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. 2024 Apr;34(4):2437-2444.
doi: 10.1007/s00330-023-10189-y. Epub 2023 Sep 11.

Longitudinal MR-based proton-density fat fraction (PDFF) and T2* for the assessment of associations between bone marrow changes and myelotoxic chemotherapy

Felix G Gassert  1 , Julia Kranz  2 , Florian T Gassert  2 , Benedikt J Schwaiger  2   3 , Christian Bogner  4 , Marcus R Makowski  2 , Leander Glanz  2 , Jonathan Stelter  2 , Thomas Baum  3 , Rickmer Braren  2 , Dimitrios C Karampinos  2 , Alexandra S Gersing  2   5
Affiliations

Longitudinal MR-based proton-density fat fraction (PDFF) and T2* for the assessment of associations between bone marrow changes and myelotoxic chemotherapy

Felix G Gassert et al. Eur Radiol. 2024 Apr.

Abstract

Objectives: MR imaging-based proton density fat fraction (PDFF) and T2* imaging has shown to be useful for the evaluation of degenerative changes in the spine. Therefore, the aim of this study was to investigate the influence of myelotoxic chemotherapy on the PDFF and T2* of the thoracolumbar spine in comparison to changes in bone mineral density (BMD).

Methods: In this study, 19 patients were included who had received myelotoxic chemotherapy (MC) and had received a MR imaging scan of the thoracolumbar vertebrates before and after the MC. Every patient was matched for age, sex, and time between the MRI scans to two controls without MC. All patients underwent 3-T MR imaging including the thoracolumbar spine comprising chemical shift encoding-based water-fat imaging to extract PDFF and T2* maps. Moreover, trabecular BMD values were determined before and after chemotherapy. Longitudinal changes in PDFF and T2* were evaluated and compared to changes in BMD.

Results: Absolute mean differences of PDFF values between scans before and after MC were at 8.7% (p = 0.01) and at -0.5% (p = 0.57) in the control group, resulting in significantly higher changes in PDFF in patients with MC (p = 0.008). BMD and T2* values neither showed significant changes in patients with nor in those without myelotoxic chemotherapy (p = 0.15 and p = 0.47). There was an inverse, yet non-significant correlation between changes in PDFF and BMD found in patients with myelotoxic chemotherapy (r = -0.41, p = 0.12).

Conclusion: Therefore, PDFF could be a useful non-invasive biomarker in order to detect changes in the bone marrow in patients receiving myelotoxic therapy.

Clinical relevance statement: Using PDFF as a non-invasive biomarker for early bone marrow changes in oncologic patients undergoing myelotoxic treatment may help enable more targeted countermeasures at commencing states of bone marrow degradation and reduce risks of possible fragility fractures.

Key points: Quantifying changes in bone marrow fat fraction, as well as T2* caused by myelotoxic pharmaceuticals using proton density fat fraction, is feasible. Proton density fat fraction could potentially be established as a non-invasive biomarker for early bone marrow changes in oncologic patients undergoing myelotoxic treatment.

Keywords: Bone density; Drug therapy; Magnetic resonance imaging; Spine.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Axial slice of the lumbar spine showing the proton-density fat fraction of a patient before (A) and 6 months after (B) myelotoxic chemotherapy as well as patient without myelotoxic chemotherapy at baseline (C) and at 6-month follow-up (D)
Fig. 2
Fig. 2
Axial slice of the lumbar spine showing T2* maps (in ms) of a patient before (A) and 6 months after (B) myelotoxic chemotherapy as well as a patient without myelotoxic chemotherapy at baseline (C) and at 6-month follow-up (D)
Fig. 3
Fig. 3
Absolute (A, B, C) and relative (D, E, F) differences in PDFF (A, D) and BMD (B, E) and T2* (C, F) between patients with and without myelotoxic chemotherapy. Myelotox = myelotoxic; CTx = chemotherapy; PDFF = Proton density fat fraction; BMD = Bone mineral density
Fig. 4
Fig. 4
Scatterplot of the correlation of relative differences in PDFF and BMD in patients with myelotoxic chemotherapy. PDFF = Proton density fat fraction; BMD = Bone mineral density
See this image and copyright information in PMC

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