Dimitrios C. Karampinos

Bone marrow fat composition as a novel imaging biomarker in postmenopausal women with prevalent fragility fractures

The goal of this magnetic resonance (MR) imaging study was to quantify vertebral bone marrow fat content and composition in diabetic and nondiabetic postmenopausal women with fragility fractures and to compare them with nonfracture controls with and without type 2 diabetes mellitus. Sixty‐nine postmenopausal women (mean age 63 ± 5 years) were recruited. Thirty‐six patients (47.8%) had spinal and/or peripheral fragility fractures. Seventeen fracture patients were diabetic. Thirty‐three women (52.2%) were nonfracture controls. Sixteen women were diabetic nonfracture controls. To quantify vertebral bone marrow fat content and composition, patients underwent MR spectroscopy (MRS) of the lumbar spine at 3 Tesla. Bone mineral density (BMD) was determined by dual‐energy X‐ray absorptiometry (DXA) of the hip and lumbar spine (LS) and quantitative computed tomography (QCT) of the LS. To evaluate associations of vertebral marrow fat content and composition with spinal and/or peripheral fragility fractures and diabetes, we used linear regression models adjusted for age, race, and spine volumetric bone mineral density (vBMD) by QCT. At the LS, nondiabetic and diabetic fracture patients had lower vBMD than controls and diabetics without fractures (p = 0.018; p = 0.005). However, areal bone mineral density (aBMD) by DXA did not differ between fracture and nonfracture patients. After adjustment for age, race, and spinal vBMD, the prevalence of fragility fractures was associated with −1.7% lower unsaturation levels (confidence interval [CI] −2.8% to −0.5%, p = 0.005) and +2.9% higher saturation levels (CI 0.5% to 5.3%, p = 0.017). Diabetes was associated with −1.3% (CI –2.3% to −0.2%, p = 0.018) lower unsaturation and +3.3% (CI 1.1% to 5.4%, p = 0.004) higher saturation levels. Diabetics with fractures had the lowest marrow unsaturation and highest saturation. There were no associations of marrow fat content with diabetes or fracture. Our results suggest that altered bone marrow fat composition is linked with fragility fractures and diabetes. MRS of spinal bone marrow fat may therefore serve as a novel tool for BMD‐independent fracture risk assessment.

Does vertebral bone marrow fat content correlate with abdominal adipose tissue, lumbar spine bone mineral density, and blood biomarkers in women with type 2 diabetes mellitus?†

To compare vertebral bone marrow fat content quantified with proton MR spectroscopy (1H‐MRS) with the volume of abdominal adipose tissue, lumbar spine volumetric bone mineral density (vBMD), and blood biomarkers in postmenopausal women with and without type 2 diabetes mellitus (T2DM).

Neural activation of swallowing and swallowing-related tasks in healthy young adults: an attempt to separate the components of deglutition.

Understanding the underlying neural pathways that govern the highly complex neuromuscular action of swallowing is considered crucial in the process of correctly identifying and treating swallowing disorders. The aim of the present investigation was to identify the neural activations of the different components of deglutition in healthy young adults using functional magnetic resonance imaging (fMRI). Ten right‐handed young healthy individuals were scanned in a 3‐Tesla Siemens Allegra MRI scanner. Participants were visually cued for both a “Swallow” task and for component/control tasks (“Prepare to swallow”, “Tap your tongue”, and “Clear your throat”) in a randomized order (event‐related design). Behavioral interleaved gradient (BIG) methodology was used to address movement‐related artifacts. Areas activated during each of the three component tasks enabled a partial differentiation of the neural localization for various components of the swallow. Areas that were more activated during throat clearing than other components included the posterior insula and small portions of the post‐ and pre‐central gyri bilaterally. Tongue tapping showed higher activation in portions of the primary sensorimotor and premotor cortices and the parietal lobules. Planning did not show any areas that were more activated than in the other component tasks. When swallowing was compared with all other tasks, there was significantly more activation in the cerebellum, thalamus, cingulate gyrus, and all areas of the primary sensorimotor cortex bilaterally. Hum Brain Mapp 2009.

Characterization of the regional distribution of skeletal muscle adipose tissue in type 2 diabetes using chemical shift‐based water/fat separation

To show the feasibility of assessing the spatial distribution of skeletal muscle adipose tissue using chemical shift‐based water/fat separation and to characterize differences in calf intermuscular adipose tissue (IMAT) compartmentalization in patients with type 2 diabetes mellitus (T2DM) compared to healthy age‐matched controls.

