3T 化学位移编码 MRI：检测糖皮质激素使用者股骨近端骨髓脂肪组织成分的改变，并通过磁共振波谱进行验证。
3T chemical shift-encoded MRI: Detection of altered proximal femur marrow adipose tissue composition in glucocorticoid users and validation with magnetic resonance spectroscopy.
机构信息
New York Langone Health, Department of Radiology, New York University School of Medicine, New York, New York, USA.
Université de Lyon, CREATIS CNRS UMR 5220, Inserm U1206, INSA-Lyon, UCBL Lyon 1, Lyon, France.
出版信息
J Magn Reson Imaging. 2019 Aug;50(2):490-496. doi: 10.1002/jmri.26586. Epub 2018 Dec 12.
BACKGROUND
Osteoporosis (OP) results in weak bone and can ultimately lead to fracture. Drugs such as glucocorticoids can also induce OP (glucocorticoid-induced osteoporosis [GIO]). Bone marrow adipose tissue composition and quantity may play a role in OP pathophysiology, but has not been thoroughly studied in GIO compared to primary OP.
PURPOSE/HYPOTHESIS: Chemical shift-encoded (CSE) MRI allows detection of subregional differences in bone marrow adipose tissue composition and quantity in the proximal femur of GIO compared to OP subjects and has high agreement with the reference standard of magnetic resonance spectroscopy (MRS).
STUDY TYPE
Prospective.
SUBJECTS
In all, 18 OP and 13 GIO subjects.
FIELDS STRENGTH
3T.
SEQUENCE
Multiple gradient-echo, stimulated echo acquisition mode (STEAM).
ASSESSMENT
Subjects underwent CSE-MRI in the proximal femurs, and for each parametric map regions of interest (ROIs) were assessed in the femoral head (fHEAD), femoral neck (fNECK), Ward's triangle (fTRIANGLE), and the greater trochanter (GTROCH). In addition, we compared CSE-MRI against the reference standard of MRS performed in the femoral neck and Ward's triangle.
STATISTICAL TESTS
Differences between OP/GIO were investigated using the Mann-Whitney nonparametric test. Bland-Altman methodology was used to assess measurement agreement between CSE-MRI and MRS.
RESULTS
GIO compared with OP subjects demonstrated: decreased monounsaturated fat fraction (MUFA) (-2.1%, P < 0.05) in fHEAD; decreased MUFA (-3.8%, P < 0.05), increased saturated fat fraction (SFA) (5.5%, P < 0.05), and decreased (-3.8 msec, P < 0.05) in fNECK; decreased proton density fat fraction (PDFF) (-15.1%, P < 0.05), MUFA (-9.8%, P < 0.05), polyunsaturated fat fraction (PUFA) (-1.8%, P < 0.01), increased SFA (11.6%, P < 0.05), and decreased (-5.4 msec, P < 0.05) in fTRIANGLE; and decreased (-1.5 msec, P < 0.05) in GTROCH. There was high measurement agreement between MRI and MRS using the Bland-Altman test.
DATA CONCLUSION
3T CSE-MRI may allow reliable assessment of subregional bone marrow adipose tissue (bMAT) quantity and composition in the proximal femur in a clinically reasonable scan time. Glucocorticoids may alter the lipid profile of bMAT and potentially result in reduced bone quality.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:490-496.
背景
骨质疏松症（OP）导致骨骼脆弱，最终可导致骨折。糖皮质激素等药物也会引起 OP（糖皮质激素诱导的骨质疏松症 [GIO]）。骨髓脂肪组织的组成和数量可能在 OP 病理生理学中发挥作用，但与原发性 OP 相比，其在 GIO 中的研究尚不彻底。
目的/假设：化学位移编码（CSE）MRI 可用于检测 GIO 与 OP 受试者相比，在股骨近端骨髓脂肪组织组成和数量方面的亚区差异，并且与参考标准磁共振光谱（MRS）具有高度一致性。
研究类型
前瞻性。
受试者
共 18 名 OP 和 13 名 GIO 受试者。
磁场强度
3T。
序列
多梯度回波、受激回波采集模式（STEAM）。
评估
受试者在股骨近端接受 CSE-MRI 检查，对于每个参数图，在股骨头（fHEAD）、股骨颈（fNECK）、Ward 三角（fTRIANGLE）和大转子（GTROCH）中评估感兴趣区域（ROI）。此外，我们将 CSE-MRI 与在股骨颈和 Ward 三角进行的参考标准 MRS 进行了比较。
统计检验
使用 Mann-Whitney 非参数检验研究 OP/GIO 之间的差异。Bland-Altman 方法用于评估 CSE-MRI 与 MRS 之间的测量一致性。
结果
与 OP 受试者相比，GIO 受试者在 fHEAD 中表现出：单不饱和脂肪分数（MUFA）减少（-2.1%，P<0.05）；在 fNECK 中 MUFA 减少（-3.8%，P<0.05）、饱和脂肪分数（SFA）增加（5.5%，P<0.05）和弛豫时间（T2）减少（-3.8 msec，P<0.05）；在 fTRIANGLE 中质子密度脂肪分数（PDFF）减少（-15.1%，P<0.05）、MUFA 减少（-9.8%，P<0.05）、多不饱和脂肪分数（PUFA）减少（-1.8%，P<0.01）、SFA 增加（11.6%，P<0.05）和弛豫时间（T2）减少（-5.4 msec，P<0.05）；在 GTROCH 中弛豫时间（T2）减少（-1.5 msec，P<0.05）。Bland-Altman 检验表明 MRI 和 MRS 之间具有高度的测量一致性。
数据结论
3T CSE-MRI 可能允许在合理的临床扫描时间内可靠地评估股骨近端骨髓脂肪组织（bMAT）的亚区数量和组成。糖皮质激素可能会改变 bMAT 的脂质谱，并可能导致骨质量降低。
证据水平
2 技术功效：第 2 阶段 J. Magn. Reson. Imaging 2019;50:490-496.
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