Share this content in WeChat
Clinical Article
Quantitative assessment of bone marrow fat fraction of proximal femur in healthy subjects based on MRI mDIXON-Quant technique
WANG Ming  ZHANG Ping  BAI Lin  WANG Yali  HOU Zishuo  REN Congcong  ZHAO Jian 

Cite this article as: Wang M, Zhang P, Bai L, et al. Quantitative assessment of bone marrow fat fraction of proximal femur in healthy subjects based on MRI mDIXON-Quant technique[J]. Chin J Magn Reson Imaging, 2022, 13(9): 63-68. DOI:10.12015/issn.1674-8034.2022.09.012.

[Abstract] Objective The proton density fat fraction (PDFF) of bone marrow was obtained by MRI mDIXON-Quant sequence. The change trend of bone marrow fat content in the proximal femur of healthy subjects was observed, and the effects of age, gender and body mass index (BMI) on bone marrow fat content were detected.Materials and Methods From June 2021 to March 2022, a total of 227 patients aged 20-80 years were recruited for routine MRI examination and mDIXON-Quant examination of the proximal femur. The inclusion criteria and the image quality were satisfactory, with age of (53.59±14.20) years. The PDFF values of femoral head, femoral neck, greater trochanter and intertrochanter were obtained. Mann-Whitney U test was used to compare the difference of bone marrow PDFF values in different age groups and genders, and Kruskal-Wallis test was used to compare the bone marrow PDFF values in different regions. The Spearman correlation test was used to analyze correlations between age, gender, BMI and bone marrow PDFF, respectively. Finally, multiple linear regression analysis was performed on the PDFF values of each region of proximal femur with age, gender and BMI.Results The PDFF value of bone marrow in young and middle-aged subjects was lower than that in old subjects, and the PDFF value of each subregion was positively correlated with age (P<0.05). The bone marrow PDFF of males was higher than that of females in all of subregions (P<0.05). There were significant differences in PDFF between the subregions (P<0.05). The bone marrow PDFF of the greater trochanter was the highest. The femoral neck PDFF was the lowest.Conclusions The bone marrow fat content in proximal femur increased with age. The amount of bone marrow fat content in the proximal femur may be higher in men than in women. The content of bone marrow fat was different between subregions of proximal femur.
[Keywords] healthy subjects;proximal femur;bone marrow;fat quantification;mDIXON-Quant;proton density fat fraction;magnetic resonance imaging

WANG Ming   ZHANG Ping   BAI Lin   WANG Yali   HOU Zishuo   REN Congcong   ZHAO Jian*  

Department of CT/MR, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China

*Zhao J, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS 2022 Hebei Province Medical Science Research Project Plan (No. 20220129); 2021 Central Guided Local Science and Technology Development Fund Project (No. 216Z7709G).
Received  2022-05-23
Accepted  2022-09-14
DOI: 10.12015/issn.1674-8034.2022.09.012
Cite this article as: Wang M, Zhang P, Bai L, et al. Quantitative assessment of bone marrow fat fraction of proximal femur in healthy subjects based on MRI mDIXON-Quant technique[J]. Chin J Magn Reson Imaging, 2022, 13(9): 63-68. DOI:10.12015/issn.1674-8034.2022.09.012.

