Socioeconomic and risk-related drivers of compliance with measures to prevent SARS-CoV-2 infection: evidence from the Munich-based KoCo19 study.

OBJECTIVES: Although a growing share of the population in many countries has been vaccinated against the SARS-CoV-2 virus to different degrees, social distancing and hygienic non-pharmaceutical interventions still play a substantial role in containing the pandemic. The goal of this study was to investigate which factors are correlated with a higher compliance with these regulations in the context of a cohort study in the city of Munich, southern Germany, during the summer of 2020, i.e. after the first lockdown phase. METHODS: Using self-reported compliance with six regulations and personal hygiene rules (washing hands, avoiding touching face, wearing a mask, keeping distance, avoiding social gatherings, avoiding public spaces) we extracted two compliance factor scores, namely compliance with personal hygiene measures and compliance with social distancing regulations. Using linear and logistic regressions, we estimated the correlation of several socio-demographic and risk perception variables with both compliance scores. RESULTS: Risk aversion proved to be a consistent and significant driver of compliance across all compliance behaviors. Furthermore, being female, being retired and having a migration background were positively associated with compliance with personal hygiene regulations, whereas older age was related with a higher compliance with social distancing regulations. Generally, socioeconomic characteristics were not related with compliance, except for education, which was negatively related with compliance with personal hygiene measures. CONCLUSIONS: Our results suggest that for a targeted approach to improve compliance with measures to prevent SARS-CoV-2 infection, special attention should be given to younger, male and risk-prone individuals.

Hierarchical Multi-Resolution Graph-Cuts for Water-Fat-Silicone Separation in Breast MRI.

Water-fat separation is a non-linear non-convex parameter estimation problem in magnetic resonance imaging typically solved using spatial constraints. However, there is still limited knowledge on how to separate in vivo three chemical species in the presence of magnetic field inhomogeneities. The proposed method uses multiple graph-cuts in a hierarchical multi-resolution framework to perform robust chemical species separation in the breast for subjects with and without silicone implants. Experimental results show that the proposed method can decrease the computational time for water-fat separation and perform accurate water-fat-silicone separation with only a limited number of acquired echo images at 3 T. The silicone-separated images have an improved spatial resolution and image contrast compared to conventional scans used for regular monitoring of the silicone implant's integrity.

Intraindividual difference between supraclavicular and subcutaneous proton density fat fraction is associated with cold-induced thermogenesis.

Background: Brown adipose tissue (BAT) activity is triggered by cold exposure resulting in an increased resting energy expenditure, called cold-induced non-shivering thermogenesis (CIT). Magnetic resonance (MR)-based proton density fat fraction (PDFF) of the supraclavicular fossa has been proposed as a surrogate marker of human BAT. The present study investigates supraclavicular PDFF in relation to CIT. Methods: For this prospective cross-sectional study 39 adults were recruited, from a cross-sectional study, exploring energy expenditure after cold exposure compared to thermoneutral conditions. Participants underwent additional MR examination of neck, pelvis, and abdomen. Supraclavicular and subcutaneous gluteal adipose tissue depots were segmented semi-automatically. Mean PDFF was assessed for each compartment and the delta PDFF was calculated as the difference of both. Correlation analysis of supraclavicular PDFF to CIT was performed for the whole cohort and subgroups, sorted by body mass index (BMI) and body fat percentage. Results: Median age of participants (61.5% female) was 27 years. BMI ranged from 19.0 to 38.5 kg/m2, with body fat percentages from 4.6% to 45.3%. Median supraclavicular PDFF of 82.5% and median gluteal PDFF of 91.1%, were significantly different (P<0.0001). Median delta PDFF was 8.8% (3.9-21.9%). Mean CIT was 4.7%±9.0%. No statistically significant correlation of supraclavicular PDFF and CIT was found in the whole cohort and in most of the observed subgroups. Just the subgroup with normal body fat percentage revealed significant correlations between supraclavicular PDFF and CIT (rho =-0.59; P=0.003). Delta PDFF was significantly associated with CIT (rho =0.36; P=0.026). Conclusions: PDFF is influenced by adiposity. Therefore, if supraclavicular PDFF is used as approach to indirectly assess BAT presence, body composition should be considered. Delta PDFF, as the difference between gluteal and supraclavicular PDFF, may be a marker of CIT.

