Longitudinal MR-based proton-density fat fraction (PDFF) and T2* for the assessment of associations between bone marrow changes and myelotoxic chemotherapy

By
Felix G. Gassert
Julia Kranz
Florian T. Gassert
Benedikt J. Schwaiger
Christian Bogner
Marcus R. Makowski
Leander Glanz
Jonathan Stelter
Thomas Baum
Rickmer Braren
Dimitrios C. Karampinos
Alexandra S. Gersing
September 11, 2023
0 min

European Radiology

Overview

This study evaluated bone marrow alterations in cancer patients undergoing myelotoxic chemotherapy using MRI-based proton-density fat fraction (PDFF) and T2* measurements. Results demonstrated significant increases in bone marrow fat fraction and changes in T2* values, correlating with bone mineral density loss, highlighting MRI as a non-invasive biomarker for marrow toxicity.

Background

Myelotoxic chemotherapy induces bone marrow toxicity by reducing hematopoietic cells and promoting adipocyte differentiation, increasing marrow fat content and risking osteoporosis and fractures. Conventional imaging methods like DXA and quantitative CT expose patients to radiation and incur costs. MRI-based PDFF offers a radiation-free quantitative assessment of marrow fat, potentially enabling earlier detection of marrow conversion and osteoporosis risk in oncologic patients.

Data Highlights

Parameter	Measurement	Findings
Patient Cohort	19 patients with myelotoxic chemotherapy, mean age 69 ± 7 years	Matched with 38 controls by sex, age, chemotherapy duration, MRI interval
Chemotherapy Regimens	FOLFIRINOX (8), Sorafenib (5), Gemcitabine (4), Gemcitabine + Cisplatin (2)	Confirmed myelotoxic agents
Imaging Technique	3T MRI with 6-echo 3D gradient-echo sequence	PDFF and T2* maps generated for lumbar vertebrae
Analysis	Manual segmentation of vertebral bodies excluding cortical bone and degenerative changes	Mean PDFF and T2* calculated per vertebra and patient

Key Findings

Myelotoxic chemotherapy leads to increased bone marrow fat fraction (PDFF), reflecting adipocyte differentiation in marrow.
T2* values change in response to marrow composition alterations, correlating with bone mineral density loss.
MRI-based PDFF provides a quantitative, radiation-free method to monitor bone marrow changes longitudinally.
Bone marrow fat fraction negatively correlates with bone mineral density, indicating marrow fat as a marker of osteoporosis risk.
Simultaneous assessment of PDFF and T2* offers comprehensive evaluation of marrow toxicity in heterogeneous cancer patient groups.

Clinical Implications

MRI-based PDFF and T2* measurements can serve as non-invasive biomarkers to detect early bone marrow changes induced by myelotoxic chemotherapy, potentially guiding timely interventions to prevent osteoporosis and fragility fractures. This imaging approach may reduce reliance on radiation-based techniques, improving patient safety and monitoring efficiency in oncology care.

Conclusion

The study supports the use of longitudinal MRI PDFF and T2* analysis as effective tools for assessing bone marrow alterations due to myelotoxic chemotherapy, offering a promising non-invasive alternative to standard imaging for osteoporosis risk evaluation in cancer patients.

References

Multiple sources (2018-2021) -- Assessment of Bone Marrow Alterations and Myelotoxic Chemotherapy through Longitudinal MR-based Proton-Density Fat Fraction (PDFF) and T2* Analysis