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Assessment of Bone Marrow Angiogenesis in Patients with Acute Myeloid Leukemia by Using Contrast-enhanced MR Imaging with Clinically Approved Iron Oxides: Initial Experience¹

¹ From the Departments of Clinical Radiology (L.M., T.P., A.W., N.M., B.T., W.H., C.B.) and Medicine/Hematology and Oncology (R.B., R.M., W.E.B.) and Interdisciplinary Center for Clinical Research (C.B.), University of Muenster, Albert-Schweitzer-Str 33, D-48129 Münster, Germany; and Philips Medical Systems, Hamburg, Germany (H.K.). From the 2003 RSNA Annual Meeting. Received August 13, 2005; revision requested October 20; revision received December 1; accepted January 2, 2006; final version accepted April 10. Address correspondence to C.B. (e-mail: bremerc{at}uni-muenster.de).

Purpose: To prospectively assess bone marrow (BM) angiogenesis in patients with acute myeloid leukemia (AML) by using iron oxide–enhanced magnetic resonance (MR) imaging.

Materials and Methods: The study was institutional ethics committee approved. Informed signed consent was obtained from each study participant. The requirement for informed consent for use of data from a reference database was waived. Eleven patients (seven women, four men; mean age, 53 years ± 4.40 [standard deviation]) with an initial diagnosis of AML were enrolled in the study and underwent T2*-weighted two-echo echo-planar MR imaging of the pelvis before and after intravenous injection of a clinically approved iron oxide blood-pool contrast agent. Six healthy control subjects (one woman, five men; mean age, 35 years ± 2.31) were examined with the same MR protocol. The iron oxide–induced change in R2* relaxation rate (R2*) was calculated, and the vascular volume fraction (VVF) of the BM was derived by dividing the R2* of the BM by the R2* of the muscle. Parametric R2* maps were calculated to visualize vessel distribution. Patients underwent BM biopsy for correlative determination of microvessel density (MVD) and vascular endothelial growth factor (VEGF). Differences in R2*, VVF, VEGF, and MVD were compared by using the Wilcoxon rank sum test.

Results: R2* maps showed prominent areas of highly vascularized BM in the patients with AML, whereas the control subjects had moderately vascularized BM with homogeneous vessel distribution. Quantitative analysis revealed VVF values to be significantly higher in patients with AML than in control subjects: The mean VVF in the pelvis was 9.18% ± 1.54 for patients versus 3.91% ± 0.61 for control subjects (P = .010). In accordance with MR results, MVD (P = .009) and VEGF expression (P = .017) were significantly elevated in the AML group compared with values in the control group.

Conclusion: Iron oxide–enhanced MR imaging enables assessment of BM angiogenesis in patients with AML.

© RSNA, 2006