Simultaneous Quantification of Bone Edema/Adiposity and Structure in Inflamed Bone Using Chemical Shift-Encoded MRI in Spondyloarthritis.

Alan Bainbridge,Yiannis Ioannou,Timothy J.P Bray,Margaret A Hall‐Craggs,Shonit Punwani

doi:10.1002/mrm.26729

Alan Bainbridge, Yiannis Ioannou + Show 3 more

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https://doi.org/10.1002/mrm.26729

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Abstract

PurposeTo evaluate proton density fat fraction (PDFF) and R2* as markers of bone marrow composition and structure in inflamed bone in patients with spondyloarthritis.MethodsPhantoms containing fat, water, and trabecular bone were constructed with proton density fat fraction (PDFF) and bone mineral density (BMD) values matching those expected in healthy bone marrow and disease states, and scanned using chemical shift‐encoded MRI (CSE‐MRI) at 3T. Measured PDFF and R2* values in phantoms were compared with reference FF and BMD values. Eight spondyloarthritis patients and 10 controls underwent CSE‐MRI of the sacroiliac joints. PDFF and R2* in areas of inflamed bone and fat metaplasia in patients were compared with normal bone marrow in controls.ResultsIn phantoms, PDFF measurements were accurate over the full range of PDFF and BMD values. R2* measurements were positively associated with BMD but also were influenced by variations in PDFF. In patients, PDFF was reduced in areas of inflammation and increased in fat metaplasia compared to normal marrow. R2* measurements were significantly reduced in areas of fat metaplasia.ConclusionPDFF measurements reflect changes in marrow composition in areas of active inflammation and structural damage and could be used for disease monitoring in spondyloarthritis. R2* measurements may provide additional information bone mineral density but also are influenced by fat content. Magn Reson Med 79:1031–1042, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Highlights

The spondyloarthritides are a group of inflammatory diseases involving the spine, lower limb joints, and entheses [1]
We show that proton density fat fraction (PDFF) measurements accurately reflect changes in bone marrow composition in areas of edema and fat metaplasia, which can be viewed as active inflammatory and structural lesions, respectively
We show that R2* measurements are reduced in areas of fat metaplasia, which may be due to a reduction in bone mineral density

Summary

Introduction

The spondyloarthritides are a group of inflammatory diseases involving the spine, lower limb joints, and entheses [1]. Clinical features of spondyloarthritis include back pain, spinal stiffness and loss of mobility, which may be caused by inflammation, structural damage, or a combination of both [2,3]. Inflammation usually occurs in the form of spondylitis, spondylodiscitis, or spondyloarthritis. Structural manifestations include syndesmophyte formation and joint fusion, which are thought to be caused by chronic inflammation and subsequent new bone formation [1]. Bone destruction occurs commonly and patients may suffer from generalized osteoporosis and increased fracture risk [4,5,6]. Spondyloarthritis usually affects young people; patients often present in their 20s [1]. Patients presenting in childhood or adolescence have a poor prognosis [8]

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Discussion

Conclusion