnormally low BMD (T < -1). Radiomic features were selected from fat-water imaging of the dual-energy spectral CT. Radscore was calculated by summing the selected features weighted by their coefficients. A nomogram combining the radiomics signature and significant clinical variables was built. The ROC curve was performed to evaluate the performance of the model. Finally, we used decision curve analysis (DCA) to evaluate the clinical usefulness of the model. Results Five radiomic features based on fat-water imaging of dual-energy spectral CT were constructed to distinguish abnormally low BMD from normal BMD, and its differential performance was high with an area under the curve (AUC) of 0.95 (95% CI, 0.89–1.00) in the training cohort and 0.97 (95% CI, 0.91–1.00) in the test cohort. The radiomics nomogram showed excellent differential ability with AUC of 0.96 (95%CI, 0.91–1.00) in the training cohort and 0.98 (95%CI, 0.93–1.00) in the test cohort, which performed better than the radiomics model and clinics model only. The DCA showed that the radiomics nomogram had a higher benefit in differentiating abnormally low BMD from normal BMD than the clinical model alone. Conclusion The radiomics nomogram incorporated radiomics features and clinical factor based the fat-water imaging of dual-energy spectral CT may serve as an efficient tool to identify abnormally low BMD from normal BMD well.
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Affiliation(s)
- Qianqian Yao
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China
| | - Mengke Liu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China
| | - Kemei Yuan
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China
| | - Yue Xin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China
| | - Xiaoqian Qiu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China
| | - Xiuzhu Zheng
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China
| | - Changqin Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China
| | - Shaofeng Duan
- GE Healthcare, Pudong new town, No1, Huatuo road, Shanghai, 210000, China
| | - Jian Qin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Taian, 271000, Shandong, China.
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16
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de Bakker CM, Knowles NK, Walker RE, Manske SL, Boyd SK. Independent changes in bone mineralized and marrow soft tissues following acute knee injury require dual-energy or high-resolution computed tomography for accurate assessment of bone mineral density and stiffness. J Mech Behav Biomed Mater 2022; 127:105091. [DOI: 10.1016/j.jmbbm.2022.105091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/12/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
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17
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Gassert FT, Kufner A, Gassert FG, Leonhardt Y, Kronthaler S, Schwaiger BJ, Boehm C, Makowski MR, Kirschke JS, Baum T, Karampinos DC, Gersing AS. MR-based proton density fat fraction (PDFF) of the vertebral bone marrow differentiates between patients with and without osteoporotic vertebral fractures. Osteoporos Int 2022; 33:487-496. [PMID: 34537863 PMCID: PMC8813693 DOI: 10.1007/s00198-021-06147-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2021] [Indexed: 12/20/2022]
Abstract
UNLABELLED The bone marrow proton density fat fraction (PDFF) assessed with MRI enables the differentiation between osteoporotic/osteopenic patients with and without vertebral fractures. Therefore, PDFF may be a potentially useful biomarker for bone fragility assessment. INTRODUCTION To evaluate whether magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) of vertebral bone marrow can differentiate between osteoporotic/osteopenic patients with and without vertebral fractures. METHODS Of the 52 study patients, 32 presented with vertebral fractures of the lumbar spine (66.4 ± 14.4 years, 62.5% women; acute low-energy osteoporotic/osteopenic vertebral fractures, N = 25; acute high-energy traumatic vertebral fractures, N = 7). These patients were frequency matched for age and sex to patients without vertebral fractures (N = 20, 69.3 ± 10.1 years, 70.0% women). Trabecular bone mineral density (BMD) values were derived from quantitative computed tomography. Chemical shift encoding-based water-fat MRI of the lumbar spine was performed, and PDFF maps were calculated. Associations between fracture status and PDFF were assessed using multivariable linear regression models. RESULTS Over all patients, mean PDFF and trabecular BMD correlated significantly (r = - 0.51, P < 0.001). In the osteoporotic/osteopenic group, those patients with osteoporotic/osteopenic fractures had a significantly higher PDFF than those without osteoporotic fractures after adjusting for age, sex, weight, height, and trabecular BMD (adjusted mean difference [95% confidence interval], 20.8% [10.4%, 30.7%]; P < 0.001), although trabecular BMD values showed no significant difference between the subgroups (P = 0.63). For the differentiation of patients with and without vertebral fractures in the osteoporotic/osteopenic subgroup using mean PDFF, an area under the receiver operating characteristic (ROC) curve (AUC) of 0.88 (P = 0.006) was assessed. When evaluating all patients with vertebral fractures, those with high-energy traumatic fractures had a significantly lower PDFF than those with low-energy osteoporotic/osteopenic vertebral fractures (P < 0.001). CONCLUSION MR-based PDFF enables the differentiation between osteoporotic/osteopenic patients with and without vertebral fractures, suggesting the use of PDFF as a potential biomarker for bone fragility.
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Affiliation(s)
- F T Gassert
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - A Kufner
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - F G Gassert
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Y Leonhardt
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - S Kronthaler
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - B J Schwaiger
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - C Boehm
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - M R Makowski
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - J S Kirschke
- Department of Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - T Baum
- Department of Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - D C Karampinos
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - A S Gersing
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
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18
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Diagnostic accuracy of quantitative dual-energy CT-based volumetric bone mineral density assessment for the prediction of osteoporosis-associated fractures. Eur Radiol 2021; 32:3076-3084. [PMID: 34713330 PMCID: PMC9038932 DOI: 10.1007/s00330-021-08323-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the predictive value of volumetric bone mineral density (BMD) assessment of the lumbar spine derived from phantomless dual-energy CT (DECT)-based volumetric material decomposition as an indicator for the 2-year occurrence risk of osteoporosis-associated fractures. METHODS L1 of 92 patients (46 men, 46 women; mean age, 64 years, range, 19-103 years) who had undergone third-generation dual-source DECT between 01/2016 and 12/2018 was retrospectively analyzed. For phantomless BMD assessment, dedicated DECT postprocessing software using material decomposition was applied. Digital files of all patients were sighted for 2 years following DECT to obtain the incidence of osteoporotic fractures. Receiver operating characteristic (ROC) analysis was used to calculate cut-off values and logistic regression models were used to determine associations of BMD, sex, and age with the occurrence of osteoporotic fractures. RESULTS A DECT-derived BMD cut-off of 93.70 mg/cm3 yielded 85.45% sensitivity and 89.19% specificity for the prediction to sustain one or more osteoporosis-associated fractures within 2 years after BMD measurement. DECT-derived BMD was significantly associated with the occurrence of new fractures (odds ratio of 0.8710, 95% CI, 0.091-0.9375, p < .001), indicating a protective effect of increased DECT-derived BMD values. Overall AUC was 0.9373 (CI, 0.867-0.977, p < .001) for the differentiation of patients who sustained osteoporosis-associated fractures within 2 years of BMD assessment. CONCLUSIONS Retrospective DECT-based volumetric BMD assessment can accurately predict the 2-year risk to sustain an osteoporosis-associated fracture in at-risk patients without requiring a calibration phantom. Lower DECT-based BMD values are strongly associated with an increased risk to sustain fragility fractures. KEY POINTS •Dual-energy CT-derived assessment of bone mineral density can identify patients at risk to sustain osteoporosis-associated fractures with a sensitivity of 85.45% and a specificity of 89.19%. •The DECT-derived BMD threshold for identification of at-risk patients lies above the American College of Radiology (ACR) QCT guidelines for the identification of osteoporosis (93.70 mg/cm3 vs 80 mg/cm3).
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19
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Dual-Energy Computed Tomography Virtual Noncalcium Technique in Diagnosing Osteoporosis: Correlation With Quantitative Computed Tomography. J Comput Assist Tomogr 2021; 45:452-457. [PMID: 34297514 PMCID: PMC8132909 DOI: 10.1097/rct.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to evaluate dual-energy computed tomography (CT) virtual noncalcium (VNCa) technique as a means of quantifying osteoporosis. Methods Dual-energy CT scans were obtained prospectively, targeting lumbar regions of 55 patients with chronic low back pain. A standard quantitative CT (QCT) phantom was positioned at the waist during each procedure, using proprietary software (QCT Pro; Mindways, Tex) to measure bone mineral density (BMD) in each vertebral body. Vendor dual-energy analytic software was altered with a specially modified configuration file to produce a “Virtual Non Calcium” or “VNCa” output, as such output variables were remapped to produce the following calcium values rather than iodine, yielding the following QCT parameters: CT value of calcium (originally “contrast media” [CM]), CT value of mixed energy imaging (regular CT value [rCT]), calcium density (originally “contrast agent density” [CaD]), and fat fraction (FF). Pearson test served to assess correlations between BMD and these parameters. Multiple linear regression analysis was applied to construct an equation for generating regressive BMD (rBMD) values. In gauging diagnostic accuracies, the criterion-standard BMD cutoff point (<80 mg/cm3) was adopted for QCT, whereas the rBMD threshold was defined by receiver operating characteristic curve. Results Contrast media, rCT, CaD, and FF values (reflecting CT value of calcium, regular CT value, calcium density, and fat fraction, respectively) significantly correlated with BMD (r values: 0.885, 0.947, 0.877, and 0.492, respectively; all P < 0.01). Contrast media, CaD, and FF showed independent associations with BMD; the regressive equation was formulated as follows: rBMD = 54.82 − 0.19 × CM + 20.03 × CaD − 1.24 × FF. The area under the curve of rBMD in diagnosing osteoporosis was 0.966 ± 0.009 (P < 0.01). At an rBMD threshold of less than 81.94 mg/cm3, sensitivity and specificity were 90.0% and 92.0%, respectively. Conclusions Dual-energy CT VNCa technique may constitute a valid alternative method for quantifying the mineral content and marrow fat composition of bone in diagnostic assessments of osteoporosis.
