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

Usefulness of fat-containing agents: an initial study on estimating fat content for magnetic resonance imaging

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.

Validation and Optimization of Proximal Femurs Microstructure Analysis Using High Field and Ultra-High Field MRI

Trabecular bone could be assessed non-invasively using MRI. However, MRI does not yet provide resolutions lower than trabecular thickness and a comparative analysis between different MRI sequences at different field strengths and X-ray microtomography (μCT) is still missing. In this study, we compared bone microstructure parameters and bone mineral density (BMD) computed using various MRI approaches, i.e., turbo spin echo (TSE) and gradient recalled echo (GRE) images used at different magnetic fields, i.e., 7T and 3T. The corresponding parameters computed from μCT images and BMD derived from dual-energy X-ray absorptiometry (DXA) were used as the ground truth. The correlation between morphological parameters, BMD and fracture load assessed by mechanical compression tests was evaluated. Histomorphometric parameters showed a good agreement between 7T TSE and μCT, with 8% error for trabecular thickness with no significative statistical difference and a good intraclass correlation coefficient (ICC > 0.5) for all the extrapolated parameters. No correlation was found between DXA-BMD and all morphological parameters, except for trabecular interconnectivity (R2 > 0.69). Good correlation (p-value < 0.05) was found between failure load and trabecular interconnectivity (R2 > 0.79). These results suggest that MRI could be of interest for bone microstructure assessment. Moreover, the combination of morphological parameters and BMD could provide a more comprehensive view of bone quality.

Survey of MRI Usefulness for the Clinical Assessment of Bone Microstructure

Bone microarchitecture has been shown to provide useful information regarding the evaluation of skeleton quality with an added value to areal bone mineral density, which can be used for the diagnosis of several bone diseases. Bone mineral density estimated from dual-energy X-ray absorptiometry (DXA) has shown to be a limited tool to identify patients' risk stratification and therapy delivery. Magnetic resonance imaging (MRI) has been proposed as another technique to assess bone quality and fracture risk by evaluating the bone structure and microarchitecture. To date, MRI is the only completely non-invasive and non-ionizing imaging modality that can assess both cortical and trabecular bone in vivo. In this review article, we reported a survey regarding the clinically relevant information MRI could provide for the assessment of the inner trabecular morphology of different bone segments. The last section will be devoted to the upcoming MRI applications (MR spectroscopy and chemical shift encoding MRI, solid state MRI and quantitative susceptibility mapping), which could provide additional biomarkers for the assessment of bone microarchitecture.

Management of primary and secondary osteoporosis in children

Osteoporosis in children differs from adults in terms of definition, diagnosis, monitoring and treatment options. Primary osteoporosis comprises primarily of osteogenesis imperfecta (OI), but there are significant other causes of bone fragility in children that require treatment. Secondary osteoporosis can be a result of muscle disuse, iatrogenic causes, such as steroids, chronic inflammation, delayed or arrested puberty and thalassaemia major. Investigations involve bone biochemistry, dual-energy X-ray absorptiometry scan for bone densitometry and vertebral fracture assessment, radiographic assessment of the spine and, in some cases, quantitative computed tomography (QCT) or peripheral QCT. It is important that bone mineral density (BMD) results are adjusted based on age, gender and height, in order to reflect size corrections in children. Genetics are being used increasingly for the diagnosis and classification of various cases of primary osteoporosis. Bone turnover markers are used less frequently in children, but can be helpful in monitoring treatment and transiliac bone biopsy can assist in the diagnosis of atypical cases of osteoporosis. The management of children with osteoporosis requires a multidisciplinary team of health professionals with expertise in paediatric bone disease. The prevention and treatment of fragility fractures and improvement of the quality of life of patients are important aims of a specialised service. The drugs used most commonly in children are bisphosphonates, that, with timely treatment, can give good results in improving BMD and reshaping vertebral fractures. The data regarding their effect on reducing long bone fractures are equivocal. Denosumab is being used increasingly for various conditions with mixed results. There are more drugs trialled in adults, but these are not yet licenced for children. Increasing awareness of risk factors for paediatric osteoporosis, screening and referral to a specialist team for appropriate management can lead to early detection and treatment of asymptomatic fractures and prevention of further bone damage.

T2, Carr-Purcell T2 and T1rho of fat and water as surrogate markers of trabecular bone structure

Magnetic resonance imaging (MRI) techniques have been developed for non-invasive assessment of the structural properties of trabecular bone. These measurements, however, suffer from relatively long acquisition times and low resolution compared to the trabecular size. Spectroscopic measurement of relaxation times could be applied for more detailed and faster assessment of relaxation properties of bone marrow and also provide surrogate information on trabecular structure. In the present study, bovine trabecular bone was investigated with spectroscopic NMR (nuclear magnetic resonance) methods to determine the relationship between structural parameters as measured with micro-CT and T(2), Carr-Purcell T(2) and T(1rho) relaxation times of fat and water. To compare bone with a sample matrix with magnetic susceptibility interfaces, phantoms consisting of glass beads with different diameters in oil or water were used. The behavior of T(2) measured with different sequences and T(1rho) at different magnitudes of spin-lock fields were characterized, and relaxation times were correlated with structural parameters. T(2) and T(1rho) showed significant associations with structural bone parameters. Strongest linear correlations (r = 0.81, p < 0.01) were established between R(1rho) (1/T(1rho)) of fat component and structural model index. For glass beads, the behavior of T(2) and T(1rho) was similar to that of the water compartment of bone marrow. The present results suggest feasibility of spectroscopic NMR measurements to assess trabecular structure. However, further studies are required to determine the sensitivity of this approach to fat content of bone marrow and to lower the field strengths used in clinical devices.

