Extent and time course of morphological changes of bone marrow induced by granulocyte‐colony stimulating factor as assessed by magnetic resonance imaging of healthy blood stem cell donors

Abstract

The aim of this study was to assess the time course and extent of signal alterations of red bone marrow after shortterm stimulation by recombinant human granulocyte-colony stimulating factor (rHuG-CSF) in healthy peripheral blood stem cell donors using magnetic resonance imaging (MRI) at low-field strength. Twelve healthy blood stem cell donors without evidence of bone marrow disorders were prospectively investigated and underwent four MRI studies of their lumbar spine. Sagittal T1-and T2-weighted spin-echo sequences and a gradient-echo (GE) sequence with an echo time for out-of-phase imaging were performed prior to rHuG-CSF application (baseline MRI), on the day of first stem cell harvest (after 70 g/kg body weight rHuG-CSF, second MRI) followed by two studies 9 -18 days (median 14.5 days, third MRI) and 26 -48 days (median 39.5 days, fourth MRI) after discontinuation of rHuG-CSF application. Baseline MRI showed normal marrow signal in all patients. The second MRI revealed a decrease of quantified bone marrow signal relative to nucleus pulposus in T1-and T2-weighted images and an increase of relative signal in out-of-phase GE sequences. The greatest changes of relative marrow signal were observed at the third MRI. Compared to baseline MRI, relative marrow signal was diminished by 12% in T1-weighted images and increased by 59% in GE sequences, consistent with a rise in marrow cellularity simulating diffuse marrow disease. At the fourth MRI quantified relative marrow signal returned to baseline levels in all sequences. In healthy individuals rHuG-CSF application leads to significant signal changes of bone marrow in lumbar vertebra that are maximal about 2 weeks after discontinuation of rHuG-CSF application. In patients with underlying marrow disorders who receive hematopoietic growth factors during treatment, these changes should not be confused with disease progression.

Characterization of hematopoietic bone marrow in male professional cyclists by magnetic resonance imaging of the lumbar spine

“…Similar observations have been reported in healthy blood stem cell donors after application of hematopoietic growth factors (4,8). The underlying process of a relative increase of the water fraction in relation to the fatty component is similar for hematological diseases and stimulated hematopoiesis (1,4). Opposedphase gradient-echo (GE) sequences are sensitive to changes of the fat-to-water ratio (9) and are therefore especially suitable for imaging bone marrow (10).…”

“…Due to the rise in marrow cellularity, the signal intensity (SI) increases in turbo inversion-recovery sequence with short inversion time (TIRM) images and decreases in T1-weighted (T1-w) spin-echo (SE) sequences (7). Similar observations have been reported in healthy blood stem cell donors after application of hematopoietic growth factors (4,8). The underlying process of a relative increase of the water fraction in relation to the fatty component is similar for hematological diseases and stimulated hematopoiesis (1,4).…”

“…Factors that are assumed to stimulate hematopoiesis include anemia, low oxygen tension, temperature, altered vascularity, and cigarette smoking (3,(11)(12)(13). Both erythropoietin and G-CSF have been shown to alter the MRI appearance of bone marrow consistent with hematopoietic hyperplasia (4,8). Shellock et al (11) reported a frequency of 43% (10/23) of hematopoietic hyperplasia in the distal femur of marathon runners as compared to 3% in normal subjects.…”

“…Diseases that cause an increase of the cell count in hematopoietic bone marrow lead to chararcteristic MRI patterns (4). These include leukemia (5), multiple myeloma (6), and diffuse marrow infiltration in patients with carcinoma.…”

Female Pelvis: Genital Organs

“…Very few prospective studies investigated post-chemo MR signal changes. Altehoefer et al found a signifi cant 33 % increase in signal intensity on STIR images at the fi rst scan, 26 days following induction chemotherapy, refl ecting temporary bone marrow edema, normalizing shortly after peripheral stem cell transplantation and G-CSF (Altehoefer et al 1997(Altehoefer et al , 2001 ). Within 1-2 weeks, chemotherapy causes a myeloid depletion with a decrease in marrow cellularity and fatty marrow replacement with an increase in signal intensity on T1-weighted images and a low signal intensity on fat-suppressed sequences.…”