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Li Z, MacDougald OA. Preclinical models for investigating how bone marrow adipocytes influence bone and hematopoietic cellularity. Best Pract Res Clin Endocrinol Metab 2021; 35:101547. [PMID: 34016532 PMCID: PMC8458229 DOI: 10.1016/j.beem.2021.101547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Laboratory mice are a crucial preclinical model system for investigating bone marrow adipocyte (BMAd)-bone and BMAd-hematopoiesis interactions. In this review, we evaluate the suitability of mice to model common human diseases related to osteopenia or hematopoietic disorders, point out consistencies and discrepancies among different studies, and provide insights into model selection. Species, age, sex, skeletal site, and treatment protocol should all be considered when designing future studies.
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Affiliation(s)
- Ziru Li
- Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ormond A MacDougald
- Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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21
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Abstract
Research examining bone marrow adipose tissue (BMAT) has rapidly expanded during the last two decades, leading to advances in knowledge on the role of BMAT in the pathogenesis of bone loss and endocrine disorders. Clinical imaging has played a crucial role for the in vivo assessment of BMAT, allowing non-invasive quantification and evaluation of BMAT composition. In the present work, we review different imaging methods for assessing properties of BMAT. Our aim is to review conventional magnetic resonance imaging (MRI), water-fat imaging, and single-voxel proton magnetic resonance spectroscopy (1H-MRS), as well as computed tomography (CT)-based techniques, including single energy and dual energy CT. We will also discuss the clinical applications of these methods in type 2 diabetes mellitus, obesity and anorexia nervosa.
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Affiliation(s)
- Mohamed Jarraya
- Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA.
| | - Miriam A Bredella
- Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA
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22
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Malkovskiy AV, Van Wassenhove LD, Goltsev Y, Osei-Sarfo K, Chen CH, Efron B, Gudas LJ, Mochly-Rosen D, Rajadas J. The Effect of Ethanol Consumption on Composition and Morphology of Femur Cortical Bone in Wild-Type and ALDH2*2-Homozygous Mice. Calcif Tissue Int 2021; 108:265-276. [PMID: 33068139 PMCID: PMC8092984 DOI: 10.1007/s00223-020-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
ALDH2 inactivating mutation (ALDH2*2) is the most abundant mutation leading to bone morphological aberration. Osteoporosis has long been associated with changes in bone biomaterial in elderly populations. Such changes can be exacerbated with elevated ethanol consumption and in subjects with impaired ethanol metabolism, such as carriers of aldehyde dehydrogenase 2 (ALDH2)-deficient gene, ALDH2*2. So far, little is known about bone compositional changes besides a decrease in mineralization. Raman spectroscopic imaging has been utilized to study the changes in overall composition of C57BL/6 female femur bone sections, as well as in compound spatial distribution. Raman maps of bone sections were analyzed using multilinear regression with these four isolated components, resulting in maps of their relative distribution. A 15-week treatment of both wild-type (WT) and ALDH2*2/*2 mice with 20% ethanol in the drinking water resulted in a significantly lower mineral content (p < 0.05) in the bones. There was no significant change in mineral and collagen content due to the mutation alone (p > 0.4). Highly localized islets of elongated adipose tissue were observed on most maps. Elevated fat content was found in ALDH2*2 knock-in mice consuming ethanol (p < 0.0001) and this effect appeared cumulative. This work conclusively demonstrates that that osteocytes in femurs of older female mice accumulate fat, as has been previously theorized, and that fat accumulation is likely modulated by levels of acetaldehyde, the ethanol metabolite.
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Affiliation(s)
- Andrey V Malkovskiy
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford Medical School, Stanford, CA, 94305, USA.
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA.
| | - Lauren D Van Wassenhove
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Yury Goltsev
- Department of Microbiology and Immunology, Baxter Laboratory in Stem Cell Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Kwame Osei-Sarfo
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Che-Hong Chen
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Bradley Efron
- Department of Biomedical Data Science, Stanford Medical School, Stanford, CA, 94305, USA
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Jayakumar Rajadas
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford Medical School, Stanford, CA, 94305, USA.
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Nowak T, Eberhard M, Schmidt B, Frey D, Distler O, Saltybaeva N, Alkadhi H, Euler A. Bone Mineral Density Quantification from Localizer Radiographs: Accuracy and Precision of Energy-integrating Detector CT and Photon-counting Detector CT. Radiology 2020; 298:147-152. [PMID: 33141002 DOI: 10.1148/radiol.2020202767] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Bone mineral density (BMD) could be derived from CT localizer radiographs and could potentially enable opportunistic osteoporosis screening. Purpose To assess the accuracy and precision of BMD measurement using two localizer radiographs obtained with energy-integrating detector CT and a single localizer radiograph obtained with photon-counting detector CT. Materials and Methods A calibration phantom and a porcine phantom with lumbar vertebrae were imaged with a dual-energy x-ray absorptiometry (DXA) scanner, a clinical energy-integrating detector CT scanner, and a prototype photon-counting detector CT scanner. Two localizer radiographs at different combinations of tube voltages were obtained with energy-integrating detector CT, and one localizer radiograph was obtained with photon-counting detector CT using different energy thresholds. BMD was calculated for all three approaches and compared with the known specifications in the calibration phantom. In the animal phantom, BMDs from both CT systems were compared with those from the DXA scanner (the reference standard). Accuracy was defined as the measurement error of BMD (ΔBMD), and precision was defined as the coefficient of variation (in percentage). Radiation doses were estimated. Nonparametric tests were applied. Results In the calibration phantom, ΔBMD was smaller with both CT systems compared with the DXA scanner (both P < .05). ΔBMD ranged from -5% to -1.8% for DXA, from -2.3% to -1.7% for energy-integrating detector CT, and from -1.6% to 1.6% for photon-counting detector CT. Precision (range, 0.3%-2.8%) was high for both CT systems. In the animal phantom, ΔBMD ranged from -0.6% to 0.1% for energy-integrating detector CT and from -0.1% to 0.6% for photon-counting detector CT, with no significant differences between CT systems (P = .65). The dose-area product in the animal phantom was 4.6 cGy ∙ cm2 for DXA, 3.5-11.5 cGy ∙ cm2 for energy-integrating detector CT, and 7.2-11.2 cGy ∙ cm2 for photon-counting detector CT, depending on tube voltage and energy threshold combination. Conclusion Experimental evidence suggests that bone mineral density measurements are accurate and precise using two localizer radiographs at different tube voltages from energy-integrating detector CT and a single localizer radiograph with different energy thresholds from photon-counting detector CT. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Pourmorteza in this issue.