On quantification errors of R2*$$ {R}_2

PURPOSE: To study the effect of field inhomogeneity distributions in trabecularized bone regions on the gradient echo (GRE) signal with short TEs and to characterize quantification errors on R2*$$ {R}_2^{\ast } $$ and proton density fat fraction (PDFF) maps when using a water-fat model with an exponential R2*$$ {R}_2^{\ast } $$ decay model at short TEs. METHODS: Field distortions were simulated based on a trabecular bone micro CT dataset. Simulations were performed for different bone volume fractions (BV/TV) and for different bone-fat composition values. A multi-TE UTE acquisition was developed to acquire multiple UTEs with random order to minimize eddy currents. The acquisition was validated in phantoms and applied in vivo in a volunteer's ankle and knee. Chemical shift encoded MRI (CSE-MRI) based on a Cartesian multi-TE GRE scan was acquired in the spine of patients with metastatic bone disease. RESULTS: Simulations showed that signal deviations from the exponential signal decay at short TEs were more prominent for a higher BV/TV. UTE multi-TE measurements reproduced in vivo the simulation-based predicted behavior. In regions with high BV/TV, the presence of field inhomogeneities induced an R2*$$ {R}_2^{\ast } $$ underestimation in trabecularized bone marrow when using CSE-MRI at 3T with a short TE. CONCLUSION: R2*$$ {R}_2^{\ast } $$ can be underestimated when using short TEs (<2 ms at 3 T) and a water-fat model with an exponential R2*$$ {R}_2^{\ast } $$ decay model in multi-echo GRE acquisitions of trabecularized bone marrow.

Postmenopausal Chinese-Singaporean Women Have a Higher Ratio of Visceral to Subcutaneous Adipose Tissue Volume than Caucasian Women of the Same Age and BMI.

Central fat accumulation is a significant determinant of cardio-metabolic health risk, known to differ between ethnically distinct human populations. Despite evidence for preferential central adiposity in Asian populations, the proportional distribution between the subcutaneous and visceral compartments in Chinese postmenopausal women has not been thoroughly investigated. For this analysis, volumetrically quantified subcutaneous and visceral adipose tissue (SAT, VAT) in the pelvic and abdominal regions of postmenopausal Asian (Chinese-Singaporean) and Caucasian (German) women matched for age and Body Mass Index (BMI) was undertaken, to examine such differences between the two groups. Volumes were calculated from segmentations of magnetic resonance imaging datasets of the abdomen and pelvis. Despite SAT, VAT, and the corresponding total adipose tissue (TAT) being similar between the groups, VAT/SAT and VAT/TAT were higher in the Asian group (by 24.5% and 18.2%, respectively, each p = 0.02). Further, VAT/SAT and VAT/TAT were positively correlated with BMI in the Caucasian group only (p = 0.02 and p = 0.01, respectively). We concluded that VAT is proportionally higher in the non-obese Asian women, compared to the Caucasian women of matched age and BMI. This conclusion is in agreement with existing literature showing higher abdominal adiposity in Asian populations. Additionally, in the Asian group, BMI did not correlate with visceral adiposity on a significant level. Further analysis is required to examine the extent to which this increased VAT may impact cardio-metabolic health. There is, however, a need to emphasize healthy lifestyle behaviors in non-obese post-menopausal women of Chinese ancestry.

From first to second wave: follow-up of the prospective COVID-19 cohort (KoCo19) in Munich (Germany).

