Bone Marrow Lipid Profiles from Peripheral Skeleton as Potential Biomarkers for Osteoporosis: A 1H-MR Spectroscopy Study

Pietro, Giulia Di; Capuani, Silvia; Manenti, Guglielmo; Vinicola, V.; Fusco, Alfredo; Baldi, Jacopo; Scimeca, Manuel; Hagberg, Gisela E.; Bozzali, Marco; Simonetti, Giovanni; Tarantino, Umberto

doi:10.1016/j.acra.2015.11.009

Cited by 50 publications

(49 citation statements)

References 49 publications

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“…We believe that the lower MUFA and PUFA and higher SFA marrow fat levels in GIO subjects compared with OP subjects is related to the GC use rather than younger age of the GIO subjects compared with the OP subjects. Recent studies have shown that lower unsaturated lipid content in the femoral neck is associated with higher age and lower BMD T‐scores . We also note that because the two groups in this study did not differ significantly in terms of BMD T‐scores or FRAX scores, then the detrimental effects of GC use on bone health may not be fully captured by the standard clinical tests of DXA and FRAX.…”

Section: Discussionmentioning

confidence: 52%

3T chemical shift‐encoded MRI: Detection of altered proximal femur marrow adipose tissue composition in glucocorticoid users and validation with magnetic resonance spectroscopy

Martel

Leporq

Saxena

et al. 2018

Magnetic Resonance Imaging

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Background Osteoporosis (OP) results in weak bone and can ultimately lead to fracture. Drugs such as glucocorticoids can also induce OP (glucocorticoid‐induced osteoporosis [GIO]). Bone marrow adipose tissue composition and quantity may play a role in OP pathophysiology, but has not been thoroughly studied in GIO compared to primary OP. Purpose/Hypothesis Chemical shift‐encoded (CSE) MRI allows detection of subregional differences in bone marrow adipose tissue composition and quantity in the proximal femur of GIO compared to OP subjects and has high agreement with the reference standard of magnetic resonance spectroscopy (MRS). Study Type Prospective. Subjects In all, 18 OP and 13 GIO subjects. Fields Strength 3T. Sequence Multiple gradient‐echo, stimulated echo acquisition mode (STEAM). Assessment Subjects underwent CSE‐MRI in the proximal femurs, and for each parametric map regions of interest (ROIs) were assessed in the femoral head (fHEAD), femoral neck (fNECK), Ward's triangle (fTRIANGLE), and the greater trochanter (GTROCH). In addition, we compared CSE‐MRI against the reference standard of MRS performed in the femoral neck and Ward's triangle. Statistical Tests Differences between OP/GIO were investigated using the Mann–Whitney nonparametric test. Bland–Altman methodology was used to assess measurement agreement between CSE‐MRI and MRS. Results GIO compared with OP subjects demonstrated: decreased monounsaturated fat fraction (MUFA) (–2.1%, P < 0.05) in fHEAD; decreased MUFA (–3.8%, P < 0.05), increased saturated fat fraction (SFA) (5.5%, P < 0.05), and decreased normalT2* (–3.8 msec, P < 0.05) in fNECK; decreased proton density fat fraction (PDFF) (–15.1%, P < 0.05), MUFA (–9.8%, P < 0.05), polyunsaturated fat fraction (PUFA) (–1.8%, P < 0.01), increased SFA (11.6%, P < 0.05), and decreased normalT2* (–5.4 msec, P < 0.05) in fTRIANGLE; and decreased normalT2* (–1.5 msec, P < 0.05) in GTROCH. There was high measurement agreement between MRI and MRS using the Bland–Altman test. Data Conclusion 3T CSE‐MRI may allow reliable assessment of subregional bone marrow adipose tissue (bMAT) quantity and composition in the proximal femur in a clinically reasonable scan time. Glucocorticoids may alter the lipid profile of bMAT and potentially result in reduced bone quality. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:490–496.

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Section: Discussionmentioning

confidence: 52%

3T chemical shift‐encoded MRI: Detection of altered proximal femur marrow adipose tissue composition in glucocorticoid users and validation with magnetic resonance spectroscopy

Martel

Leporq

Saxena

et al. 2018

Magnetic Resonance Imaging

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“…The utility of the 4–4.5 ppm triglyceride glycerol methylene protons in fat composition assessment, for example in the study of osteoporosis, is emerging. In addition, there is potential for the resonance to provide information on free fatty acid to triglyceride content, which has shown relevance in disease .…”

Section: Discussionmentioning

confidence: 99%

“…Like the methyl group, triglycerides contain a fixed number of glycerol protons (four protons from the two glycerol CH 2 groups); therefore, they provide a suitable reference signal in tissue primarily composed of triglycerides such as bone marrow . A recent in vivo 3 T MRS study using a short echo time (TE) point resolved spectroscopy (PRESS) sequence demonstrated significant differences between femoral neck bone marrow glycerol methylene signals of healthy volunteers and osteoporotic patients . In addition, methylene to glycerol CH 2 ratios measured from calcaneus bone marrow enabled osteopenic bone to be distinguished from osteoporotic .…”