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Affiliation(s)
- Tristan Nowak
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Matthias Eberhard
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Bernhard Schmidt
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Diana Frey
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Oliver Distler
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Natalia Saltybaeva
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hatem Alkadhi
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - André Euler
- From Siemens Healthcare, An der Laende 1, 91301 Forchheim, Germany (T.N., B.S.); Institute of Diagnostic and Interventional Radiology (M.E., N.S., H.A., A.E.) and Department of Rheumatology (D.F., O.D.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Feng T, Zhu Y, Morris R, Kozloff KM, Wang X. Functional Photoacoustic and Ultrasonic Assessment of Osteoporosis: A Clinical Feasibility Study. BME FRONTIERS 2020; 2020:1081540. [PMID: 37849970 PMCID: PMC10521673 DOI: 10.34133/2020/1081540] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 10/19/2023] Open
Abstract
Objective and Impact Statement. To study the feasibility of combined functional photoacoustic (PA) and quantitative ultrasound (US) for diagnosis of osteoporosis in vivo based on the detection of chemical and microarchitecture (BMA) information in calcaneus bone. Introduction. Clinically available X-ray or US technologies for the diagnosis of osteoporosis do not report important parameters such as chemical information and BMA. With unique advantages, including good sensitivity to molecular and metabolic properties, PA bone assessment techniques hold a great potential for clinical translation. Methods. By performing multiwavelength PA measurements, the chemical information in the human calcaneus bone, including mineral, lipid, oxygenated-hemoglobin, and deoxygenated-hemoglobin, were assessed. In parallel, by performing PA spectrum analysis, the BMA as an important bone physical property was quantified. An unpaired t -test and a two-way ANOVA test were conducted to compare the outcomes from the two subject groups. Results. Multiwavelength PA measurement is capable of assessing the relative contents of several chemical components in the trabecular bone in vivo, including both minerals and organic materials such as oxygenated-hemoglobin, deoxygenated-hemoglobin, and lipid, which are relevant to metabolic activities and bone health. In addition, PA measurements of BMA show good correlations (R 2 up to 0.65) with DEXA. Both the chemical and microarchitectural measurements from PA techniques can differentiate the two subject groups. Conclusion. The results from this initial clinical study suggest that PA techniques, by providing additional chemical and microarchitecture information relevant to bone health, may lead to accurate and early diagnosis, as well as sensitive monitoring of the treatment of osteoporosis.
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Affiliation(s)
- Ting Feng
- Department of Biomedical Engineering, University of Michigan Medical School, MI 48109, USA
| | - Yunhao Zhu
- Department of Biomedical Engineering, University of Michigan Medical School, MI 48109, USA
| | | | - Kenneth M. Kozloff
- Department of Biomedical Engineering, University of Michigan Medical School, MI 48109, USA
- Department of Orthopaedic Surgery, University of Michigan Medical School, MI 48109, USA
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan Medical School, MI 48109, USA
- Department of Radiology, University of Michigan Medical School, MI 48109, USA
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Abstract
Although advanced quantitative imaging may not be currently used to any degree in the routine reporting of spinal examinations, this situation will change in the not too distant future. Advanced quantitative imaging has already allowed us to understand a great deal more regarding spinal development, marrow physiology, and disease pathogenesis. Radiologists are ideally suited to drive this research forward. To speed up this process and optimize the impact of studies reporting spine quantitative data, we should work toward universal standards on the acquisition of spine data that will allow quantitative studies to be more easily compared, contrasted, and amalgamated.
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Molwitz I, Leiderer M, Özden C, Yamamura J. Dual-Energy Computed Tomography for Fat Quantification in the Liver and Bone Marrow: A Literature Review. ROFO-FORTSCHR RONTG 2020; 192:1137-1153. [DOI: 10.1055/a-1212-6017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background With dual-energy computed tomography (DECT) it is possible to quantify certain elements and tissues by their specific attenuation, which is dependent on the X-ray spectrum. This systematic review provides an overview of the suitability of DECT for fat quantification in clinical diagnostics compared to established methods, such as histology, magnetic resonance imaging (MRI) and single-energy computed tomography (SECT).
Method Following a systematic literature search, studies which validated DECT fat quantification by other modalities were included. The methodological heterogeneity of all included studies was processed. The study results are presented and discussed according to the target organ and specifically for each modality of comparison.
Results Heterogeneity of the study methodology was high. The DECT data was generated by sequential CT scans, fast-kVp-switching DECT, or dual-source DECT. All included studies focused on the suitability of DECT for the diagnosis of hepatic steatosis and for the determination of the bone marrow fat percentage and the influence of bone marrow fat on the measurement of bone mineral density. Fat quantification in the liver and bone marrow by DECT showed valid results compared to histology, MRI chemical shift relaxometry, magnetic resonance spectroscopy, and SECT. For determination of hepatic steatosis in contrast-enhanced CT images, DECT was clearly superior to SECT. The measurement of bone marrow fat percentage via DECT enabled the bone mineral density quantification more reliably.
Conclusion DECT is an overall valid method for fat quantification in the liver and bone marrow. In contrast to SECT, it is especially advantageous to diagnose hepatic steatosis in contrast-enhanced CT examinations. In the bone marrow DECT fat quantification allows more valid quantification of bone mineral density than conventional methods. Complementary studies concerning DECT fat quantification by split-filter DECT or dual-layer spectral CT and further studies on other organ systems should be conducted.
Key points:
Citation Format
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Affiliation(s)
- Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Leiderer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Accuracy, agreement, and reliability of DECT-derived vBMD measurements: an initial ex vivo study. Eur Radiol 2020; 31:191-199. [PMID: 32757052 DOI: 10.1007/s00330-020-07118-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/03/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess the agreement and reliability of DECT (dual-energy CT)-derived vBMD (volumetric bone mineral density) measurements from excised human femoral heads and to compare DECT-derived BMD with that measured by DXA (dual-energy X-ray absorptiometry) and QCT (quantitative CT) to determine its accuracy. METHODS Twenty patients that underwent total hip arthroplasty were enrolled to this study. Femoral heads were excised to rectangles without cortical bones for scanning. A dual-source DECT scanner generated images under 80/Sn140 kVp and 100/Sn140 kVp scanning conditions. Specimens were subsequently scanned by QCT and DXA to produce QCT-derived vBMD (mg/cm3) and DXA-derived BMM (bone mineral mass, g). DECT images were loaded to a post-processing workstation to calculate DECT-derived vBMD and BMM. RESULTS Higher DECT-derived vBMD and BMM were found under 80/Sn140 and 100/Sn140 kVp compared with those for QCT and DXA (p = 0.005). DECT-derived vBMD was highly correlated with QCT-derived vBMD (r = 0.961 ~ 0.993, p < 0.05). Similarly, DECT-derived BMM was strongly correlated with DXA-derived BMM (r = 0.927 ~ 0.943, p < 0.05). Agreement of the inter- and intra-observation of DECT-derived vBMD was excellent. Linear regression was carried out to calibrate DECT-derived vBMD of 80/Sn140 kVp (14 + 0.7 × DECT-derived vBMD) and 100/Sn140 kVp (74 + 0.4 × DECT-derived vBMD) with the reference of QCT-derived vBMD. After calibration, excellent agreement was found for vBMD and BMM within various imaging modalities. CONCLUSIONS Our study showed that DECT-derived vBMD exhibited high agreement and reliability features, and after calibration, it also displayed a high degree of accuracy. However, in vivo studies are needed to extend its potential utility in clinical settings. KEY POINTS • Measurements of DECT-derived vBMD had high intra- and inter-observer agreement and reliability. • Measurements of DECT-derived vBMD and BMM had a high correlation with those derived from QCT and DXA. • DECT-derived vBMD and BMM were accurate after calibration compared with QCT and DXA.
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Kim D, Kim SK, Lee SJ, Choo HJ, Park JW, Kim KY. Simultaneous Estimation of the Fat Fraction and R₂ * Via T₂ *-Corrected 6-Echo Dixon Volumetric Interpolated Breath-hold Examination Imaging for Osteopenia and Osteoporosis Detection: Correlations with Sex, Age, and Menopause. Korean J Radiol 2020; 20:916-930. [PMID: 31132817 PMCID: PMC6536792 DOI: 10.3348/kjr.2018.0032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/14/2019] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the relationships of T2*-corrected 6-echo Dixon volumetric interpolated breath-hold examination (VIBE) imaging-based fat fraction (FF) and R2* values with bone mineral density (BMD); determine their associations with sex, age, and menopause; and evaluate the diagnostic performance of the FF and R2* for predicting osteopenia and osteoporosis. Materials and Methods This study included 153 subjects who had undergone magnetic resonance (MR) imaging, including MR spectroscopy (MRS) and T2*-corrected 6-echo Dixon VIBE imaging. The FF and R2* were measured at the L4 vertebra. The male and female groups were divided into two subgroups according to age or menopause. Lin's concordance and Pearson's correlation coefficients, Bland-Altman 95% limits of agreement, and the area under the curve (AUC) were calculated. Results The correlation between the spectroscopic and 6-echo Dixon VIBE imaging-based FF values was statistically significant for both readers (pc = 0.940 [reader 1], 0.908 [reader 2]; both p < 0.001). A small measurement bias was observed for the MRS-based FF for both readers (mean difference = −0.3% [reader 1], 0.1% [reader 2]). We found a moderate negative correlation between BMD and the FF (r = −0.411 [reader 1], −0.436 [reader 2]; both p <0.001) with younger men and premenopausal women showing higher correlations. R2* and BMD were more significantly correlated in women than in men, and the highest correlation was observed in postmenopausal women (r = 0.626 [reader 1], 0.644 [reader 2]; both p < 0.001). For predicting osteopenia and osteoporosis, the FF had a higher AUC in men and R2* had a higher AUC in women. The AUC for predicting osteoporosis was highest with a combination of the FF and R2* in postmenopausal women (AUC = 0.872 [reader 1], 0.867 [reader 2]; both p < 0.001). Conclusion The FF and R2* measured using T2*-corrected 6-echo Dixon VIBE imaging can serve as predictors of osteopenia and osteoporosis. R2* might be useful for predicting osteoporosis, especially in postmenopausal women.