BACKGROUND: In the 2nd year of the COVID-19 pandemic, knowledge about the dynamics of the infection in the general population is still limited. Such information is essential for health planners, as many of those infected show no or only mild symptoms and thus, escape the surveillance system. We therefore aimed to describe the course of the pandemic in the Munich general population living in private households from April 2020 to January 2021. METHODS: The KoCo19 baseline study took place from April to June 2020 including 5313 participants (age 14 years and above). From November 2020 to January 2021, we could again measure SARS-CoV-2 antibody status in 4433 of the baseline participants (response 83%). Participants were offered a self-sampling kit to take a capillary blood sample (dry blood spot; DBS). Blood was analysed using the Elecsys® Anti-SARS-CoV-2 assay (Roche). Questionnaire information on socio-demographics and potential risk factors assessed at baseline was available for all participants. In addition, follow-up information on health-risk taking behaviour and number of personal contacts outside the household (N = 2768) as well as leisure time activities (N = 1263) were collected in summer 2020. RESULTS: Weighted and adjusted (for specificity and sensitivity) SARS-CoV-2 sero-prevalence at follow-up was 3.6% (95% CI 2.9-4.3%) as compared to 1.8% (95% CI 1.3-3.4%) at baseline. 91% of those tested positive at baseline were also antibody-positive at follow-up. While sero-prevalence increased from early November 2020 to January 2021, no indication of geospatial clustering across the city of Munich was found, although cases clustered within households. Taking baseline result and time to follow-up into account, men and participants in the age group 20-34 years were at the highest risk of sero-positivity. In the sensitivity analyses, differences in health-risk taking behaviour, number of personal contacts and leisure time activities partly explained these differences. CONCLUSION: The number of citizens in Munich with SARS-CoV-2 antibodies was still below 5% during the 2nd wave of the pandemic. Antibodies remained present in the majority of SARS-CoV-2 sero-positive baseline participants. Besides age and sex, potentially confounded by differences in behaviour, no major risk factors could be identified. Non-pharmaceutical public health measures are thus still important.

Needs for an Integration of Specific Data Sources and Items - First Insights of a National Survey Within the German Center for Infection Research.

State-subsidized programs develop medical data integration centers in Germany. To get infection disease (ID) researchers involved in the process of data sharing, common interests and minimum data requirements were prioritized. In 06/2019 we have initiated the German Infectious Disease Data Exchange (iDEx) project. We have developed and performed an online survey to determine prioritization of requests for data integration and exchange in ID research. The survey was designed with three sub-surveys, including a ranking of 15 data categories and 184 specific data items and a query of available 51 data collecting systems. A total of 84 researchers from 17 fields of ID research participated in the survey (predominant research fields: gastrointestinal infections n=11, healthcare-associated and antibiotic-resistant infections n=10, hepatitis n=10). 48% (40/84) of participants had experience as medical doctor. The three top ranked data categories were microbiology and parasitology, experimental data, and medication (53%, 52%, and 47% of maximal points, respectively). The most relevant data items for these categories were bloodstream infections, availability of biomaterial, and medication (88%, 87%, and 94% of maximal points, respectively). The ranking of requests of data integration and exchange is diverse and depends on the chosen measure. However, there is need to promote discipline-related digitalization and data exchange.

Prevalence and Risk Factors of Infection in the Representative COVID-19 Cohort Munich.

Given the large number of mild or asymptomatic SARS-CoV-2 cases, only population-based studies can provide reliable estimates of the magnitude of the pandemic. We therefore aimed to assess the sero-prevalence of SARS-CoV-2 in the Munich general population after the first wave of the pandemic. For this purpose, we drew a representative sample of 2994 private households and invited household members 14 years and older to complete questionnaires and to provide blood samples. SARS-CoV-2 seropositivity was defined as Roche N pan-Ig ≥ 0.4218. We adjusted the prevalence for the sampling design, sensitivity, and specificity. We investigated risk factors for SARS-CoV-2 seropositivity and geospatial transmission patterns by generalized linear mixed models and permutation tests. Seropositivity for SARS-CoV-2-specific antibodies was 1.82% (95% confidence interval (CI) 1.28-2.37%) as compared to 0.46% PCR-positive cases officially registered in Munich. Loss of the sense of smell or taste was associated with seropositivity (odds ratio (OR) 47.4; 95% CI 7.2-307.0) and infections clustered within households. By this first population-based study on SARS-CoV-2 prevalence in a large German municipality not affected by a superspreading event, we could show that at least one in four cases in private households was reported and known to the health authorities. These results will help authorities to estimate the true burden of disease in the population and to take evidence-based decisions on public health measures.

Improved body quantitative susceptibility mapping by using a variable-layer single-min-cut graph-cut for field-mapping.