Section: Introductionmentioning

confidence: 99%

“…A recent in vivo 3 T MRS study using a short echo time (TE) point resolved spectroscopy (PRESS) sequence demonstrated significant differences between femoral neck bone marrow glycerol methylene signals of healthy volunteers and osteoporotic patients . In addition, methylene to glycerol CH 2 ratios measured from calcaneus bone marrow enabled osteopenic bone to be distinguished from osteoporotic . However, the study acknowledged that water signal (≈4.7 ppm) overlapping the glycerol CH 2 resonances may have affected its quantification.…”

Section: Introductionmentioning

confidence: 99%

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Long TE PRESS and STEAM for measuring the triglyceride glycerol CH₂ protons at 3 T

2018

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The glycerol methylene proton resonances (4–4.5 parts per million, ppm), which arise from the triglyceride backbone, are relevant to fat composition assessment and can be measured with proton MRS. The purpose of the presented work is to determine long TE (echo time) point resolved spectroscopy (PRESS) and stimulated echo acquisition mode (STEAM) values at 3 T to resolve the glycerol resonances from that of overlapping water. The response of the glycerol methylene protons of nine edible oils as a function of PRESS and STEAM TE (mixing time, TM = 20 ms) was investigated. In addition, high resolution NMR spectra of the oils were acquired at 16.5 T. Long TE values where J‐coupling losses were lowest were selected, namely a TE of 180 ms for PRESS (first echo time 17 ms) and a TE of 100 ms for STEAM (mixing time 20 ms). Oil olefinic (≈5.4 ppm) to glycerol ratios were calculated from the long TE spectra and correlated with 16.5 T ratios. The two techniques yielded olefinic/glycerol ratios that correlated with 16.5 T ratios (R2 = 0.79 for PRESS and 0.90 for STEAM). The efficacy of the sequences in resolving the glycerol resonance from that of water was verified in vivo on tibial bone marrow of four healthy volunteers. In addition, the potential for using the glycerol methylene signal normalized to the methyl signal (≈0.9 ppm) to assess changes in free fatty acid content was demonstrated by measuring differences in spectra acquired from a triglyceride peanut oil phantom and from a phantom composed of a mixture of peanut oil and free fatty acid oleic acid.

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“…Although this review focuses on the advancements on in vivo MRI of bone microarchitecture and structure over the last decade, we do note that important progress has also been made on using MRI as a tool to evaluate bone physiology. In particular, there has been increasing literature on the use of MRI to quantitatively assess marrow fat content and composition using spectroscopy and chemical shift‐based methods . The development of such methods is important because marrow fat may serve as a risk factor for osteoporosis independent of bone mineral density .…”

Section: Technical Advances Over the Last Decadementioning

confidence: 99%

MRI assessment of bone structure and microarchitecture

Chang

Boone

Martel

et al. 2017

Magnetic Resonance Imaging

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Osteoporosis is a disease of weak bone and increased fracture risk caused by low bone mass and microarchitectural deterioration of bone tissue. The standard-of-care test used to diagnose osteoporosis, dual-energy x-ray absorptiometry (DXA) estimation of areal bone mineral density (BMD), has limitations as a tool to identify patients at risk for fracture and as a tool to monitor therapy response. Magnetic resonance imaging (MRI) assessment of bone structure and microarchitecture has been proposed as another method to assess bone quality and fracture risk in vivo. MRI is advantageous because it is noninvasive, does not require ionizing radiation and can evaluate both cortical and trabecular bone. In this review article, we summarize and discuss research progress on MRI of bone structure and microarchitecture over the last decade, focusing on in vivo translational studies. Single center, in vivo studies have provided some evidence for the added value of MRI as a biomarker of fracture risk or treatment response. Larger, prospective, multicenter studies are needed in the future to validate the results of these initial translational studies.

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Bone Marrow Lipid Profiles from Peripheral Skeleton as Potential Biomarkers for Osteoporosis: A 1H-MR Spectroscopy Study

Cited by 50 publications

References 49 publications

3T chemical shift‐encoded MRI: Detection of altered proximal femur marrow adipose tissue composition in glucocorticoid users and validation with magnetic resonance spectroscopy

3T chemical shift‐encoded MRI: Detection of altered proximal femur marrow adipose tissue composition in glucocorticoid users and validation with magnetic resonance spectroscopy

Long TE PRESS and STEAM for measuring the triglyceride glycerol CH₂ protons at 3 T

MRI assessment of bone structure and microarchitecture

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Bone Marrow Lipid Profiles from Peripheral Skeleton as Potential Biomarkers for Osteoporosis: A 1H-MR Spectroscopy Study

Cited by 50 publications

References 49 publications

3T chemical shift‐encoded MRI: Detection of altered proximal femur marrow adipose tissue composition in glucocorticoid users and validation with magnetic resonance spectroscopy

3T chemical shift‐encoded MRI: Detection of altered proximal femur marrow adipose tissue composition in glucocorticoid users and validation with magnetic resonance spectroscopy

Long TE PRESS and STEAM for measuring the triglyceride glycerol CH2 protons at 3 T

MRI assessment of bone structure and microarchitecture

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Long TE PRESS and STEAM for measuring the triglyceride glycerol CH₂ protons at 3 T