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Affiliation(s)
- Donghyun Kim
- Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Sung Kwan Kim
- Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Sun Joo Lee
- Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
| | - Hye Jung Choo
- Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jung Won Park
- Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Kun Yung Kim
- Department of Radiology, Chonbuk National University Hospital, Jeonju, Korea
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Cheng X, Li K, Zhang Y, Wang L, Xu L, Liu Y, Duanmu Y, Chen D, Tian W, Blake GM. The accurate relationship between spine bone density and bone marrow in humans. Bone 2020; 134:115312. [PMID: 32145459 DOI: 10.1016/j.bone.2020.115312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT The accuracy of QCT measurements of lumbar spine trabecular volumetric bone mineral density (vBMD) is decreased due to differences in the amount of bone marrow adipose tissue (BMAT). OBJECTIVE To correct vBMD measurements for differences in marrow composition and investigate the true relationship between vBMD and BMAT. DESIGN Cross-sectional study. SETTING University teaching hospital. PARTICIPANTS Healthy Chinese subjects (233 women, 167 men) aged between 21 and 82 years. MAIN OUTCOME MEASURES vBMD and BMAT were measured using QCT (120 kV) and chemical shift-encoded MRI of the L2-L4 vertebrae. vBMD measurements were standardized to the European Spine Phantom (ESP) and corrected for differences in BMAT. Linear regression was used to analyze BMAT, ESP adjusted vBMD (vBMDESPcorr) and BMAT corrected vBMD (vBMDBMATcorr) against age and corrected vBMD against BMAT. RESULTS BMAT in the L2-L4 vertebral bodies increased with age in both sexes, with a faster rate of change in women compared with men (0.54%/year vs. 0.27%/year, P < 0.0001). After vBMD measurements were corrected for BMAT there were statistically significant changes in the slope of the regression line with age in both sexes (women: -3.00 ± 0.13 vs. -2.57 ± 0.11 mg/cm3/year, P < 0.0001; men: -1.92 ± 0.15 vs. -1.70 ± 0.14 mg/cm3/year, P < 0.0001). When vBMDBMATcorr was plotted against BMAT, vBMD decreased linearly with increasing BMAT in both sexes (women: -3.30 ± 0.18 mg/cm3/%; men: -2.69 ± 0.25 mg/cm3/%, P = 0.048). CONCLUSION Our approach reveals the true relationship between vBMD and BMAT and provides a new tool for studying the interaction between bone and marrow adipose tissue.
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Affiliation(s)
- Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Kai Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Li Xu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yangyang Duanmu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Di Chen
- Department of Community Medical Care, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Tian
- Department of Spine Surgery, The Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China.
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
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Abstract
PURPOSE OF REVIEW To provide an overview on recent technical development for quantifying marrow composition using magnetic resonance imaging (MRI) and spectroscopy (MRS) techniques, as well as a summary on recent findings of interrelationship between marrow adipose tissue (MAT) and skeletal health in the context of osteoporosis. RECENT FINDINGS There have been significant technical advances in reliable quantification of marrow composition using MR techniques. Cross-sectional studies have demonstrated a negative correlation between MAT and bone, with trabecular bone associating more strongly with MAT than cortical bone. However, longitudinal studies of MAT and bone are limited. MAT contents and composition have been associated with prevalent vertebral fracture. The evidence between MAT and clinical fracture is more limited, and, to date, no studies have reported on the relationship between MAT and incident fracture. Increasing evidence suggests a dynamic role of marrow fat in skeletal health. Reliable non-invasive quantification of marrow composition will facilitate developing novel treatment strategies for osteoporosis.
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Affiliation(s)
- Xiaojuan Li
- Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA.
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Bravenboer N, Bredella MA, Chauveau C, Corsi A, Douni E, Ferris WF, Riminucci M, Robey PG, Rojas-Sutterlin S, Rosen C, Schulz TJ, Cawthorn WP. Standardised Nomenclature, Abbreviations, and Units for the Study of Bone Marrow Adiposity: Report of the Nomenclature Working Group of the International Bone Marrow Adiposity Society. Front Endocrinol (Lausanne) 2020; 10:923. [PMID: 32038486 PMCID: PMC6993042 DOI: 10.3389/fendo.2019.00923] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022] Open
Abstract
Research into bone marrow adiposity (BMA) has expanded greatly since the late 1990s, leading to development of new methods for the study of bone marrow adipocytes. Simultaneously, research fields interested in BMA have diversified substantially. This increasing interest is revealing fundamental new knowledge of BMA; however, it has also led to a highly variable nomenclature that makes it difficult to interpret and compare results from different studies. A consensus on BMA nomenclature has therefore become indispensable. This article addresses this critical need for standardised terminology and consistent reporting of parameters related to BMA research. The International Bone Marrow Adiposity Society (BMAS) was formed in 2017 to consolidate the growing scientific community interested in BMA. To address the BMA nomenclature challenge, BMAS members from diverse fields established a working group (WG). Based on their broad expertise, the WG first reviewed the existing, unsystematic nomenclature and identified terms, and concepts requiring further discussion. They thereby identified and defined 8 broad concepts and methods central to BMA research. Notably, these had been described using 519 unique combinations of term, abbreviation and unit, many of which were overlapping or redundant. On this foundation a second consensus was reached, with each term classified as "to use" or "not to use." As a result, the WG reached a consensus to craft recommendations for 26 terms related to concepts and methods in BMA research. This was approved by the Scientific Board and Executive Board of BMAS and is the basis for the present recommendations for a formal BMA nomenclature. As an example, several terms or abbreviations have been used to represent "bone marrow adipocytes," including BMAds, BM-As, and BMAs. The WG decided that BMA should refer to "bone marrow adiposity"; that BM-A is too similar to BMA; and noted that "Ad" has previously been recommended to refer to adipocytes. Thus, it was recommended to use BMAds to represent bone marrow adipocytes. In conclusion, the standard nomenclature proposed in this article should be followed for all communications of results related to BMA. This will allow for better interactions both inside and outside of this emerging scientific community.
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Affiliation(s)
- Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam Movement Sciences, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Christophe Chauveau
- Univ. Littoral Côte d'Opale, Boulogne-sur-Mer, France
- Univ. Lille, Lille, France
- CHU Lille, Lille, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne-sur-Mer, France
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Eleni Douni
- Biological Sciences Research Center “Alexander Fleming”, Athens, Greece
- Department of Biotechnology, Agricultural University of Athens, Athens, Greece
| | - William F. Ferris
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mara Riminucci
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Pamela G. Robey
- Skeletal Biology Section, NIDCR, NIH, DHHS, Bethesda, MD, United States
| | - Shanti Rojas-Sutterlin
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada
| | - Clifford Rosen
- Maine Medical Research Center Institute, Scarborough, ME, United States
| | - Tim J. Schulz
- German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München, Germany
| | - William P. Cawthorn
- BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Tratwal J, Labella R, Bravenboer N, Kerckhofs G, Douni E, Scheller EL, Badr S, Karampinos DC, Beck-Cormier S, Palmisano B, Poloni A, Moreno-Aliaga MJ, Fretz J, Rodeheffer MS, Boroumand P, Rosen CJ, Horowitz MC, van der Eerden BCJ, Veldhuis-Vlug AG, Naveiras O. Reporting Guidelines, Review of Methodological Standards, and Challenges Toward Harmonization in Bone Marrow Adiposity Research. Report of the Methodologies Working Group of the International Bone Marrow Adiposity Society. Front Endocrinol (Lausanne) 2020; 11:65. [PMID: 32180758 PMCID: PMC7059536 DOI: 10.3389/fendo.2020.00065] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/31/2020] [Indexed: 12/14/2022] Open
Abstract
The interest in bone marrow adiposity (BMA) has increased over the last decade due to its association with, and potential role, in a range of diseases (osteoporosis, diabetes, anorexia, cancer) as well as treatments (corticosteroid, radiation, chemotherapy, thiazolidinediones). However, to advance the field of BMA research, standardization of methods is desirable to increase comparability of study outcomes and foster collaboration. Therefore, at the 2017 annual BMA meeting, the International Bone Marrow Adiposity Society (BMAS) founded a working group to evaluate methodologies in BMA research. All BMAS members could volunteer to participate. The working group members, who are all active preclinical or clinical BMA researchers, searched the literature for articles investigating BMA and discussed the results during personal and telephone conferences. According to the consensus opinion, both based on the review of the literature and on expert opinion, we describe existing methodologies and discuss the challenges and future directions for (1) histomorphometry of bone marrow adipocytes, (2) ex vivo BMA imaging, (3) in vivo BMA imaging, (4) cell isolation, culture, differentiation and in vitro modulation of primary bone marrow adipocytes and bone marrow stromal cell precursors, (5) lineage tracing and in vivo BMA modulation, and (6) BMA biobanking. We identify as accepted standards in BMA research: manual histomorphometry and osmium tetroxide 3D contrast-enhanced μCT for ex vivo quantification, specific MRI sequences (WFI and H-MRS) for in vivo studies, and RT-qPCR with a minimal four gene panel or lipid-based assays for in vitro quantification of bone marrow adipogenesis. Emerging techniques are described which may soon come to complement or substitute these gold standards. Known confounding factors and minimal reporting standards are presented, and their use is encouraged to facilitate comparison across studies. In conclusion, specific BMA methodologies have been developed. However, important challenges remain. In particular, we advocate for the harmonization of methodologies, the precise reporting of known confounding factors, and the identification of methods to modulate BMA independently from other tissues. Wider use of existing animal models with impaired BMA production (e.g., Pfrt-/-, KitW/W-v) and development of specific BMA deletion models would be highly desirable for this purpose.