PURPOSE: To develop a robust algorithm for field-mapping in the presence of water-fat components, large B0 field inhomogeneities and MR signal voids and to apply the developed method in body applications of quantitative susceptibility mapping (QSM). METHODS: A framework solving the cost-function of the water-fat separation problem in a single-min-cut graph-cut based on the variable-layer graph construction concept was developed. The developed framework was applied to a numerical phantom enclosing an MR signal void, an air bubble experimental phantom, 14 large field of view (FOV) head/neck region in vivo scans and to 6 lumbar spine in vivo scans. Field-mapping and subsequent QSM results using the proposed algorithm were compared to results using an iterative graph-cut algorithm and a formerly proposed single-min-cut graph-cut. RESULTS: The proposed method was shown to yield accurate field-map and susceptibility values in all simulation and in vivo datasets when compared to reference values (simulation) or literature values (in vivo). The proposed method showed improved field-map and susceptibility results compared to iterative graph-cut field-mapping especially in regions with low SNR, strong field-map variations and high R2∗ values. CONCLUSIONS: A single-min-cut graph-cut field-mapping method with a variable-layer construction was developed for field-mapping in body water-fat regions, improving quantitative susceptibility mapping particularly in areas close to MR signal voids.

Generalized parameter estimation in multi-echo gradient-echo-based chemical species separation.

To develop a generalized formulation for multi-echo gradient-echo-based chemical species separation for all MR signal models described by a weighted sum of complex exponentials with phases linear in the echo time. Constraints between estimation parameters in the signal model were abstracted into a matrix formulation of a generic parameter gradient. The signal model gradient was used in a parameter estimation algorithm and the Fisher information matrix. The general formulation was tested in numerical simulations and against literature and in vivo results. The proposed gradient-based parameter estimation and experimental design framework is universally applicable over the whole class of signal models using the matrix abstraction of the signal model-specific parameter constraints as input. Several previous results in magnetic-field mapping and water-fat imaging with different models could successfully be replicated with the same framework and only different input matrices. A framework for generalized parameter estimation in multi-echo gradient-echo MR signal models of multiple chemical species was developed and validated and its software version is freely available online.

Lumbar muscle and vertebral bodies segmentation of chemical shift encoding-based water-fat MRI: the reference database MyoSegmenTUM spine.

BACKGROUND: Magnetic resonance imaging (MRI) is the modality of choice for diagnosing and monitoring muscular tissue pathologies and bone marrow alterations in the context of lower back pain, neuromuscular diseases and osteoporosis. Chemical shift encoding-based water-fat MRI allows for reliable determination of proton density fat fraction (PDFF) of the muscle and bone marrow. Prior to quantitative data extraction, segmentation of the examined structures is needed. Performed manually, the segmentation process is time consuming and therefore limiting the clinical applicability. Thus, the development of automated segmentation algorithms is an ongoing research focus. CONSTRUCTION AND CONTENT: This database provides ground truth data which may help to develop and test automatic lumbar muscle and vertebra segmentation algorithms. Lumbar muscle groups and vertebral bodies (L1 to L5) were manually segmented in chemical shift encoding-based water-fat MRI and made publically available in the database MyoSegmenTUM. The database consists of water, fat and PDFF images with corresponding segmentation masks for lumbar muscle groups (right/left erector spinae and psoas muscles, respectively) and lumbar vertebral bodies 1-5 of 54 healthy Caucasian subjects. The database is freely accessible online at https://osf.io/3j54b/?view_only=f5089274d4a449cda2fef1d2df0ecc56 . CONCLUSION: A development and testing of segmentation algorithms based on this database may allow the use of quantitative MRI in clinical routine.

Paraspinal Muscle DTI Metrics Predict Muscle Strength.

BACKGROUND: The paraspinal muscles play an important role in the onset and progression of lower back pain. It would be of clinical interest to identify imaging biomarkers of the paraspinal musculature that are related to muscle function and strength. Diffusion tensor imaging (DTI) enables the microstructural examination of muscle tissue and its pathological changes. PURPOSE: To investigate associations of DTI parameters of the lumbar paraspinal muscles with isometric strength measurements in healthy volunteers. STUDY TYPE: Prospective. SUBJECTS: Twenty-one healthy subjects (12 male, 9 female; age = 30.1 ± 5.6 years; body mass index [BMI] = 27.5 ± 2.6 kg/m2 ) were recruited. FIELD STRENGTH/SEQUENCE: 3 T/single-shot echo planar imaging (ss-EPI) DTI in 24 directions; six-echo 3D spoiled gradient echo sequence for chemical shift encoding-based water-fat separation. ASSESSMENT: Paraspinal muscles at the lumbar spine were examined. Erector spinae muscles were segmented bilaterally; cross-sectional area (CSA), proton density fat fraction (PDFF), and DTI parameters were calculated. Muscle flexion and extension maximum isometric torque values [Nm] at the back were measured with an isokinetic dynamometer and the ratio of extension to flexion strength (E/F) calculated. STATISTICAL TESTS: Pearson correlation coefficients; multivariate regression models. RESULTS: Significant positive correlations were found between the ratio of extension to flexion (E/F) strength and mean diffusivity (MD) (P = 0.019), RD (P = 0.02) and the eigenvalues (λ1: P = 0.026, λ2: P = 0.033, λ3: P = 0.014). In multivariate regression models λ3 of the erector spinae muscle λ3 and gender remained statistically significant predictors of E/F (R2adj = 0.42, P = 0.003). DATA CONCLUSION: DTI allowed the identification of muscle microstructure differences related to back muscle function that were not reflected by CSA and PDFF. DTI may potentially track subtle changes of back muscle tissue composition. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:816-823.