Quantitative MRI of parallel changes of articular cartilage and underlying trabecular bone in degeneration

OBJECTIVE

To determine the interrelations between degenerative changes in articular cartilage and underlying trabecular bone during development of osteoarthritis and to test the ability of quantitative magnetic resonance imaging (MRI) to detect those changes.

METHODS

Human cadaver patellae were investigated with quantitative MRI methods, T(2) and dGEMRIC, at 1.5T. Same measurements for isolated cartilage samples were performed at 9.4T. Bone samples, taken at sites matched with cartilage analyses, were measured with MRI and peripheral quantitative computed tomography (pQCT). Mechanical and quantitative microscopic methods were also utilized for both cartilage and bone samples.

RESULTS

Significant differences were found between the samples with different stages of degeneration in mechanical properties, T(2) at 1.5T and proteoglycan (PG) content of articular cartilage. dGEMRIC at 9.4T discerned samples with advanced degeneration from the others. Bone variables measured with pQCT discerned samples with no or minimal and advanced degeneration, and mechanical properties of trabecular bone discerned samples with no or minimal degeneration from the others. Significant linear correlations were found between the bone and cartilage parameters. Characteristically, associations between variables were stronger within the samples with no or minimal degeneration compared to all samples.

CONCLUSIONS

Quantitative MRI variables, especially T(2) relaxation time of articular cartilage, may be feasible surrogate markers for early and advanced osteoarthritic changes in joint tissues, including decreased elastic moduli, PG and collagen contents of cartilage and mineral density and volume fraction of trabecular bone. Further work is required to resolve the relaxation mechanisms at clinically applicable field strengths.

Prediction of mechanical properties of trabecular bone using quantitative MRI

Techniques for quantitative magnetic resonance imaging (MRI) have been developed for non-invasive estimation of the mineral density and structure of trabecular bone. The R*(2) relaxation rate (i.e. 1/T*(2)) is sensitive to bone mineral density (BMD) via susceptibility differences between trabeculae and bone marrow, and by binarizing MRI images, structural variables, such as apparent bone volume fraction, can be assessed. In the present study, trabecular bone samples of human patellae were investigated in vitro at 1.5 T to determine the ability of MRI-derived variables (R*(2) and bone volume fraction) to predict the mechanical properties (Young's modulus, yield stress and ultimate strength). Further, the MRI variables were correlated with reference measurements of volumetric BMD and bone area fraction as determined with a clinical pQCT system. The MRI variables correlated significantly (p < 0.01) with the mechanical variables (r = 0.32-0.46), BMD (r = 0.56) and bone structure (r = 0.51). A combination of R*(2) and MRI-derived bone volume fraction further improved the prediction of yield stress and ultimate strength. Although pQCT showed a trend towards better prediction of the mechanical properties, current results demonstrate the feasibility of combined MR imaging of marrow susceptibility and bone volume fraction in predicting the mechanical strength of trabecular bone and bone mineral density.

Estimation of femoral head bone density using magnetic resonance imaging: comparison between men with and without hip osteoarthritis

Bone changes are thought to be one important etiological element in the pathogenesis of hip osteoarthritis (OA). The magnetic resonance imaging (MRI)-derived T2* relaxation time has been shown to provide information about bone mineral status of the femoral neck. The aim of this study was to test the hypothesis that the MRI-derived T2* relaxation time of the proximal femur in hip OA differs from that seen in healthy subjects. Based on the American College of Rheumatology criteria regarding classification of the OA of the hip, 27 men (aged 47-64 yr) with unilateral or bilateral hip OA and 30 age-matched randomly selected healthy men were studied. Bone mineral density (BMD), bone mineral content (BMC), and bone width of the femoral neck were measured with dual-energy X-ray absorptiometry (DXA). Subsequently, T2* measurements were performed with a 1.5-T scanner (Siemens Magnetom 63SP; Erlangen, Germany). A single 10-mm-thick coronal slice was generated on the femur, with a repetition time of 60 ms and nine echo times (4-20 ms) to derive T2* values. T2* measurements were performed from the different region of interests (ROIs) from the femoral neck and head. T2* relaxation times showed significant negative correlations with BMC, BMD (r = -0.401 to -0.794; p < 0.05-0.001). T2* relaxation time values revealed no significant differences between the groups in the femoral neck and in the head of the femur, whereas it was 12% lower (p < 0.01) in OA subjects than in controls in acetabulum. There were no significant differences in the T2* relaxation time values between the radiographic OA subgroups. Our findings suggest that hip OA is not associated with an increase of BMD in the femoral neck or in the head of the femur.