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Affiliation(s)
- Josefine Tratwal
- Laboratory of Regenerative Hematopoiesis, Institute of Bioengineering and Swiss Institute for Experimental Cancer Research, Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Rossella Labella
- Tissue and Tumour Microenvironments Lab, The Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Section of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, Netherlands
| | - Greet Kerckhofs
- Biomechanics Lab, Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Department Materials Engineering, KU Leuven, Leuven, Belgium
| | - Eleni Douni
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, Athens, Greece
- Institute for Bioinnovation, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Erica L. Scheller
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
| | - Sammy Badr
- Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, Lille, France
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Sarah Beck-Cormier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
| | - Biagio Palmisano
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, United States
| | - Antonella Poloni
- Hematology, Department of Clinic and Molecular Science, Università Politecnica Marche-AOU Ospedali Riuniti, Ancona, Italy
| | - Maria J. Moreno-Aliaga
- Centre for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra's Health Research Institute, Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Centre of Biomedical Research Network, ISCIII, Madrid, Spain
| | - Jackie Fretz
- Department of Orthopaedics and Rehabilitation, Cellular and Developmental Biology, Yale University School of Medicine, New Haven, CT, United States
| | - Matthew S. Rodeheffer
- Department of Comparative Medicine and Molecular, Cellular and Developmental Biology, Yale University School of Medicine, New Haven, CT, United States
| | - Parastoo Boroumand
- Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Clifford J. Rosen
- Maine Medical Center Research Institute, Center for Clinical and Translational Research, Scarborough, ME, United States
| | - Mark C. Horowitz
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, United States
| | - Bram C. J. van der Eerden
- Laboratory for Calcium and Bone Metabolism, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Annegreet G. Veldhuis-Vlug
- Section of Endocrinology, Department of Internal Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, Netherlands
- Maine Medical Center Research Institute, Center for Clinical and Translational Research, Scarborough, ME, United States
- Jan van Goyen Medical Center/OLVG Hospital, Department of Internal Medicine, Amsterdam, Netherlands
- *Correspondence: Annegreet G. Veldhuis-Vlug
| | - Olaia Naveiras
- Laboratory of Regenerative Hematopoiesis, Institute of Bioengineering and Swiss Institute for Experimental Cancer Research, Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Hematology Service, Departments of Oncology and Laboratory Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Olaia Naveiras ;
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Bani Hassan E, Ghasem-Zadeh A, Imani M, Kutaiba N, Wright DK, Sepehrizadeh T, Duque G. Bone Marrow Adipose Tissue Quantification by Imaging. Curr Osteoporos Rep 2019; 17:416-428. [PMID: 31713178 DOI: 10.1007/s11914-019-00539-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The significance and roles of marrow adipose tissue (MAT) are increasingly known, and it is no more considered a passive fat storage but a tissue with significant paracrine and endocrine activities that can cause lipotoxicity and inflammation. RECENT FINDINGS Changes in the MAT volume and fatty acid composition appear to drive bone and hematopoietic marrow deterioration, and studying it may open new horizons to predict bone fragility and anemia development. MAT has the potential to negatively impact bone volume and strength through several mechanisms that are partially described by inflammaging and lipotoxicity terminology. Evidence indicates paramount importance of MAT in age-associated decline of bone and red marrow structure and function. Currently, MAT measurement is being tested and validated by several techniques. However, purpose-specific adaptation of existing imaging technologies and, more importantly, development of new modalities to quantitatively measure MAT are yet to be done.
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Affiliation(s)
- Ebrahim Bani Hassan
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Ali Ghasem-Zadeh
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
- Department of Medicine and Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Mahdi Imani
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Numan Kutaiba
- Austin Health, Department of Radiology, Heidelberg, VIC, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tara Sepehrizadeh
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia.
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia.
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Badr S, Legroux-Gérot I, Vignau J, Chauveau C, Ruschke S, Karampinos DC, Budzik JF, Cortet B, Cotten A. Comparison of regional bone marrow adiposity characteristics at the hip of underweight and weight-recovered women with anorexia nervosa using magnetic resonance spectroscopy. Bone 2019; 127:135-145. [PMID: 31146035 DOI: 10.1016/j.bone.2019.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
Bone marrow adiposity (BMA) is an underestimated tissue, with properties that may alter bone strength especially in diseases that fragilize bone such as anorexia nervosa. In the present study, we investigated the regional characteristics of BMA at the hip of 40 underweight and 36 weight-recovered anorexic women, along with 10 healthy women, using magnetic resonance spectroscopy at multiple anatomical subregions (acetabulum, femoral neck, proximal femoral diaphysis and greater trochanter) to measure bone marrow fat fraction (BMFF) and apparent lipid unsaturation levels (aLUL). Correlations between BMFF, aLUL, body fat percentage (BF), and bone mineral density (BMD) at the femoral neck and total hip, both measured using dual-energy X-ray absorptiometry, were assessed in anorexic patients. Whereas BMFF was significantly higher and aLUL significantly lower at the femoral neck of underweight and weight-recovered patients compared to controls (BMFF: 90.1 ± 6.7% and 90.3 ± 7.5% respectively versus 81.3 ± 8.1%; aLUL: 7.6 ± 1.4% and 7.3 ± 1.3% versus 9.2 ± 1.5%), BMFF and aLUL were not significantly different between the 2 subgroups of patients. Besides, three noteworthy features were observed between BMA and the other measured parameters in anorexic patients. First, synergic alterations of BMA were observed at all sites, with an inverse relationship between BMFF and aLUL (ρ = -0.88). Second, bone mineral compartment and BMA were associated, as a negative correlation between total hip BMD and BMFF was observed at all sites except the greater trochanter (ρ = [-0.32;-0.29]), as well as a positive correlation with aLUL at all sites except the proximal femoral diaphysis (ρ = [0.25;0.37]). Finally, we found a positive correlation between BF and BMFF at the femoral neck (ρ = 0.35), and a negative correlation between BF and aLUL at this same subregion (ρ = -0.33), which suggest a complex relationship between BMA and BF. Overall, BMA possesses regional specificities which may impair bone health, even after weight recovering.
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Affiliation(s)
- Sammy Badr
- CHU Lille, Service de radiologie et imagerie musculosquelettique, F-59000 Lille, France; Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, F-59000 Lille, France.
| | - Isabelle Legroux-Gérot
- Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, F-59000 Lille, France; CHU Lille, Service de rhumatologie, F-59000 Lille, France
| | - Jean Vignau
- Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, F-59000 Lille, France; CHU Lille, Service d'addictologie, F-59000 Lille, France
| | - Christophe Chauveau
- Univ. Littoral Côte d'Opale, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, F-62200 Boulogne-sur-Mer, France
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jean-François Budzik
- Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, F-59000 Lille, France; Service d'Imagerie Médicale, Groupe Hospitalier de l'Institut Catholique de Lille / Université Catholique de Lille, F-59000 Lille, France
| | - Bernard Cortet
- Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, F-59000 Lille, France; CHU Lille, Service de rhumatologie, F-59000 Lille, France
| | - Anne Cotten
- CHU Lille, Service de radiologie et imagerie musculosquelettique, F-59000 Lille, France; Univ. Lille, EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, F-59000 Lille, France
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Sebo ZL, Rendina-Ruedy E, Ables GP, Lindskog DM, Rodeheffer MS, Fazeli PK, Horowitz MC. Bone Marrow Adiposity: Basic and Clinical Implications. Endocr Rev 2019; 40:1187-1206. [PMID: 31127816 PMCID: PMC6686755 DOI: 10.1210/er.2018-00138] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 04/03/2019] [Indexed: 12/14/2022]
Abstract
The presence of adipocytes in mammalian bone marrow (BM) has been recognized histologically for decades, yet, until recently, these cells have received little attention from the research community. Advancements in mouse transgenics and imaging methods, particularly in the last 10 years, have permitted more detailed examinations of marrow adipocytes than ever before and yielded data that show these cells are critical regulators of the BM microenvironment and whole-body metabolism. Indeed, marrow adipocytes are anatomically and functionally separate from brown, beige, and classic white adipocytes. Thus, areas of BM space populated by adipocytes can be considered distinct fat depots and are collectively referred to as marrow adipose tissue (MAT) in this review. In the proceeding text, we focus on the developmental origin and physiologic functions of MAT. We also discuss the signals that cause the accumulation and loss of marrow adipocytes and the ability of these cells to regulate other cell lineages in the BM. Last, we consider roles for MAT in human physiology and disease.
