Marrow Fat Content and Composition in β-Thalassemia: A Study using 1 H-MRS

Umi Nabilah Ismail; Che Ahmad Azlan; Shasha Khairullah; Raja Rizal Azman; Nur Farhayu Omar; Mohammad Nazri Md Shah; Chai Hong Yeong; Nicholas Jackson; Kwan Hoong Ng

doi:10.1002/jmri.27294

Marrow Fat Content and Composition in β-Thalassemia: A Study using ¹ H-MRS

J Magn Reson Imaging. 2021 Jan;53(1):190-198. doi: 10.1002/jmri.27294. Epub 2020 Aug 15.

Authors

Umi Nabilah Ismail¹, Che Ahmad Azlan¹, Shasha Khairullah², Raja Rizal Azman¹, Nur Farhayu Omar³, Mohammad Nazri Md Shah¹, Chai Hong Yeong⁴, Nicholas Jackson⁵, Kwan Hoong Ng¹

Affiliations

¹ Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
² Haematology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
³ Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
⁴ School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia.
⁵ Red Cell Unit, Department of Haematology, University College Hospital, London, UK.

PMID: 33237616
DOI: 10.1002/jmri.27294

Abstract

Background: β-thalassemia is a genetic disease that causes abnormal production of red blood cells (ineffective erythropoiesis, IE). IE is a condition known to change bone marrow composition.

Purpose: To evaluate the effect of IE on the marrow fat content and fat unsaturation levels in the proximal femur using ¹ H-MRS.

Study type: Prospective.

Subjects: Twenty-three subjects were included in this study, seven control and 16 β-thalassemia subjects.

Field strength/sequence: 3.0T; stimulated echo acquisition Mode (STEAM); magnetic resonance spectroscopy (MRS) sequence.

Assessment: Multiecho MRS scans were performed in four regions of the proximal left femur of each subject, that is, diaphysis, femoral neck, femoral head, and greater trochanter. The examined regions were grouped into red (diaphysis and femoral neck) and yellow marrow regions (femoral head and greater trochanter).

Statistical tests: The Jonckheere-Terpstra test was used to evaluate the impact of increasing disease severity on bone marrow fat fraction (BMFF), marrow conversion index, and fat unsaturation index (UI). Pairwise comparison analysis was performed when a significant trend (P < 0.05) was found. K-means clustering analysis was used to examine the clusters observed when BMFF in the red and yellow regions were studied (diaphysis against greater trochanter).

Results: BMFF showed a significant decreasing trend with increasing disease severity in both red (T_JT = 109.00, z = -4.414, P < 0.05) and yellow marrow regions (T_JT = 108.00, z = -4.438, P < 0.05). The opposite trend was observed in UI in both bone marrow regions (red marrow: T_JT = 180.5, z = 3.515, P < 0.05; yellow marrow: T_JT = 155.0, z = 2.282, P = 0.05). Three distinct forms of marrow adipogenesis were found when plotting BMFF diaphysis against BMFF greater trochanter: 1) normal (centroid: 80.4%, 66.6%), 2) partial disruption (centroid: 51.1%, 16.6%), and 3) total disruption (centroid: 2.6%, 1.6%).

Data conclusion: β-thalassemia is associated with decreased marrow fat, and increased marrow fat unsaturation level.

Level of evidence: 2 TECHNICAL EFFICACY STAGE: 3.

Keywords: MRS; bone marrow fat; hematopoiesis; ineffective erythropoiesis; marrow adipose tissue (MAT); β-thalassemia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adipose Tissue / diagnostic imaging
Bone Marrow* / diagnostic imaging
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Prospective Studies
beta-Thalassemia* / diagnostic imaging

Abstract

Publication types

MeSH terms

Grants and funding