STUDY OF DIAGNOSTIC CAPABILITIES OF FAT FRACTION MEASUREMENT WITH MAGNETIC RESONANCE IMAGING IN DETECTING DECREASE IN BONE MINERAL DENSITY IN PATIENTS WITH HEMOBLASTOSIS: RETROSPECTIVE DESCRIPTIVE SINGLE–CENTER

INTRODUCTION: Bone strength depends on the amount of minerals, microarchitecture and the amount of organic matter, including adipose tissue. Traditional methods for assessing the amount of fat in bone marrow are invasive. Magnetic resonance imaging is noninvasive and can be used to assess the fat fraction in bone. The associations between fat fraction and bone mineral density are poorly understood.

OBJECTIVE: To study the diagnostic capabilities of measuring fat fraction using magnetic resonance imaging in patients with hemoblastoses.

MATERIALS AND METHODS: Magnetic resonance imaging (MRI) scans of lumbar vertebrae 1–4 (IDEAL pulse sequence) and dual-energy X-ray absorptiometry (DXA) data from 46 patients with hematological malignancies (mean age of women, 41.6±13.7 years; mean age of men, 43.7±12.3 years) were analyzed. MRI and DXA scans were performed using GE Signa Voyager and Dexxum systems respectively. The fat fraction was calculated as the ratio of the signal intensity of fat protons to water protons in lumbar vertebrae images.

Statistics: ROC analysis was used to assess the diagnostic significance of the methods. Pearson correlation analysis was used to calculate correlation. The Bland-Altman graphical method was used to calculate interobserver variability.

RESULTS: The fat fraction values for men with normal bone mineral density values were 67.8±6% (58–72%), and for women – 58.3±11% (45–68%). For men with decreased BMD the fat fraction values were 72.2±8% (61–86%), and for women – 74.1±7% (59–83%). The average difference in the signal intensity measurements from fat protons between two observers was 7%, for water protons – 8% (p<0.05). For women a moderate correlation was found between BMD and fat fraction (r=0.38, (p=0.04), a moderate correlation was found between fat fraction and age (r=0.39, (p=0.04). For men a weak correlation was found between BMD and fat fraction (r=0.26, (p=0.05). The sensitivity for a fat fraction greater than 75% with a decrease in bone mineral density was 60%, specificity 85%, accuracy 73% (p<0.05).

DISCUSSION: With decreasing bone mineral density the fat fraction increases, and with increasing age the fat fraction increases. For men with normal bone mineral density values the fat fraction is higher than for women of the same age. Low interobserver variability values indicate high reproducibility of signal intensity values calculation on IDEAL sequence images. These data are consistent with data from other studies.

CONCLUSION: In patients with hemoblastoses lumbar spine MRI supplemented with the IDEAL sequence can be used for noninvasive bone assessment, fat fraction measurement, and indirect assessment of bone mineral density loss with relatively with moderate diagnostic accuracy and reproducibility, without the need for dual-energy X-ray absorptiometry.

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