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Affiliation(s)
- Zachary L Sebo
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut.,Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, Connecticut
| | | | - Gene P Ables
- Orentreich Foundation for the Advancement of Science, Cold Spring, New York
| | - Dieter M Lindskog
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew S Rodeheffer
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut.,Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, Connecticut
| | - Pouneh K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark C Horowitz
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
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Roski F, Hammel J, Mei K, Baum T, Kirschke JS, Laugerette A, Kopp FK, Bodden J, Pfeiffer D, Pfeiffer F, Rummeny EJ, Noël PB, Gersing AS, Schwaiger BJ. Bone mineral density measurements derived from dual-layer spectral CT enable opportunistic screening for osteoporosis. Eur Radiol 2019; 29:6355-6363. [PMID: 31115622 PMCID: PMC6795615 DOI: 10.1007/s00330-019-06263-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Objective To investigate the in vivo applicability of non-contrast-enhanced hydroxyapatite (HA)-specific bone mineral density (BMD) measurements based on dual-layer CT (DLCT). Methods A spine phantom containing three artificial vertebral bodies with known HA densities was measured to obtain spectral data using DLCT and quantitative CT (QCT), simulating different patient positions and grades of obesity. BMD was calculated from virtual monoenergetic images at 50 and 200 keV. HA-specific BMD values of 174 vertebrae in 33 patients (66 ± 18 years; 33% women) were determined in non-contrast routine DLCT and compared with corresponding QCT-based BMD values. Results Examining the phantom, HA-specific BMD measurements were on a par with QCT measurements. In vivo measurements revealed strong correlations between DLCT and QCT (r = 0.987 [95% confidence interval, 0.963–1.000]; p < 0.001) and substantial agreement in a Bland–Altman plot. Conclusion DLCT-based HA-specific BMD measurements were comparable with QCT measurements in in vivo analyses. This suggests that opportunistic DLCT-based BMD measurements are an alternative to QCT, without requiring phantoms and specific protocols. Key Points • DLCT-based hydroxyapatite-specific BMD measurements show a substantial agreement with QCT-based BMD measurements in vivo. • DLCT-based hydroxyapatite-specific measurements are on a par with QCT in spine phantom measurements. • Opportunistic DLCT-based BMD measurements may be a feasible alternative for QCT, without requiring dedicated examination protocols or a phantom.
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Affiliation(s)
- Ferdinand Roski
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Johannes Hammel
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Kai Mei
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexis Laugerette
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Felix K Kopp
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jannis Bodden
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Franz Pfeiffer
- Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, 85748, Garching, Germany
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 1 Silverstein, Philadelphia, PA, 19104, USA
| | - Alexandra S Gersing
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Cheng X, Blake GM, Guo Z, Keenan Brown J, Wang L, Li K, Xu L. Correction of QCT vBMD using MRI measurements of marrow adipose tissue. Bone 2019; 120:504-511. [PMID: 30583123 DOI: 10.1016/j.bone.2018.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Quantitative computed tomography (QCT) measurements of volumetric bone mineral density (vBMD) are subject to errors due to variations in the amount of bone marrow adipose tissue (BMAT). The purpose of our study was to describe and validate a novel method to correct lumbar spine trabecular vBMD measurements for BMAT using chemical shift-encoded magnetic resonance imaging (CSE-MRI). METHODS CSE-MRI measurements of proton density fat fraction (PDFF) were used to correct QCT spine vBMD measurements for BMAT based on the H2O and K2HPO4 basis set equivalent densities of bone, red and yellow bone marrow. BMAT corrected and uncorrected vBMD measurements of the L1 vertebra were compared with dual-energy QCT (DEQCT) measurements in 18 subjects (mean age: 68 y, range 60 to 93 y). A further 400 subjects (mean age: 53 y, range 21 to 82 y) had 120 kVp single-energy QCT and CES-MRI scans of L2-L4 and the data used to simplify the adipose tissue correction by deriving a linear equation between the CSE-MRI vBMD correction and fractional BMAT content. RESULTS Application of the CSE-MRI derived vBMD correction changed the bias (95% limits of agreement) compared with DEQCT from 26.7 (11.0 to 42.4) mg/cm3 to 2.2 (-9.5 to 13.9) mg/cm3 at 80 kVp, and from 22.4 (3.3 to 41.6) mg/cm3 to 2.9 (-12.6 to 18.4) mg/cm3 at 120 kVp. Data for the 400 subjects gave the following relationship valid at 120 kVp: vBMD correction (mg/cm3) = -12.96 + 75.76 × BMAT. CONCLUSION CSE-MRI measurements of PDFF can be used to correct for BMAT content and improve the accuracy of lumbar spine QCT vBMD measurements calibrated using a K2HPO4 phantom.
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Affiliation(s)
- Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom.
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - J Keenan Brown
- Mindways Software Inc., Austin, TX, United States of America
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Kai Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Li Xu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
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38
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Abstract
Bone strength is affected not only by bone mineral density (BMD) and bone microarchitecture but also its microenvironment. Recent studies have focused on the role of marrow adipose tissue (MAT) in the pathogenesis of bone loss. Osteoblasts and adipocytes arise from a common mesenchymal stem cell within bone marrow and many osteoporotic states, including aging, medication use, immobility, over - and undernutrition are associated with increased marrow adiposity. Advancements in imaging technology allow the non-invasive quantification of MAT. This article will review magnetic resonance imaging (MRI)- and computed tomography (CT)-based imaging technologies to assess the amount and composition of MAT. The techniques that will be discussed are anatomic T1-weighted MRI, water-fat imaging, proton MR spectroscopy, single energy CT and dual energy CT. Clinical applications of MRI and CT techniques to determine the role of MAT in patients with obesity, anorexia nervosa, and type 2 diabetes will be reviewed.
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Affiliation(s)
- Vibha Singhal
- Pediatric Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Interventions, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
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39
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Magnetic Resonance Spectroscopy for Evaluating the Effect of Pulsed Electromagnetic Fields on Marrow Adiposity in Postmenopausal Women With Osteopenia. J Comput Assist Tomogr 2018; 42:792-797. [PMID: 29901507 DOI: 10.1097/rct.0000000000000757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Pulsed electromagnetic fields (PEMFs) could promote osteogenic differentiation and suppress adipogenic differentiation in bone mesenchymal stem cells ex vivo. However, data on the effect of PEMF on marrow adiposity in humans remain elusive. We aimed to determine the in vivo effect of PEMF on marrow adiposity in postmenopausal women using magnetic resonance spectroscopy. METHODS Sixty-one postmenopausal women with osteopenia, aged 53 to 85 years, were randomly assigned to receive either PEMF treatment or placebo. The session was performed 3 times per week for 6 months. All women received adequate dietary calcium and vitamin D. Bone mineral density (BMD) by dual-energy x-ray absorptiometry, vertebral marrow fat content by magnetic resonance spectroscopy, and serum biomarkers were evaluated before and after 6 months of treatment. RESULTS A total of 27 (87.1%) and 25 (83.3%) women completed the treatment schedule in the PEMF and placebo groups, respectively. After the 6-month treatment, lumbar spine and hip BMD increased by 1.46% to 2.04%, serum bone-specific alkaline phosphatase increased by 3.23%, and C-terminal telopeptides of type 1 collagen decreased by 9.12% in the PEMF group (P < 0.05), whereas the mean percentage changes in BMD and serum biomarkers were not significant in the placebo group. Pulsed electromagnetic field treatment significantly reduced marrow fat fraction by 4.81%. The treatment difference between the 2 groups was -4.43% (95% confidence interval, -3.70% to -5.65%; P = 0.009). CONCLUSIONS Pulsed electromagnetic field is an effective physiotherapy in postmenopausal women, and this effect may, at least in part, regulate the amount of fat within the bone marrow. Magnetic resonance spectroscopy may serve as a complementary imaging biomarker for monitoring response to therapy in osteoporosis.