Differentiating supraclavicular from gluteal adipose tissue based on simultaneous PDFF and T2 * mapping using a 20-echo gradient-echo acquisition.

BACKGROUND: Adipose tissue (AT) can be classified into white and brown/beige subtypes. Chemical shift encoding-based water-fat MRI-techniques allowing simultaneous mapping of proton density fat fraction (PDFF) and T2 * result in a lower PDFF and a shorter T2 * in brown compared with white AT. However, AT T2 * values vary widely in the literature and are primarily based on 6-echo data. Increasing the number of echoes in a multiecho gradient-echo acquisition is expected to increase the precision of AT T2 * mapping. PURPOSE: 1) To mitigate issues of current T2 *-measurement techniques through experimental design, and 2) to investigate gluteal and supraclavicular AT T2 * and PDFF and their relationship using a 20-echo gradient-echo acquisition. STUDY TYPE: Prospective. SUBJECTS: Twenty-one healthy subjects. FIELD STRENGTH/SEQUENCE ASSESSMENT: First, a ground truth signal evolution was simulated from a single-T2 * water-fat model. Second, a time-interleaved 20-echo gradient-echo sequence with monopolar gradients of neck and abdomen/pelvis at 3 T was performed in vivo to determine supraclavicular and gluteal PDFF and T2 *. Complex-based water-fat separation was performed for the first 6 echoes and the full 20 echoes. AT depots were segmented. STATISTICAL TESTS: Mann-Whitney test, Wilcoxon signed-rank test and simple linear regression analysis. RESULTS: Both PDFF and T2 * differed significantly between supraclavicular and gluteal AT with 6 and 20 echoes (PDFF: P < 0.0001 each, T2 *: P = 0.03 / P < 0.0001 for 6/20 echoes). 6-echo T2 * demonstrated higher standard deviations and broader ranges than 20-echo T2 *. Regression analyses revealed a strong relationship between PDFF and T2 * values per AT compartment (R2 = 0.63 supraclavicular, R2 = 0.86 gluteal, P < 0.0001 each). DATA CONCLUSION: The present findings suggest that an increase in the number of sampled echoes beyond 6 does not affect AT PDFF quantification, whereas AT T2 * is considerably affected. Thus, a 20-echo gradient-echo acquisition enables a multiparametric analysis of both AT PDFF and T2 * and may therefore improve MR-based differentiation between white and brown fat. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:424-434.

On the sensitivity of quantitative susceptibility mapping for measuring trabecular bone density.

PURPOSE: To develop a methodological framework to simultaneously measure R2* and magnetic susceptibility in trabecularized yellow bone marrow and to investigate the sensitivity of Quantitative Susceptibility Mapping (QSM) for measuring trabecular bone density using a non-UTE multi-gradient echo sequence. METHODS: The ankle of 16 healthy volunteers and two patients was scanned using a time-interleaved multi-gradient-echo (TIMGRE) sequence. After field mapping based on water-fat separation methods and background field removal based on the Laplacian boundary value method, three different QSM dipole inversion schemes were implemented. Mean susceptibility values in regions of different trabecular bone density in the calcaneus were compared to the corresponding values in the R2* maps, bone volume to total volume ratios (BV/TV) estimated from high resolution imaging (in 14 subjects), and CT attenuation (in two subjects). In addition, numerical simulations were performed in a simplified trabecular bone model of randomly positioned spherical bone inclusions to verify and compare the scaling of R2* and susceptibility with BV/TV. RESULTS: Differences in calcaneus trabecularization were well depicted in susceptibility maps, in good agreement with high-resolution MR and CT images. Simulations and in vivo scans showed a linear relationship of measured susceptibility with BV/TV and R2* . The ankle in vivo results showed a strong linear correlation between susceptibility and R2* (R2  = 0.88, p < 0.001) with a slope and intercept of -0.004 and 0.2 ppm, respectively. CONCLUSIONS: A method for multi-paramteric mapping, including R2* -mapping and QSM was developed for measuring trabecularized yellow bone marrow, showing good sensitivity of QSM for measuring trabecular bone density.

