Abstract
The pathogenesis of chronic kidney disease (CKD) is multifactorial. In the progression of CKD arthropathy, arteriosclerosis may alter the knee subchondral bone marrow by altering blood flow through the bone vasculature. Herein, multi-parametric MRI assessment, including dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), magnetic resonance spectroscopy (MRS), MRI T2*, contrast enhanced MR angiography (CE-MRA), and micro-CT were applied in a rodent nephrectomy model to: 1) investigate the blood perfusion of subchondral bone marrow and its relationship to fat water content and trabeculation pattern in CKD and 2) demonstrate the feasibility of using multi-parametric MRI parameters as imaging biomarkers to evaluate the disease’s progression. Two groups of rats in our study underwent either 1) no intervention or 2) 5/6 nephrectomy. We found that in the CKD group, perfusion amplitude A and elimination constant kel values were significantly decreased, and vascular permeability kep was significantly increased. MRS showed that fat fraction (FF) was significantly lower, water fraction (WF) was significantly higher in the CKD group. Micro-CT showed a significant loss of trabecular bone. Knee subchondral bone marrow perfusion deficiency in experimental CKD may be associated with decreased fat content, increased water content, and sparse trabeculation.
Highlights
Chronic kidney disease (CKD) is a global health problem and has a high worldwide incidence and prevalence
This study demonstrates the relationship between hypoperfusion and subchondral bone marrow changes in experimental CKD
We found a decrease in subchondral bone marrow fat content and osteoporotic change of marrow trabeculation during disease progression after 5/6 nephrectomy
Summary
Chronic kidney disease (CKD) is a global health problem and has a high worldwide incidence and prevalence. Griffith et al investigated the proximal femur from 120 age-matched females by DCE-MRI, MRS, and bone mineral density (BMD) testing They found decreased femur perfusion and increased marrow fat in osteoporotic subjects as compared to osteopenic and normal subjects[25]. Multi-parametric MRI enables investigation of the changes in subchondral bone marrow parameters, including fat-water content and blood perfusion. Understanding these changes may provide insight into the pathogenesis of CKD. The imaging characteristics of CKD-MBD on BMD testing, high-resolution peripheral quantitative computed tomography (HR-pQCT), and micro-computed tomography (μCT) have been well documented[31, 32], the quantitative MRI evidence for change in knee subchondral bone marrow characteristics as CKD progresses is scarce. MRS may be a valuable method to elucidate pathophysiological changes in osteoporotic bone marrow as CKD progresses
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