Spinal multiparametric MRI and DEXA changes over time in men with prostate cancer treated with androgen deprivation therapy: a potential imaging biomarker of treatment toxicity
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To explore changes in bone mineral density (BMD) measured by DEXA and MRS fat fraction (FF), Dixon FF, and ADC in lower spinal vertebral bodies in men with prostate cancer treated with androgen deprivation therapy (ADT).
Twenty-eight men were enrolled onto a clinical trial. All received ADT. DEXA imaging was performed at baseline and 12 months. L-spine MRI was done at baseline and 6 months.
The number of patients who underwent DEXA, Dixon, ADC, and MRS at baseline/follow-up were 28/27, 28/26, 28/26, and 22/20. An increase in FF was observed from T11 to S2 (average 1 %/vertebra). There was a positive correlation between baseline MRS FF and Dixon FF (r = 0.85, p < 0.0001) and a negative correlation between MRS FF and ADC (r = -0.56, p = 0.036). Over 6 months, MRS FF increased by a median of 25 % in relative values (p = 0.0003), Dixon FF increased (p < 0.0001) and ADC values decreased (p = 0.0014). Men with >5 % BMD loss after 1 year had triple the percentage increase in MRS FF at 6 months (61.1 % vs. 20.9 %, p = 0.19).
Changes are observed on L-spine MRI after 6 months of ADT. Further investigation is warranted of MRS change as a potential predictive biomarker for later BMD loss.
• Spinal marrow fat fraction increases after 6 months of androgen deprivation therapy.
• More inferior vertebral bodies tend to have higher fat fractions.
• MRS fat fraction changes were associated with later changes in DEXA BMD.
KeywordsMagnetic resonance imagining Bone density Prostate neoplasms Biomarkers Toxicity
Androgen depravation therapy
Bone mineral density
Dual-energy X-ray absorptiometry
Diffusion weighted imaging
High risk prostate cancer
Point resolved spectroscopy
Prostate cancer imaging, treatment, and toxicity
Single voxel spectroscopic
The authors wish to acknowledge the assistance of Katie Baker and Hannah Woodford who assisted in MRI data extraction. Mary-Clare Hanlon assisted with manuscript submission. Peter Stanwell assisted with MRI sequence programming. Abbvie pharmaceuticals provided an unrestricted investigator initiated grant which funded the scans, trial management and statistical analysis. All analysis and manuscript preparation was performed without any input from Abbvie Pharmaceuticals.
The scientific guarantor of this publication is Associate Professor Jarad Martin. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by Abbvie Pharmaceuticals. Dr Kerrin Palazzi (one of the authors) kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.
Some of the same subjects also had assays performed for circulating tumour cells, as well as a nomogram guided radiotherapy target volume, both of which have been reported separately. The current study completely addresses bone health and imaging, neither of which have been reported in the previous manuscripts.
Methodology: Prospective, diagnostic or prognostic study / observational / experimental, performed at one institution.
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