Martel D, Leporq B, Bruno M, et al. Chemical shift-encoded MRI for assessment of bone marrow adipose tissue fat composition: pilot study in premenopausal versus postmenopausal women[J]. Magn Reson Imaging, 2018, 53: 148-155. DOI: 10.1016/j.mri.2018.07.001.
Hardouin P, Rharass T, Lucas S. Bone marrow adipose tissue: to Be or not to Be a typical adipose tissue?[J]. Front Endocrinol (Lausanne), 2016, 7: 85. DOI: 10.3389/fendo.2016.00085.
Wong AK, Abinaa C, Rachel W, et al. Bone marrow and muscle fat infiltration are correlated among postmenopausal women with osteoporosis: the AMBERS cohort study[J]. J Bone Miner Res, 2020, 35(3): 516-527.
Zeng ZL, Ma XZ, Guo YF, et al. Quantifying bone marrow fat fraction and iron by MRI for distinguishing aplastic Anemia from myelodysplastic syndromes[J]. J Magn Reson Imaging, 2021, 54(6): 1754-1760. DOI: 10.1002/jmri.27769.
Zhao YX, Huang MQ, Ding J, et al. Prediction of abnormal bone density and osteoporosis from lumbar spine MR using modified Dixon quant in 257 subjects with quantitative computed tomography as reference[J]. J Magn Reson Imaging, 2019, 49(2): 390-399. DOI: 10.1002/jmri.26233.
Lai JKC, Robertson PL, Goh C, et al. Intraobserver and interobserver variability of the bone marrow burden (BMB) score for the assessment of disease severity in Gaucher disease. Possible impact of reporting experience[J]. Blood Cells Mol Dis, 2018, 68: 121-125. DOI: 10.1016/j.bcmd.2016.11.004.
Angelini A, Trovarelli G, Berizzi A, et al. Treatment of pathologic fractures of the proximal femur[J]. Injury, 2018, 49(Suppl 3): S77-S83. DOI: 10.1016/j.injury.2018.09.044.
Song Y, Song QW, Zhang HN, et al. 3D mDixon Quant based on compressed SENSE for quantitative study of lumbar vertebral body fat content[J]. Chin J Magn Reson Imaging, 2021, 12(4): 51-56. DOI: 10.12015/issn.1674-8034.2021.04.010.
Zhai SJ, Ma JX, Zhao LP, et al. The diagnostic application of fat quantification in the primary osteoporosis[J]. J Pract Radiol, 2018, 34(1): 71-74. DOI: 10.3969/j.issn.1002-1671.2018.01.019.
Zhang Y, Cheng XG, Yu AH, et al. Quantitative radiological evaluation of interaction of lumbar vertebral bone marrow fat, bone mineral density and age[J]. Chin J Radiol, 2017(10): 771-776. DOI: 10.3760/j.issn.1005-1201.2017.10.010.
Aoki T, Yamaguchi S, Kinoshita S, et al. Quantification of bone marrow fat content using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL): reproducibility, site variation and correlation with age and menopause[J/OL]. Br J Radiol. 2016, 89(1065) [2022-07-25]. DOI: 10.1259/bjr.20150538.
Gregory JS, Barr RJ, Varela V, et al. MRI and the distribution of bone marrow fat in hip osteoarthritis[J]. J Magn Reson Imaging, 2017, 45(1): 42-50. DOI: 10.1002/jmri.25318.
Burian E, Syväri J, Dieckmeyer M, et al. Age- and BMI-related variations of fat distribution in sacral and lumbar bone marrow and their association with local muscle fat content [J/OL]. Sci Rep, 2020, 10(1) [2022-07-25]. DOI: 10.1038/s41598-020-66649-8.
Dieckmeyer M, Junker D, Ruschke S, et al. Vertebral Bone Marrow Heterogeneity Using Texture Analysis of Chemical Shift Encoding-Based MRI: Variations in Age, Sex, and Anatomical Location[J/OL]. Front Endocrinol (Lausanne), 2020, 11 [2022-07-25]. DOI: 10.3389/fendo.2020.555931.
Burian E, Subburaj K, Mookiah MRK, et al. Texture analysis of vertebral bone marrow using chemical shift encoding-based water-fat MRI: a feasibility study[J]. Osteoporos Int, 2019, 30(6): 1265-1274. DOI: 10.1007/s00198-019-04924-9.
Deng XL, Yang L, Chen SH, et al. The value of routine MRI examination for evaluating osteoporosis[J]. Chin J Magn Reson Imaging, 2020, 11(8): 663-665. DOI: 10.12015/issn.1674-8034.2020.08.014.