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40
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Ermetici F, Briganti S, Delnevo A, Cannaò P, Leo GD, Benedini S, Terruzzi I, Sardanelli F, Luzi L. Bone marrow fat contributes to insulin sensitivity and adiponectin secretion in premenopausal women. Endocrine 2018. [PMID: 28624865 DOI: 10.1007/s12020-017-1349-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Bone marrow fat is a functionally distinct adipose tissue that may contribute to systemic metabolism. This study aimed at evaluating a possible association between bone marrow fat and insulin sensitivity indices. METHODS Fifty obese (n = 23) and non-obese (n = 27) premenopausal women underwent proton magnetic resonance spectroscopy to measure vertebral bone marrow fat content and unsaturation index at L4 level. Abdominal visceral, subcutaneous fat, and epicardial fat were also measured using magnetic resonance imaging. Bone mineral density was measured by dual-energy X-ray absorptiometry. Body composition was assessed by bioelectrical impedance analysis. Fasting serum glucose, insulin, lipids, adiponectin were measured; the insulin resistance index HOMA (HOMA-IR) was calculated. RESULTS Bone marrow fat content and unsaturation index were similar in obese and non-obese women (38.5 ± 0.1 vs. 38.6 ± 0.1%, p = 0.994; 0.162 ± 0.065 vs. 0.175 ± 0.048, p = 0.473, respectively). Bone marrow fat content negatively correlated with insulin and HOMA-IR (r = -0.342, r = -0.352, respectively, p = 0.01) and positively with high density lipoprotein cholesterol (r = 0.270, p = 0.043). From a multivariate regression model including lnHOMA-IR as a dependent variable and visceral, subcutaneous, epicardial fat, and bone marrow fat as independent variables, lnHOMA-IR was significantly associated with bone marrow fat (β = -0.008 ± 0.004, p = 0.04) and subcutaneous fat (β = 0.003 ± 0.001, p = 0.04). Bone marrow fat, among the other adipose depots, was a significant predictor of circulating adiponectin (β = 0.147 ± 0.060, p = 0.021). Bone marrow fat unsaturation index negatively correlated with visceral fat (r = -0.316, p = 0.026). CONCLUSIONS There is a relationship between bone marrow fat content and insulin sensitivity in obese and non-obese premenopausal women, possibly mediated by adiponectin secretion. Visceral fat does not seem to regulate bone marrow fat content while it may affect bone marrow fat composition.
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Affiliation(s)
- Federica Ermetici
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Silvia Briganti
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandra Delnevo
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Paola Cannaò
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Stefano Benedini
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Livio Luzi
- Endocrinology and Metabolism, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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41
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Longitudinal assessment of marrow fat content using three-point Dixon technique in osteoporotic rabbits. Menopause 2018; 23:1339-1344. [PMID: 27529463 DOI: 10.1097/gme.0000000000000721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this longitudinal pilot study, we aimed to investigate the intra-, interobserver, and scan-rescan reproducibility of marrow fat fraction (FF) measurements using three-point Dixon imaging in osteoporotic rabbits: comparison with histopathology. METHODS Twenty female rabbits were randomly assigned to sham-operation and ovariectomy in combination with daily methylprednisolone hemisuccinate groups (n = 10 per group). Marrow FF by three-point Dixon technique and bone density by dual-energy x-ray absorptiometry were assessed at baseline, 6 and 12 weeks after operation. Intra-, inter-reader, and scan-rescan reliability of FF measurements were evaluated using intraclass correlation coefficient (ICC) and Bland-Altman 95% limit of agreement. Histomorphometry was performed to quantify marrow adipocyte parameters. RESULTS Intra- and inter-reader reproducibility of FF measurements was "substantial" (ICC = 0.984 and 0.978, respectively). Although the ICC for scan-rescan reliability was excellent (ICC = 0.962), increased measurement variability was observed using Bland-Altman plot. Relative to the sham-operated rabbits, the adipocytes mean diameter, density, and percent adipocytes area in the osteoporotic rabbits increased by 23.4%, 68.9%, and 117.0%, respectively. Marrow FF was positively correlated with the quantitative parameters of adipocytes, particularly with percent adipocyte area, but inversely associated with bone density. At the relatively early stage, the percentage of bone loss was similar to that of elevated fatty marrow in the osteoporotic rabbits; at the later stage, the change for the latter outweighed that of the former. CONCLUSIONS Results of three-point Dixon technique demonstrated a very reproducible manner within and between observers and acceptable scan-rescan performance in the assessment of marrow fat in rabbits.
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Mei K, Schwaiger BJ, Kopp FK, Ehn S, Gersing AS, Kirschke JS, Muenzel D, Fingerle AA, Rummeny EJ, Pfeiffer F, Baum T, Noël PB. Bone mineral density measurements in vertebral specimens and phantoms using dual-layer spectral computed tomography. Sci Rep 2017; 7:17519. [PMID: 29235542 PMCID: PMC5727524 DOI: 10.1038/s41598-017-17855-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022] Open
Abstract
To assess whether phantomless calcium-hydroxyapatite (HA) specific bone mineral density (BMD) measurements with dual-layer spectral computed tomography are accurate in phantoms and vertebral specimens. Ex-vivo human vertebrae (n = 13) and a phantom containing different known HA concentrations were placed in a semi-anthropomorphic abdomen phantom with different extension rings simulating different degrees of obesity. Phantomless dual-layer spectral CT was performed at different tube current settings (500, 250, 125 and 50 mAs). HA-specific BMD was derived from spectral-based virtual monoenergetic images at 50 keV and 200 keV. Values were compared to the HA concentrations of the phantoms and conventional qCT measurements using a reference phantom, respectively. Above 125 mAs, errors for phantom measurements ranged between -1.3% to 4.8%, based on spectral information. In vertebral specimens, high correlations were found between BMD values assessed with spectral CT and conventional qCT (r ranging between 0.96 and 0.99; p < 0.001 for all) with different extension rings, and a high agreement was found in Bland Altman plots. Different degrees of obesity did not have a significant influence on measurements (P > 0.05 for all). These results suggest a high validity of HA-specific BMD measurements based on dual-layer spectral CT examinations in setups simulating different degrees of obesity without the need for a reference phantom, thus demonstrating their feasibility in clinical routine.
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Affiliation(s)
- Kai Mei
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Felix K Kopp
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ehn
- Physics Department & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Muenzel
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander A Fingerle
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Physics Department & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Physics Department & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
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Neumayer B, Widek T, Stollberger R, Scheurer E. Reproducibility of relaxometry of human lumbar vertebrae at 3 Tesla using 1
H MR spectroscopy. J Magn Reson Imaging 2017; 48:153-159. [DOI: 10.1002/jmri.25912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/14/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Bernhard Neumayer
- Ludwig Boltzmann Institute for Clinical Forensic Imaging; Graz Austria
- BioTechMed-Graz; Austria
| | - Thomas Widek
- Ludwig Boltzmann Institute for Clinical Forensic Imaging; Graz Austria
- BioTechMed-Graz; Austria
| | - Rudolf Stollberger
- BioTechMed-Graz; Austria
- Institute of Medical Engineering; Graz University of Technology; Graz Austria
| | - Eva Scheurer
- Institute of Forensic Medicine; University of Basel; Basel Switzerland
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Bastos CM, Araújo IM, Nogueira-Barbosa MH, Salmon CEG, de Paula FJA, Troncon LEA. Reduced bone mass and preserved marrow adipose tissue in patients with inflammatory bowel diseases in long-term remission. Osteoporos Int 2017; 28:2167-2176. [PMID: 28405731 DOI: 10.1007/s00198-017-4014-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/15/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED Bone marrow adipose tissue has not been studied in patients with inactive inflammatory bowel disease. We found that these patients have preserved marrow adiposity even with low bone mass. Factors involved in bone loss in active disease may have long-lasting effects but do not seem to affect bone marrow adiposity. INTRODUCTION Reduced bone mass is known to occur at varying prevalence in patients with inflammatory bowel diseases (IBD) because of inflammation, malnutrition, and steroid therapy. Osteoporosis may develop in these patients as the result of an imbalanced relationship between osteoblasts and adipocytes in bone marrow. This study aimed to evaluate for the first time bone mass and bone marrow adipose tissue (BMAT) in a particular subgroup of IBD patients characterized by long-term, steroid-free remission. METHODS Patients with Crohn's disease (CD; N = 21) and ulcerative colitis (UC; N = 15) and controls (C; N = 65) underwent dual X-ray energy absorptiometry and nuclear magnetic resonance spectroscopy of the L3 lumbar vertebra for BMAT assessment. RESULTS Both the CD and UC subgroups showed significantly higher proportions of patients than controls with Z-score ≤-2.0 at L1-L4 (C 1.54%; CD 19.05%; UC 20%; p = 0.02), but not at other sites. The proportions of CD patients with a T-score ˂-1.0 at the femoral neck (C 18.46%; CD 47.62%; p = 0.02) and total hip (C 16.92%; CD 42.86%; p = 0.03) were significantly higher than among controls. There were no statistically significant differences between IBD patients and controls regarding BMAT at L3 (C 28.62 ± 8.15%; CD 29.81 ± 6.90%; UC 27.35 ± 9.80%; p = 0.67). CONCLUSIONS IBD patients in long-term, steroid-free remission may have a low bone mass in spite of preserved BMAT. These findings confirm the heterogeneity of bone disorders in IBD and may indicate that factors involved in bone loss in active disease may have long-lasting effects on these patients.
