Magnetic Resonance Imaging of the Bone Marrow following Treatment with Recombinant Human Erythropoietin in Patients with End-Stage Renal Disease

Jensen, Karl Erik; Stenver, Doris I.; Jensen, Mikael; Sørensen, P. G.; Karle, Hans; Thomsen, Carsten; Henriksen, O.; Nielsen, Bent

doi:10.1177/039139889001300806

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…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).…”

supporting

confidence: 53%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Altehoefer

Schmid

Büchert

et al. 2002

Magnetic Resonance Imaging

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Purpose: To prospectively evaluate hematopoietic bone marrow of male professional cyclists in relation to performance data and laboratory data, and in comparison to age-matched healthy volunteers. Materials and Methods:Twenty male cyclists and 44 volunteers (27 males and 17 females) were prospectively studied by magnetic resonance imaging (MRI) at high-field strength. A sagittal T1-weighted (T1-w) spin-echo (SE) sequence, a gradient-echo (GE) sequence with an echo time (TE) for out-of-phase (OOP) imaging, and a turbo inversionrecovery sequence with short inversion time (TIRM) for fat suppression was used. The averaged bone marrow signal intensity (SI) of three adjacent vertebrae was related to the signal of an adjacent nondegenerative disk. Results:The cyclists revealed a significantly different SI as compared to male volunteers in the OOP (0.34 Ϯ 0.14 vs. 0.28 Ϯ 0.09, P Ͻ 0.05) and T1-w sequences (1.62 Ϯ 0.19 vs. 1.77 Ϯ 0.30, P Ͻ 0.05). Only in TIRM was there a significant difference compared to female volunteers (0.36 Ϯ 0.08 vs. 0.44 Ϯ 0.04, P Ͻ 0.01). MRI data of cyclists did not correlate to hemoglobin, erythrocyte, or reticulocyte counts; ferritin, relative heart volume, relative maximal power (rPmax; W/kg bw), or relative maximal oxygen consumption (VO 2 max). A borderline linear correlation was found for hematocrit (OOP: r ϭ 0.42, P ϭ 0.06; TIRM: r ϭ 0.44, P ϭ 0.06). Conclusion:Bone marrow hyperplasia is observed in male professional cyclists in the axial skeleton. The MR findings are probably independent of mechanically induced marrow edema. A multifactorial cause must be considered, as single laboratory and performance data did not appear to contribute significantly to these results.

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supporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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

Altehoefer

Schmid

Büchert

et al. 2002

Magnetic Resonance Imaging

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“…Leukemia, multiple myeloma, and marrow infiltration in patients with carcinoma are diseases that cause an increase in the cell count of the hematopoietic bone marrow [1][2][3][4]. Similar observations have been reported after application of hematopoietic growth factors like recombinant human granulocyte colony stimulating factor (rHuG-CSF) or recombinant hematopoietic growth factor erythropoietin (rHuEpo) described in our study [5,6]. It is essentially to know that these factors may cause an augmentation in marrow cellularity and tissue water so that the signal increases in turbo inversion-recovery sequence with short inversion time (Turbo-STIR), and decreases in T1-weighted spine-echo sequences [7].…”

Section: Introductionsupporting

confidence: 85%

“…It also seems a valuable diagnostic tool for evaluating the response to chemotherapy [5,9,18] and the response to epoietin and rHuG-CSF therapy [2,6,9,19,20], yielding additional information on prognosis and patient outcome [3,4,17]. However, sex-related differences and factors such as smoking and surgical intervention influence the bone marrow compound of the lumbar spine and lead to reconversion [9,15,16,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…RHuEpo stimulates and modulates the terminal survival and growth of CFU-E, the proliferation of proerythroblasts and basophile erythroblasts [11,12]. It is used to treat severe anemia caused for example by end-stage kidney failure, tumor or chemotherapy-induced anemia, in order to improve quality of life [6,[11][12][13]. The target organ of erythropoietin is the bone marrow.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative and Semiquantitative Evaluation of Erythropoietin-Induced Bone Marrow Signal Changes in Lumbar Spine MRI in Patients with Tumor Anemia

Ghanem

Lerche²,

Lohrmann³

et al. 2007

Oncol Res Treat

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The topic of this article is the quantitative and semiquantitative assessment of bone marrow signal alteration in magnetic resonance imaging (MRI) of the lumbar spine in patients with tumor anemia during therapy with epoietin β or placebo. Patients and Methods: We examined 32 patients with head or neck cancer (16 epoietin β, 16 placebo) during radiotherapy in a doubleblind multicenter trial. During radiotherapy, the patients underwent epoietin β therapy for 7-9 weeks. Lumbar spine measurements using T1-w SE, OPP and Turbo- STIR were taken prior to the first epoietin ß or placebo therapy, after the acquired hemoglobin level had been reached, and after the final radiotherapy. The semiquantitative assessment was made blinded by 2 independent radiologists. Results: We found significant differences between both groups. The first MRI showed normal marrow signals. The second MRI revealed a quantified decrease in bone marrow signal in T1-w SE (p < 0.018) and an increase in OPP (p < 0.01) and Turbo-TIR (p < 0.048) sequences. At the third MR imaging, quantified relative marrow signals returned to baseline level in all sequences. Semiquantitative assessment confirmed these results. Conclusion: In both analyses, lumbar spine MRI demonstrates significant bone marrow changes in T1-w SE, OPP and Turbo-STIR sequences during epoietin ß therapy.

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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

Altehoefer

Bertz

Ghanem

et al. 2001

Magnetic Resonance Imaging

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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.

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Magnetic Resonance Imaging of the Bone Marrow following Treatment with Recombinant Human Erythropoietin in Patients with End-Stage Renal Disease

Cited by 7 publications

References 11 publications

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

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

Quantitative and Semiquantitative Evaluation of Erythropoietin-Induced Bone Marrow Signal Changes in Lumbar Spine MRI in Patients with Tumor Anemia

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

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