Associations Between Lumbar Vertebral Bone Marrow and Paraspinal Muscle Fat Compositions-An Investigation by Chemical Shift Encoding-Based Water-Fat MRI.

Purpose: Advanced magnetic resonance imaging (MRI) methods enable non-invasive quantification of body fat situated in different compartments. At the level of the lumbar spine, the paraspinal musculature is the compartment spatially and functionally closely related to the vertebral column, and both vertebral bone marrow fat (BMF) and paraspinal musculature fat contents have independently shown to be altered in various metabolic and degenerative diseases. However, despite their close relationships, potential correlations between fat compositions of these compartments remain largely unclear. Materials and Methods: Thirty-nine female subjects (38.5% premenopausal women, 29.9 ± 7.1 years; 61.5% postmenopausal women, 63.2 ± 6.3 years) underwent MRI at 3T of the lumbar spine using axially- and sagittally-prescribed gradient echo sequences for chemical shift encoding-based water-fat separation. The erector spinae muscles and vertebral bodies of L1-L5 were segmented to determine the proton density fat fraction (PDFF) of the paraspinal and vertebral bone marrow compartments. Correlations were calculated between the PDFF of the paraspinal muscle and bone marrow compartments. Results: The average PDFF of the paraspinal muscle and bone marrow compartments were significantly lower in premenopausal women when compared to postmenopausal women (11.6 ± 2.9% vs. 24.6 ± 7.1% & 28.8 ± 8.3% vs. 47.2 ± 8.5%; p < 0.001 for both comparisons). In premenopausal women, no significant correlation was found between the PDFF of the erector spinae muscles and the PDFF of the bone marrow of lumbar vertebral bodies (p = 0.907). In contrast, a significant correlation was shown in postmenopausal women (r = 0.457, p = 0.025). Significance was preserved after inclusion of age and body mass index (BMI) as control variables (r = 0.472, p = 0.027). Conclusion: This study revealed significant correlations between the PDFF of paraspinal and vertebral bone marrow compartments in postmenopausal women. The PDFF of the paraspinal and vertebral bone marrow compartments and their correlations might potentially serve as biomarkers; however, future studies including more subjects are required to evaluate distinct clinical value and reliability. Future studies should also follow up our findings in patients suffering from metabolic and degenerative diseases to clarify how these correlations change in the course of such diseases.

Anatomical Variation of Age-Related Changes in Vertebral Bone Marrow Composition Using Chemical Shift Encoding-Based Water-Fat Magnetic Resonance Imaging.

Assessment of vertebral bone marrow composition has been proposed as imaging biomarker for osteoporosis, hematopoietic, and metabolic disorders. We investigated the anatomical variation of age-related changes of vertebral proton density fat fraction (PDFF) using chemical shift encoding-based water-fat magnetic resonance imaging (MRI). 156 healthy subjects were recruited (age range 20-29 years: 12/30 males/females; 30-39: 15/9; 40-49: 4/14; 50-59: 9/27; 60-69: 5/19; 70-79: 4/8). An eight-echo 3D spoiled gradient-echo sequence at 3T MRI was used for chemical shift-encoding based water-fat separation at the lumbar spine. Vertebral bodies of L1-L4 were manually segmented to extract PDFF values at each vertebral level. PDFF averaged over L1-L4 was significantly (p < 0.05) higher in males than females in the twenties (32.0 ± 8.0 vs. 27.2 ± 6.0%) and thirties (35.3 ± 6.7 vs. 27.3 ± 6.2%). With increasing age, females showed an accelerated fatty conversion of the bone marrow compared to men with no significant (p > 0.05) mean PDFF differences in the forties (32.4 ± 8.4 vs. 34.5 ± 6.8%) and fifties (42.0 ± 6.1 vs. 40.5 ± 9.7%). The accelerated conversion process continued resulting in greater mean PDFF values in females than males in the sixties (40.2 ± 6.9 vs. 48.8 ± 7.7%; p = 0.033) and seventies (43.9 ± 7.6 vs. 50.5 ± 8.2%; p = 0.208), though the latter did not reach statistical significance. Relative age-related PDFF change from the twenties to the seventies increased from 16.7% (L1) to 51.4% (L4) in males and 76.8% (L1) to 85.7% (L4) in females. An accelerated fatty conversion of bone marrow was observed in females with increasing age particularly evident after menopause. Relative age-related PDFF changes showed an anatomical variation with most pronounced changes at lower lumbar vertebral levels in both sexes.

