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Assessment of Bone Marrow Edema Perfusion with Dynamic Contrast-enhanced MR Imaging
Abstract
PURPOSE
Bone Marrow Edema (BME) has been associated with many diseases including osteoathritis and osteonecrosis; however, the pathophysiology of BME is not known. In this study, we investigate perfusion kinetics of BME with dynamic contrast enhanced MRI (DCE-MRI).
METHOD AND MATERIALS
MR imaging was performed on 16 adults with BME using a 1.5T magnet (Symphony; Siemens, Erlangen, Germany) and a standard knee coil. Prior to DCE-MRI, short tau inversion recovery MR imaging (STIR) [3500/17/150 (TR/TE/TI)] and multi-echo conventional spin-echo intermediate- and T2-weighted (2320/20,30 [TR/TE]) MR imaging was performed to localize the largest focus of BME. DCE-MRI using the volumetric interpolated breath-hold examination sequence [5.50/2.89 (TR/TE); 10° (flip-angle), 350 Hz/pixel (bandwidth); 16cm (FOV); 5mm, slice thickness; one excitation; and 256 x 151, matrix] was performed before and during intravenous administration of 0.1mmol/kg of gadodiamide at 2cc/sec. DCE-MRI images were analyzed with customized IDL 6.1 software. Separate regions of interest (ROIs) were placed on areas of BME and normal bone marrow, and signal intensity-time curves were generated. Pharmacokinetic modeling was performed using the two-compartment Brix model to generate rate constants [A], [kep], and [kel]. A paired Student’s t-test was used to compare kinetic parameters between normal and edematous marrow.
RESULTS
Signal intensity-time curves demonstrate higher wash-in rate and lower wash-out in bone marrow edema when compared with normal tissue. Brix model parameters show higher mean [A] (p=9.1 E-6), lower [kep] (p=0.036) and lower [kel] (p=0.017) in bone marrow edema compared to normal bone marrow.
CONCLUSION
DCE-MRI demonstrates significantly increased perfusion and reduced contrast elimination in BME compared to normal bone marrow. Lower wash-out rate may be explained by increased intraosseus pressure in BME, which may lead to outflow obstruction and therefore decreased [kel]. These results are consistent with previous studies performed on Dunkin-Hartley guinea pig animal models.
CLINICAL RELEVANCE/APPLICATION
Pharmacokinetic modeling of bone marrow perfusion using DCE-MRI can provide insight into the pathophysiology of bone marrow edema.
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