Perfusion parameters analysis of the vertebral bone marrow in patients with Ph¹⁻ chronic myeloproliferative neoplasms (Ph^negMPN): A dynamic contrast‐enhanced MRI (DCE‐MRI) study

Abstract

Purpose: To evaluate perfusion parameters of the vertebral bone marrow in patients with Philadelphia negative chronic myeloproliferative neoplasms (Ph neg MPN) using dynamic contrast-enhanced MRI (DCE-MRI). Materials and Methods:The study enrolled 24 patients with Ph neg MPN: 12 patients with myelofibrosis (Group A), 6 with essential thrombocythemia (ET), and 6 with polycythemia vera (PV) (Group B) who underwent DCE-MRI of the lumbosacral spine. Twelve normal individuals served as control group (Group C). Wash-in (WIN), wash-out (WOUT), maximum contrast-enhancement (CE max ), timeto-peak (TTPK), time-to-maximum slope (TMSP), and the WIN/TMSP ratio (WTSP) were calculated.Results: WIN, CE max , and WTSP parameters were higher in Group A than in Group C (P < 0.05). These parameters were significant (P < 0.0001) in discriminating patients with myelofibrosis from normal individuals with sensitivities 74.14%, 87.93%, 74.14%, and specificities 91.07%, 83.93%, 91.07%, respectively. WIN, WOUT, CE max , and WTSP parameters were higher in Group A than in Group B (P < 0.05). Group B exhibited no differences in perfusion parameters as compared with Group C with the exception of WOUT. Conclusion:Patients with myelofibrosis exhibited increased perfusion parameters in vertebral bone marrow, which could be consisted with increased vascularity, probably related to neoangiogenesis as opposed to ET or PV patients showing no increased perfusion. DCE-MRI may be of value in discriminating subgroups of Ph neg MPN patients and in indicating those progressing to myelofibrosis.

Quantitative Dynamic Contrast-Enhanced MRI of Pelvic and Lumbar Bone Marrow: Effect of Age and Marrow Fat Content on Pharmacokinetic Parameter Values

“…Several examples of the potential utility of DCE-MRI in diseased marrow include providing prognostic data in the setting of acute myeloid leukemia (AML) [5][6][7][8], predicting progression to myelofibrosis in patients with myeloproliferative neoplasms [9], and establishing disease involvement and monitoring response to chemotherapy in patients with multiple myeloma [10,11]. Consensus recommendations for the use of DCE-MRI include using a voxel-by-voxel analysis with K trans (transfer constant; units, min −1 ) and i AUGC (initial area under the gadolinium curve) as primary endpoints [19].…”

A Pilot Study of Quantitative MRI Parametric Response Mapping of Bone Marrow Fat for Treatment Assessment in Myelofibrosis

“…Resolution of bone marrow fibrosis and osteosclerosis by MRI also correlated with successful outcomes of stem cell transplants. In addition, dynamic contrast-enhanced MRI of the lumbosacral spine distinguished patients with MF from those with PV and ET on the basis of greater perfusion of bone marrow in patients with MF, which was attributed to neoangiogenesis ( 44 ).…”

Recent developments in myelofibrosis

“…Rarely a hypercellular marrow pathology with little fibrosis is encountered. Magnetic resonance imaging or isotopic marrow imaging can be employed, 69 but is rarely used by the authors' group. Fibrosis is more commonly found with certain molecular aberrations including the JAK2V617F mutation, 13q deletion, and trisomy 9.…”