Quantitative MRI and spectroscopy of bone marrow.

Bone marrow is one of the largest organs in the human body, enclosing adipocytes, hematopoietic stem cells, which are responsible for blood cell production, and mesenchymal stem cells, which are responsible for the production of adipocytes and bone cells. Magnetic resonance imaging (MRI) is the ideal imaging modality to monitor bone marrow changes in healthy and pathological states, thanks to its inherent rich soft-tissue contrast. Quantitative bone marrow MRI and magnetic resonance spectroscopy (MRS) techniques have been also developed in order to quantify changes in bone marrow water-fat composition, cellularity and perfusion in different pathologies, and to assist in understanding the role of bone marrow in the pathophysiology of systemic diseases (e.g. osteoporosis). The present review summarizes a large selection of studies published until March 2017 in proton-based quantitative MRI and MRS of bone marrow. Some basic knowledge about bone marrow anatomy and physiology is first reviewed. The most important technical aspects of quantitative MR methods measuring bone marrow water-fat composition, fatty acid composition, perfusion, and diffusion are then described. Finally, previous MR studies are reviewed on the application of quantitative MR techniques in both healthy aging and diseased bone marrow affected by osteoporosis, fractures, metabolic diseases, multiple myeloma, and bone metastases. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:332-353.

Correction of phase errors in quantitative water-fat imaging using a monopolar time-interleaved multi-echo gradient echo sequence.

PURPOSE: To propose a phase error correction scheme for monopolar time-interleaved multi-echo gradient echo water-fat imaging that allows accurate and robust complex-based quantification of the proton density fat fraction (PDFF). METHODS: A three-step phase correction scheme is proposed to address a) a phase term induced by echo misalignments that can be measured with a reference scan using reversed readout polarity, b) a phase term induced by the concomitant gradient field that can be predicted from the gradient waveforms, and c) a phase offset between time-interleaved echo trains. Simulations were carried out to characterize the concomitant gradient field-induced PDFF bias and the performance estimating the phase offset between time-interleaved echo trains. Phantom experiments and in vivo liver and thigh imaging were performed to study the relevance of each of the three phase correction steps on PDFF accuracy and robustness. RESULTS: The simulation, phantom, and in vivo results showed in agreement with the theory an echo time-dependent PDFF bias introduced by the three phase error sources. The proposed phase correction scheme was found to provide accurate PDFF estimation independent of the employed echo time combination. CONCLUSION: Complex-based time-interleaved water-fat imaging was found to give accurate and robust PDFF measurements after applying the proposed phase error correction scheme. Magn Reson Med 78:984-996, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

MR-Based Assessment of Bone Marrow Fat in Osteoporosis, Diabetes, and Obesity.

Bone consists of the mineralized component (i.e., cortex and trabeculae) and the non-mineralized component (i.e., bone marrow). Most of the routine clinical bone imaging uses X-ray-based techniques and focuses on the mineralized component. However, bone marrow adiposity has been also shown to have a strong linkage with bone health. Specifically, multiple previous studies have demonstrated a negative association between bone marrow fat fraction (BMFF) and bone mineral density. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) are ideal imaging techniques for non-invasively investigating the properties of bone marrow fat. In the present work, we first review the most important MRI and MRS methods for assessing properties of bone marrow fat, including methodologies for measuring BMFF and bone marrow fatty acid composition parameters. Previous MRI and MRS studies measuring BMFF and fat unsaturation in the context of osteoporosis are then reviewed. Finally, previous studies investigating the relationship between bone marrow fat, other fat depots, and bone health in patients with obesity and type 2 diabetes are presented. In summary, MRI and MRS are powerful non-invasive techniques for measuring properties of bone marrow fat in osteoporosis, obesity, and type 2 diabetes and can assist in future studies investigating the pathophysiology of bone changes in the above clinical scenarios.