Susanta K. Hui PhD, Presenter: Nothing to Disclose

Luke Arentsen PhD, ARRT, Abstract Co-Author: Nothing to Disclose

Keenan Brown, Abstract Co-Author: Employee, Mindways Software, Inc Stockholder, Mindways Software, Inc

Patrick J. Bolan PhD, Abstract Co-Author: Research Consultant, Breast-Med, Inc

Rahel G. Ghebre MD, Abstract Co-Author: Nothing to Disclose

Levi S. Downs MD, MSc, Abstract Co-Author: Speaker, GlaxoSmithKline plc Consultant, GlaxoSmithKline plc Investigator, GlaxoSmithKline plc Investigator, Celgene Corporation Institutional research contract, GlaxoSmithKline plc

Ryan Shanley MSc, Abstract Co-Author: Nothing to Disclose

Karen Hansen MD, Abstract Co-Author: Nothing to Disclose

Yutaka Takahashi PhD, Abstract Co-Author: Nothing to Disclose

Masashi Yagi, Abstract Co-Author: Nothing to Disclose

Bruno Beomonte Zobel MD, Abstract Co-Author: Nothing to Disclose

Jerry W. Froelich MD, Abstract Co-Author: Nothing to Disclose

Douglas Yee MD, Abstract Co-Author: Nothing to Disclose

Cancer survivors have an increased risk of osteoporotic fractures. However the extent of bone and marrow damage is poorly understood. The purpose is to develop multimodality imaging to monitor B&M changes quantitatively with time

We used dual energy CT (DECT), water-fat MRI (WFMRI), quantitative CT (QCT) and DXA to measure one-year changes in MF and BMD associated with three cancer treatments: oophorectomy, radiotherapy or chemotherapy. We also measured changes in circulating adiponectin levels. Twenty nine patients with gynecologic malignancies underwent DECT and DXA at 0, 6 and 12 months post-treatment; 15 were also imaged by WF-MRI.

We observed a high overall correlation (r = 0.77, 95% CI: 0.69, 0.83) between DECT and WF-MRI based MF quantification at L3, L4, and L5 for 15 subjects (Figure A). Likewise, changes in MF from 0 to 12 months were highly correlated by both imaging methods (r = 0.91, 95% CI: 0.84, 0.95). MF increased significantly from 0 to 12 months (p<0.002 at L3, L4, L5, and FN). All three treatments increased MF (p<0.032), but chemotherapy and radiation caused greater increases than oophorectomy (Figure B &C). L4 BMD measured by DECT decreased most after chemotherapy (p=0.01), followed by radiation (p=0.09) and oophorectomy (p=0.24). L4 BMD decreased 14% by DECT, 20% by QCT, but only by 5% by DXA (p<0.002 for all) (Figure D). At baseline, we observed a statistically significant, inverse association between MF and BMD. By contrast, at 12 months the inverse association between MF and BMD was dramatically attenuated (Figure E &F). Adiponectin increased from 0 to 12 months without changes in total body fat.

Our study demonstrated rapid increases in MF following radiotherapy and chemotherapy. Additionally, DECT detected much greater changes in BMD than did conventional DXA. Our results suggest that contrary to the general population, MF and BMD cannot be used interchangeably to monitor skeletal health following cancer therapy. Longitudinal studies in larger population are needed to determine if increases in MF and adiponectin are associated with long-term sustained bone damage and ultimate ability to predict fracture risk.

If MF is the key results of cytotoxic therapy, more effective preventive therapy must be to reverse or suppress adipogenesis in addition to common method of antiresorptive therapy that is common used for general population

Hui, S, Arentsen, L, Brown, K, Bolan, P, Ghebre, R, Downs, L, Shanley, R, Hansen, K, Takahashi, Y, Yagi, M, Zobel, B, Froelich, J, Yee, D, Multimodality Imaging Shows Cytotoxic Cancer Therapy Causes Rapid Expansion of Marrow Fat (MF) and but Slower Decrease in BMD Causing Failure of Their Inverse Correlation Why We Should Think Differently about Cancer Survivors; Bone Health - Multi-modal.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015335.html