Abstract
BackgroundThe aim of this study was to assess the added value of chemical shift imaging when used with routine MRI study in evaluation of bone marrow changes in SCD. Forty-two patients with SCD and bone pain were included in the study; they underwent CSI and routine MRI study on the symptomatic anatomic part of the skeleton.ResultsFour patterns of diffuse bone marrow changes were recognized; they varied from persistent red marrow to diffuse hypointense patterns with abnormal signal loss percentage on CSI that suggest presence of iron overload (n = 28, 66.6%). Serum ferritin level was increasing in accordance to the degree of signal changes found on CSI with significant high negative correlation between the percentage of signal loss on CSI obtained from IP-OP/IP formula and serum ferritin level. In focal marrow lesions, all T1 hyperintense lesions demonstrated corresponding hyperintensity on IP and OP; the detection frequency on CSI was relatively higher on OP compared with IP images.ConclusionCSI has high diagnostic performance in detecting diffuse marrow changes and development of iron overload in SCD. In SCD-related focal marrow lesions, CSI could have a complementary role in detection of T1 hyperintensity and lesion conspicuity.
Highlights
The aim of this study was to assess the added value of chemical shift imaging when used with routine Magnetic resonance imaging (MRI) study in evaluation of bone marrow changes in Sickle cell disease (SCD)
Sickle cell disease (SCD) is one of the hemoglobinopathies that is characterized by abnormal production of hemoglobin, repeated cycles of sickling and unsickling, stasis and sequestration of blood cells, vascular obstruction, red cell destruction, hemolytic anemia, and bone marrow hyperplasia
Various ranges of serum ferritin level were found across different patterns of diffuse marrow changes; their means were increasing in accordance to the grade of marrow changes and the degree of signal changes found on Chemical shift imaging (CSI) with statistically significant difference (Table 2)
Summary
The aim of this study was to assess the added value of chemical shift imaging when used with routine MRI study in evaluation of bone marrow changes in SCD. Forty-two patients with SCD and bone pain were included in the study; they underwent CSI and routine MRI study on the symptomatic anatomic part of the skeleton. Sickle cell disease (SCD) is one of the hemoglobinopathies that is characterized by abnormal production of hemoglobin, repeated cycles of sickling and unsickling, stasis and sequestration of blood cells, vascular obstruction, red cell destruction, hemolytic anemia, and bone marrow hyperplasia. As blood transfusion has a prominent role in patient’s management in SCD, there is an increased risk of Magnetic resonance imaging (MRI) is the most effective imaging tool used to evaluate focal bone marrow abnormalities as well as transfusion-related iron overload in a noninvasive way. Being characterized by higher echo time than the OP images, the IP images are more sensitive to iron deposition because of its T2* effect, this in turn explains why signal intensity reduction of iron-overloaded marrow is observed on IP not OP images [4, 5]
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