Dynamic contrast-enhanced MRI in Paget’s disease of bone–correlation of regional microcirculation and bone turnover

Abstract

The purpose of this study was to evaluate regional microcirculation in Paget's disease of bone (PD) with dynamic contrast-enhanced MR imaging (DCE-MRI). Additionally, we correlated regional bone perfusion with alkaline phosphatase as serum marker of bone turnover. We examined 71 patients with PD (27 men, 44 women, 67+/-10 years) localized at the axial and appendicular skeleton. Contrast uptake was analyzed using a two-compartment model with the output variables amplitude A and exchange rate constant k(ep). Color-coded parametric images were generated to visualize microcirculation. Serum levels of alkaline phosphatase (AP) were compared with DCE-MRI parameters. Amplitude A and exchange rate constant k(ep) were significantly increased in PD compared to unaffected bone (A(PD) 0.81+/-0.24 vs. A(control) 0.34+/-0.1 and k(ep PD) 4.0+/-2.86 vs. k(ep control) 1.73+/-0.88, p<0.001). There was a significant correlation (r(s)=0.5-0.7) of DCE-MRI parameters and AP at the axial (pelvis, spine) and appendicular skeleton (femur, tibia). The long bones showed increased circulation of the advancing peripheral zones and no vascularization of the central part, which had been replaced by fatty tissue. Regional microcirculation in PD is inhomogeneous with focal areas of excessive hypervascularity, especially in the advancing peripheral zone. There is a significant correlation of bone circulation and bone turnover in PD. DCE-MRI might therefore be a diagnostic tool for monitoring therapeutic effects of bisphosphonates in Paget's disease of bone.

Muscle-Based Pharmacokinetic Modeling of Marrow Perfusion for Osteoporotic Bone in Females

“…Further, pharmacokinetic models have been employed to analyze bone perfusion function in patients with multiple myeloma, bone edema, and Paget's disease of bone [17, 18, 23]. Bone is composed of trabecular and cortical bone.…”

“…Most previous work employed Tofts model to assess the bone perfusion [14, 17, 18], of which the analysis of the bone perfusion was much dependent on AIF. It is good to involve the contrast dynamics in the artery when analyzing the perfusion in the tissue.…”

“…Bone perfusion by DCE-MRI can be assessed by semiquantitative method [10–14] and pharmacokinetic model [15–18]. The former method provides a direct measure of the bone perfusion with semiquantitative parameters derived from the perfusion curves.…”

Dynamic contrast-enhanced MRI as a valuable non-invasive tool to evaluate tissue perfusion of free flaps: Preliminary results

“…DCE MRI is a well established method in the differential diagnosis of breast cancer [16,20] or liver lesions [15,21]. But only a few publications are available with regard to dynamic studies in the musculoskeletal system [10,18,19]. In our study we used DCE MRI to gain information about microvascular circulation and perfusion in different territories and tissue layers of free flaps.…”

Comparison of time-intensity-curve- (TIC-) analysis of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced (DCE) MRI for postoperative control of microcirculation in free flaps – First results and critical comments

“…Therefore, its reliability for postoperative monitoring of free flaps has to be assessed relative to other techniques. Due to its excellent soft tissue contrast and good coverage of free flaps, dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) yields important advantages compared to local methods (spot checks or cutaneous imaging techniques) like oxygen tension or fluorescence angiography [6,14,15]. However, contraindications for MR contrast agents and for the MR examination in general have to be taken into account -metallic implants or surgical clips might worsen image quality or even prevent the examination.…”