Chiarilli MG, Delli Pizzi A, Mastrodicasa D, et al. Bone marrow magnetic resonance imaging: physiologic and pathologic findings that radiologist should know[J]. Radiol Med, 2021, 126(2): 264-276. DOI: 10.1007/s11547-020-01239-2.
Bertheau RC, Lorbeer R, Nattenmüller J, et al. Bone marrow fat fraction assessment in regard to physical activity: KORA FF4-3-T MR imaging in a population-based cohort[J]. Eur Radiol, 2020, 30(6): 3417-3428. DOI: 10.1007/s00330-019-06612-y.
Ruschke S, Pokorney A, Baum T, et al. Measurement of vertebral bone marrow proton density fat fraction in children using quantitative water-fat MRI[J]. Magn Reson Mater Phy, 2017, 30(5): 449-460. DOI: 10.1007/s10334-017-0617-0.
Burian E, Franz D, Greve T, et al. Age- and gender-related variations of cervical muscle composition using chemical shift encoding-based water-fat MRI[J/OL]. Eur J Radiol. 2020, 125 [2022-07-25]. DOI: 10.1016/j.ejrad.2020.108904.
Huang Y, Wang L, Zeng X, et al. Association of Paraspinal Muscle CSA and PDFF Measurements With Lumbar Intervertebral Disk Degeneration in Patients With Chronic Low Back Pain[J/OL]. Front Endocrinol (Lausanne). 2022, 13 [2022-07-25]. DOI: 10.3389/fendo.2022.792819.
Gassert FT, Kufner A, Gassert FG, et al. MR-based proton density fat fraction (PDFF) of the vertebral bone marrow differentiates between patients with and without osteoporotic vertebral fractures[J]. Osteoporos Int, 2022, 33(2): 487-496. DOI: 10.1007/s00198-021-06147-3.
Davis SR, Lambrinoudaki I, Lumsden M, et al. Menopause[J/OL]. Nature reviews Disease primers, 2015, 1 [2022-07-25]. DOI: 10.1016/j.mcna.2015.01.006.
Gondim Teixeira PA, Cherubin T, Badr S, et al. Proximal femur fat fraction variation in healthy subjects using chemical shift-encoding based MRI[J/OL]. Sci Rep, 2019, 9(1) [2022-07-25]. DOI: 10.1038/s41598-019-56611-8.
Syed FA, Oursler MJ, Hefferanm TE, et al. Effects of estrogen therapy on bone marrow adipocytes in postmenopausal osteoporotic women[J]. Osteoporos Int, 2008, 19(9): 1323-1330. DOI: 10.1007/s00198-008-0574-6.
Fukuda T, Huang MQ, Janardhanan A, et al. Correlation of bone marrow cellularity and metabolic activity in healthy volunteers with simultaneous PET/MR imaging[J]. Skeletal Radiol, 2019, 48(4): 527-534. DOI: 10.1007/s00256-018-3058-6.
Hawkes CP, Mostoufi-Moab S. Fat-bone interaction within the bone marrow milieu: impact on hematopoiesis and systemic energy metabolism[J]. Bone, 2019, 119: 57-64. DOI: 10.1016/j.bone.2018.03.012.
Martel D, Honig S, Monga A, et al. Analysis of muscle, hip, and subcutaneous fat in osteoporosis patients with varying degrees of fracture risk using 3T Chemical Shift Encoded MRI[J/OL]. Bone Rep. 2020, 12 [2022-07-25]. DOI: 10.1016/j.bonr.2020.100259.
Pino AM, Rodríguez JP. Is fatty acid composition of human bone marrow significant to bone health?[J]. Bone, 2019, 118: 53-61. DOI: 10.1016/j.bone.2017.12.014.
Beekman KM, Regenboog M, Nederveen AJ, et al. Gender- and Age-Associated Differences in Bone Marrow Adipose Tissue and Bone Marrow Fat Unsaturation Throughout the Skeleton, Quantified Using Chemical Shift Encoding-Based Water-Fat MRI[J/OL]. Front Endocrinol (Lausanne), 2022, 13 [2022-07-25]. DOI: 10.3389/fendo.2022.815835.
Budzik JF, Lefebvre G, Behal H, et al. Bone marrow perfusion measured with dynamic contrast enhanced magnetic resonance imaging is correlated to body mass index in adults[J]. Bone, 2017, 99: 47-52. DOI: 10.1016/j.bone.2017.03.048.

PREV Identification of triangular fibrocartilage complex injury based on MRI radiomics model
NEXT Experimental study on the evaluation of acute mesenteric artery ischemia in the small intestine wall injury of rabbits by quantitative magnetic resonance T2‐mapping technique

Tel & Fax: +8610-67113815    E-mail: