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Dynamic contrast-enhanced MRI for monitoring bisphosphonate therapy in Paget’s disease of bone

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Abstract

Purpose

The purpose of this study was to evaluate changes in regional bone perfusion in Paget’s disease (PD) following bisphosphonate therapy. We used dynamic contrast-enhanced MRI (DCE-MRI) for assessment of bone perfusion and compared MRI findings with alkaline phosphatase (AP) as a serum marker of bone turnover.

Materials and methods

We examined 20 patients (8 women, 12 men, 66 ± 11 years) with symptomatic PD of the axial skeleton. Patients were selected for infusion therapy with the bisphosphonate pamidronate. The most affected bone of lumbar spine or pelvis was examined by DCE-MRI prior to therapy and after a 6-month follow-up. The contrast uptake was evaluated using a two-compartment model with the parameters amplitude A and exchange rate constant Kep. Color-coded parametric images were generated to visualize bone vascularization.

Results

After a 6-month follow-up there was a significant decrease in alkaline phosphatase and in DCE-MRI parameters A and Kep (p < 0.0001). Patients without previous bisphosphonate treatment showed a significantly greater decrease in alkaline phosphatase and Kep (p < 0.001).

Conclusion

DCE-MRI shows a significant reduction in regional bone perfusion in PD following parenteral bisphosphonate treatment. Reduction in bone perfusion is greater in bisphosphonate-naïve patients than in those who had been previously treated.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Deaconess Hospital, Schwäbisch Hall, Germany

    Martin Libicher

  2. Department of Medicine I, University of Heidelberg, Heidelberg, Germany

    C. Kasperk & P. Nawroth

  3. Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany

    M. Daniels-Wredenhagen, T. Heye, H. U. Kauczor & W. Hosch

  4. Department of Radiology, German Cancer Research Center, Heidelberg, Germany

    S. Delorme

  5. Institut für diagnostische und interventionelle Radiologie, Diakonie-Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523, Schwäbisch Hall, Germany

    Martin Libicher

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  1. Martin Libicher
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Correspondence to Martin Libicher.

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Libicher, M., Kasperk, C., Daniels-Wredenhagen, M. et al. Dynamic contrast-enhanced MRI for monitoring bisphosphonate therapy in Paget’s disease of bone. Skeletal Radiol 42, 225–230 (2013). https://doi.org/10.1007/s00256-012-1423-4

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  • DOI: https://doi.org/10.1007/s00256-012-1423-4

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