Fat Quantification in the Vertebral Body: Comparison of Modified Dixon Technique with Single-Voxel Magnetic Resonance Spectroscopy

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Abstract

Objective

To compare the lumbar vertebral bone marrow fat-signal fractions obtained from six-echo modified Dixon sequence (6-echo m-Dixon) with those from single-voxel magnetic resonance spectroscopy (MRS) in patients with low back pain.

Materials and Methods

Vertebral bone marrow fat-signal fractions were quantified by 6-echo m-Dixon (repetition time [TR] = 7.2 ms, echo time (TE) = 1.21 ms, echo spacing = 1.1 ms, total imaging time = 50 seconds) and single-voxel MRS measurements in 25 targets (23 normal bone marrows, two focal lesions) from 24 patients. The point-resolved spectroscopy sequence was used for localized single-voxel MRS (TR = 3000 ms, TE = 35 ms, total scan time = 1 minute 42 seconds). A 2 × 2 × 1.5 cm ³ voxel was placed within the normal L2 or L3 vertebral body, or other lesions including a compression fracture or metastasis. The bone marrow fat spectrum was characterized on the basis of the magnitude of measurable fat peaks and a priori knowledge of the chemical structure of triglycerides. The imaging-based fat-signal fraction results were then compared to the MRS-based results.

Results

There was a strong correlation between m-Dixon and MRS-based fat-signal fractions (slope = 0.86, R ² = 0.88, p < 0.001). In Bland-Altman analysis, 92.0% (23/25) of the data points were within the limits of agreement. Bland-Altman plots revealed a slight but systematic error in the m-Dixon based fat-signal fraction, which showed a prevailing overestimation of small fat-signal fractions (< 20%) and underestimation of high fat-signal fractions (> 20%).

Conclusion

Given its excellent agreement with single-voxel-MRS, 6-echo m-Dixon can be used for visual and quantitative evaluation of vertebral bone marrow fat in daily practice.

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Most cited references 26

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Vertebral bone mineral density, marrow perfusion, and fat content in healthy men and men with osteoporosis: dynamic contrast-enhanced MR imaging and MR spectroscopy.

David Yeung, Mathew Griffith, Susan Wong … (2005)

To prospectively use hydrogen 1 (1H) magnetic resonance (MR) spectroscopy and dynamic contrast material-enhanced MR imaging to measure vertebral body marrow fat content and bone marrow perfusion in older men with varying bone mineral densities as documented with dual x-ray absorptiometry (DXA). This study had institutional review board approval, and all participants provided informed consent. DXA, 1H MR spectroscopy, and dynamic contrast-enhanced MR imaging of the lumbar spine were performed in 90 men (mean age, 73 years; range, 67-101 years). Vertebral marrow fat content and perfusion (maximum enhancement and enhancement slope) were compared for subject groups with differing bone densities (normal, osteopenic, and osteoporotic). The t test was used for comparisons between groups, and the Pearson test was used to determine correlation between marrow fat content and perfusion indexes. Eight subjects were excluded, yielding a final cohort of 82 subjects (mean age, 73 years; range, 67-101 years) that included 42 subjects with normal bone density (mean T score, 0.8 +/- 1.1 [standard deviation]), 23 subjects with osteopenia (mean T score, -1.6 +/- 0.4), and 17 subjects with osteoporosis (mean T score, -3.2 +/- 0.5). Vertebral marrow fat content was significantly increased in subjects with osteoporosis (mean fat content, 58.23% +/- 7.8) (P = .002) or osteopenia (mean fat content, 55.68% +/- 10.2) (P = .034) compared with that in subjects with normal bone density (50.45% +/- 8.7). Vertebral marrow perfusion indexes were significantly decreased in osteoporotic subjects (mean enhancement slope, 0.78%/sec +/- 0.3) compared with those in osteopenic subjects (mean enhancement slope, 1.15%/sec +/- 0.6) (P = .007) and those in subjects with normal bone density (mean enhancement slope, 1.48%/sec +/- 0.7) (P < .001). Subjects with osteoporosis have decreased vertebral marrow perfusion and increased marrow fat compared with these parameters in subjects with osteopenia. Similarly, subjects with osteopenia have decreased vertebral marrow perfusion and increased marrow fat compared with these parameters in subjects with normal bone density.

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Quantitative MRI and spectroscopy of bone marrow

Dimitrios C. Karampinos, Stefan Ruschke, Michael Dieckmeyer … (2017)

Bone marrow is one of the largest organs in the human body, enclosing adipocytes, hematopoietic stem cells, which are responsible for blood cell production, and mesenchymal stem cells, which are responsible for the production of adipocytes and bone cells. Magnetic resonance imaging (MRI) is the ideal imaging modality to monitor bone marrow changes in healthy and pathological states, thanks to its inherent rich soft‐tissue contrast. Quantitative bone marrow MRI and magnetic resonance spectroscopy (MRS) techniques have been also developed in order to quantify changes in bone marrow water–fat composition, cellularity and perfusion in different pathologies, and to assist in understanding the role of bone marrow in the pathophysiology of systemic diseases (e.g. osteoporosis). The present review summarizes a large selection of studies published until March 2017 in proton‐based quantitative MRI and MRS of bone marrow. Some basic knowledge about bone marrow anatomy and physiology is first reviewed. The most important technical aspects of quantitative MR methods measuring bone marrow water–fat composition, fatty acid composition, perfusion, and diffusion are then described. Finally, previous MR studies are reviewed on the application of quantitative MR techniques in both healthy aging and diseased bone marrow affected by osteoporosis, fractures, metabolic diseases, multiple myeloma, and bone metastases. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:332–353.

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Vertebral marrow fat content and diffusion and perfusion indexes in women with varying bone density: MR evaluation.

David Yeung, Samuel Leung, Jean Woo … (2006)

To prospectively study the relationship among vertebral marrow fat content, marrow diffusion indexes, and marrow and erector spinae muscle perfusion indexes in female subjects with varying bone mineral density. Institutional study approval and informed consent were obtained. Dual x-ray absorptiometry, proton magnetic resonance (MR) spectroscopy, diffusion-weighted MR imaging, and dynamic contrast material-enhanced MR imaging of the lumbar spine and erector spinae muscle were performed in 110 women (mean age, 73 years; range, 67-84 years). Marrow fat content, marrow apparent diffusion coefficient (ADC), and perfusion indexes (maximum enhancement and enhancement slope) of marrow and erector spinae muscle were compared among three bone density groups (normal, osteopenic, and osteoporotic). The t test comparisons and Pearson correlations were applied. Seven subjects were excluded, which yielded a final cohort of 103 subjects: 18 with normal bone density, 30 with osteopenia, and 55 with osteoporosis. Vertebral marrow fat content was significantly increased in the osteoporotic group (67.8% +/- 8.5 [standard deviation]) when compared with that of the normal bone density group (59.2% +/- 10.0, P = .002). Vertebral marrow perfusion indexes were significantly decreased in the osteoporotic group (enhancement slope, 1.10%/sec +/- 0.51) compared with those of the osteopenic group (1.45%/sec +/- 0.51, P = .01) and normal bone density group (1.70%/sec +/- 0.52, P < .001). Erector spinae muscle perfusion indexes did not decrease as bone density decreased. The ADC of vertebral marrow did not change with bone density. The subjects experienced a decrease in vertebral marrow maximum enhancement and enhancement slope and an increase in marrow fat content as bone density decreased. The reduction in perfusion indexes occurred only within the vertebral body and not in the paravertebral tissues supplied by the same artery. (c) RSNA, 2006.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Radiol

Journal ID (iso-abbrev): Korean J Radiol

Journal ID (publisher-id): KJR

Title: Korean Journal of Radiology

Publisher: The Korean Society of Radiology

ISSN (Print): 1229-6929

ISSN (Electronic): 2005-8330

Publication date (Print): January 2019

Publication date (Electronic): 27 December 2018

Volume: 20

Issue: 1

Pages: 126-133

Affiliations

[1 ]Department of Radiology, Seoul National University Hospital, Seoul, Korea.

[2 ]Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

[3 ]Department of Radiological Science, College of Health Science, Gimcheon University, Gimcheon, Korea.

[4 ]Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

Author notes

Corresponding author: Hye Jin Yoo, MD, PhD, Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: (822) 2072-0856, Fax: (822) 743-6385, dalnara3@ 123456gmail.com

Author information

Sang Hyup Lee https://orcid.org/0000-0002-6773-2965

Hye Jin Yoo https://orcid.org/0000-0002-9704-7870

Article

DOI: 10.3348/kjr.2018.0174

PMC ID: 6315074

PubMed ID: 30627028

SO-VID: ea9135df-cf62-4224-addd-cdf258c451cc

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 20 March 2018

Date accepted : 03 August 2018

Funding

Funded by: National Research Foundation of Korea, CrossRef https://doi.org/10.13039/501100003725;

Fat Quantification in the Vertebral Body: Comparison of Modified Dixon Technique with Single-Voxel Magnetic Resonance Spectroscopy

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Abstract

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Materials and Methods

Results

Conclusion

Related collections

Probing cerebral hemodynamics with BOLD fMRI

Most cited references 26

Vertebral bone mineral density, marrow perfusion, and fat content in healthy men and men with osteoporosis: dynamic contrast-enhanced MR imaging and MR spectroscopy.

Quantitative MRI and spectroscopy of bone marrow

Vertebral marrow fat content and diffusion and perfusion indexes in women with varying bone density: MR evaluation.

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