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Affiliation(s)
- C M Bastos
- Gastroenterology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - I M Araújo
- Endocrinology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - M H Nogueira-Barbosa
- Radiology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - C E G Salmon
- Department of Physics, Ribeirão Preto Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | - F J A de Paula
- Endocrinology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - L E A Troncon
- Gastroenterology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
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Karampinos DC, Ruschke S, Dieckmeyer M, Diefenbach M, Franz D, Gersing AS, Krug R, Baum T. Quantitative MRI and spectroscopy of bone marrow. J Magn Reson Imaging 2017; 47:332-353. [PMID: 28570033 PMCID: PMC5811907 DOI: 10.1002/jmri.25769] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Bone marrow is one of the largest organs in the human body, enclosing adipocytes, hematopoietic stem cells, which are responsible for blood cell production, and mesenchymal stem cells, which are responsible for the production of adipocytes and bone cells. Magnetic resonance imaging (MRI) is the ideal imaging modality to monitor bone marrow changes in healthy and pathological states, thanks to its inherent rich soft‐tissue contrast. Quantitative bone marrow MRI and magnetic resonance spectroscopy (MRS) techniques have been also developed in order to quantify changes in bone marrow water–fat composition, cellularity and perfusion in different pathologies, and to assist in understanding the role of bone marrow in the pathophysiology of systemic diseases (e.g. osteoporosis). The present review summarizes a large selection of studies published until March 2017 in proton‐based quantitative MRI and MRS of bone marrow. Some basic knowledge about bone marrow anatomy and physiology is first reviewed. The most important technical aspects of quantitative MR methods measuring bone marrow water–fat composition, fatty acid composition, perfusion, and diffusion are then described. Finally, previous MR studies are reviewed on the application of quantitative MR techniques in both healthy aging and diseased bone marrow affected by osteoporosis, fractures, metabolic diseases, multiple myeloma, and bone metastases. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:332–353.
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Affiliation(s)
- Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Maximilian Diefenbach
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Baum
- Section for Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
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Measurement of vertebral bone marrow proton density fat fraction in children using quantitative water-fat MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 30:449-460. [PMID: 28382554 DOI: 10.1007/s10334-017-0617-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the feasibility of employing a 3D time-interleaved multi-echo gradient-echo (TIMGRE) sequence to measure the proton density fat fraction (PDFF) in the vertebral bone marrow (VBM) of children and to examine cross-sectional changes with age and intra-individual variations from the lumbar to the cervical region in the first two decades of life. MATERIALS AND METHODS Quantitative water-fat imaging of the spine was performed in 93 patients (49 girls; 44 boys; age median 4.5 years; range 0.1-17.6 years). For data acquisition, a six-echo 3D TIMGRE sequence was used with phase correction and complex-based water-fat separation. Additionally, single-voxel MR spectroscopy (MRS) was performed in the L4 vertebrae of 37 patients. VBM was manually segmented in the midsagittal slice of each vertebra. Univariable and multivariable linear regression models were calculated between averaged lumbar, thoracic and cervical bone marrow PDFF and age with adjustments for sex, height, weight, and body mass index percentile. RESULTS Measured VBM PDFF correlated strongly between imaging and MRS (R 2 = 0.92, slope = 0.94, intercept = -0.72%). Lumbar, thoracic and cervical VBM PDFF correlated significantly (all p < 0.001) with the natural logarithm of age. Differences between female and male patients were not significant (p > 0.05). CONCLUSION VBM development in children showed a sex-independent cross-sectional increase of PDFF correlating with the natural logarithm of age and an intra-individual decrease of PDFF from the lumbar to the cervical region in all age groups. The present results demonstrate the feasibility of using a 3D TIMGRE sequence for PDFF assessment in VBM of children.
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Patino M, Prochowski A, Agrawal MD, Simeone FJ, Gupta R, Hahn PF, Sahani DV. Material Separation Using Dual-Energy CT: Current and Emerging Applications. Radiographics 2017; 36:1087-105. [PMID: 27399237 DOI: 10.1148/rg.2016150220] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dual-energy (DE) computed tomography (CT) offers the opportunity to generate material-specific images on the basis of the atomic number Z and the unique mass attenuation coefficient of a particular material at different x-ray energies. Material-specific images provide qualitative and quantitative information about tissue composition and contrast media distribution. The most significant contribution of DE CT-based material characterization comes from the capability to assess iodine distribution through the creation of an image that exclusively shows iodine. These iodine-specific images increase tissue contrast and amplify subtle differences in attenuation between normal and abnormal tissues, improving lesion detection and characterization in the abdomen. In addition, DE CT enables computational removal of iodine influence from a CT image, generating virtual noncontrast images. Several additional materials, including calcium, fat, and uric acid, can be separated, permitting imaging assessment of metabolic imbalances, elemental deficiencies, and abnormal deposition of materials within tissues. The ability to obtain material-specific images from a single, contrast-enhanced CT acquisition can complement the anatomic knowledge with functional information, and may be used to reduce the radiation dose by decreasing the number of phases in a multiphasic CT examination. DE CT also enables generation of energy-specific and virtual monochromatic images. Clinical applications of DE CT leverage both material-specific images and virtual monochromatic images to expand the current role of CT and overcome several limitations of single-energy CT. (©)RSNA, 2016.
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Affiliation(s)
- Manuel Patino
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Andrea Prochowski
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Mukta D Agrawal
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Frank J Simeone
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Rajiv Gupta
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Peter F Hahn
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Dushyant V Sahani
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
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Bredella MA, Greenblatt LB, Eajazi A, Torriani M, Yu EW. Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue. Bone 2017; 95:85-90. [PMID: 27871812 PMCID: PMC5222731 DOI: 10.1016/j.bone.2016.11.014] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/19/2016] [Accepted: 11/14/2016] [Indexed: 02/07/2023]
Abstract
Bariatric surgery is associated with bone loss but skeletal consequences may differ between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed bariatric procedures. Furthermore, severe weight loss is associated with high marrow adipose tissue (MAT); however, MAT is also increased in visceral adiposity. The purpose of our study was to determine the effects of RYGB and SG on BMD and MAT. We hypothesized that both bariatric procedures would lead to a decrease in BMD and MAT. We studied 21 adults with morbid obesity (mean BMI 44.1±5.1kg/m2) prior to and 12months after RYGB (n=11) and SG (n=10). All subjects underwent DXA and QCT of the lumbar spine and hip to assess aBMD and vBMD. Visceral (VAT) and subcutaneous (SAT) adipose tissue was quantified at L1-L2. MAT of the lumbar spine and femur was assessed by 1H-MR spectroscopy. Calcitropic hormones and bone turnover markers were determined. At 12months after surgery, mean weight and abdominal fat loss was similar between the RYGB and SG groups. Mean serum calcium, 25(OH)-vitamin D, and PTH levels were unchanged after surgery and within the normal range in both groups. Bone turnover markers P1NP and CTX increased within both groups and P1NP increased to a greater extent in the RYGB group (p=0.03). There were significant declines from baseline in spine aBMD and vBMD within the RYGB and SG groups, although the changes were not significantly different between groups (p=0.3). Total hip and femoral neck aBMD by DXA decreased to a greater extent in the RYGB than the SG group (p<0.04) although the change in femoral vBMD by QCT was not significantly different between groups (p>0.2). MAT content of the lumbar spine and femoral diaphysis did not change from baseline in the RYGB group but increased after SG (p=0.03). Within the SG group, 12-month change in weight and VAT were positively associated with 12-month change in MAT (p<0.04), suggesting that subjects with less weight and VAT loss had higher MAT. In conclusion, RYGB and SG are associated with declines in lumbar spine BMD, however, the changes are not significantly different between the groups. RYGB may be associated with greater decline of aBMD at the total hip and femoral neck compared to SG. MAT content increased after SG and this was associated with lower weight and VAT loss.
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Affiliation(s)
- Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Logan B Greenblatt
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alireza Eajazi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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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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