The Effects of a Higher Protein Intake During Energy Restriction on Changes in Body Composition and Physical Function in Older Women

BACKGROUND The purpose of this double-blind randomized clinical trial was to compare the relative effectiveness of a higher protein and conventional carbohydrate intake during weight loss on body composition and physical function in older women. METHODS Thirty-one overweight or obese, postmenopausal women (mean ± SD: age 65.2 ± 4.6 years, body mass index 33.7 ± 4.9 kg/m(2)) were prescribed a reduced calorie diet (1,400 kcal/day; 15%, 65%, 30% energy from protein, carbohydrate, and fat, respectively) and randomly assigned to 2 × 25 g/day whey protein (PRO n = 15) or maltodextrin (CARB n = 16) supplementation for 6 months. Lean soft tissue (LST) via dual-energy X-ray absorptiometry; thigh muscle, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue with magnetic resonance imaging; knee strength with isokinetic dynamometry; balance and physical function with a battery of performance tests. RESULTS PRO lost more weight than CARB (-8.0% ± 6.2%, -4.1% ± 3.6%, p = .059; respectively). Changes in LST, %LST, and strength, balance, or physical performance measures did not differ between groups (all p > .05). Weight to leg LST ratio improved more in PRO versus CARB (-4.6 ± 3.6%, -1.8 ± 2.6%, p = .03). PRO lost 4.2% more muscle (p = .01), 10.9% more SAT (p = .02), and 8.2% more intermuscular adipose tissue (p = .03) than CARB. Relative to thigh volume changes, PRO gained 5.8% more muscle (p = .049) and lost 3.8% greater SAT (p = .06) than CARB. Weight to leg LST ratio (r(2) = .189, p = .02) and SAT (r(2) = .163, p = .04) predicted improved up and go, relative muscle (r(2) = .238, p = .01) and SAT (r(2) = .165, p = .04) predicted improved transfer test, and %LST predicted improved balance (r(2) = .179, p = .04). CONCLUSIONS A higher protein intake during caloric restriction maintains muscle relative to weight lost, which in turn enhances physical function in older women.

Bone marrow fat quantification in the presence of trabecular bone: initial comparison between water-fat imaging and single-voxel MRS.

The purpose of the present study was to test the relative performance of chemical shift‐based water‐fat imaging in measuring bone marrow fat fraction in the presence of trabecular bone, having as reference standard the single‐voxel magnetic resonance spectroscopy (MRS).

T1‐corrected fat quantification using chemical shift‐based water/fat separation: Application to skeletal muscle

Chemical shift‐based water/fat separation, like iterative decomposition of water and fat with echo asymmetry and least‐squares estimation, has been proposed for quantifying intermuscular adipose tissue. An important confounding factor in iterative decomposition of water and fat with echo asymmetry and least‐squares estimation‐based intermuscular adipose tissue quantification is the large difference in T1 between muscle and fat, which can cause significant overestimation in the fat fraction. This T1 bias effect is usually reduced by using small flip angles. T1‐correction can be performed by using at least two different flip angles and fitting for T1 of water and fat. In this work, a novel approach for the water/fat separation problem in a dual flip angle experiment is introduced and a new approach for the selection of the two flip angles, labeled as the unequal small flip angle approach, is developed, aiming to improve the noise efficiency of the T1‐correction step relative to existing approaches. It is shown that the use of flip angles, selected such the muscle water signal is assumed to be T1‐independent for the first flip angle and the fat signal is assumed to be T1‐independent for the second flip angle, has superior noise performance to the use of equal small flip angles (no T1 estimation required) and the use of large flip angles (T1 estimation required). Magn Reson Med, 2011.

Quantitative assessment of fat infiltration in the rotator cuff muscles using water-fat MRI

To evaluate a chemical shift‐based fat quantification technique in the rotator cuff muscles in comparison with the semiquantitative Goutallier fat infiltration classification (GC) and to assess their relationship with clinical parameters.

Intravoxel partially coherent motion technique: characterization of the anisotropy of skeletal muscle microvasculature.

To propose a reformulation of the intravoxel incoherent motion (IVIM) technique exploiting the low b‐value diffusion‐weighted imaging regime that can characterize microcirculation of tissues perfused with partially coherent blood flow.

Removal of olefinic fat chemical shift artifact in diffusion MRI

Diffusion‐weighted (DW) MRI has emerged as a key tool for assessing the microstructure of tissues in healthy and diseased states. Because of its rapid acquisition speed and insensitivity to motion, single‐shot echo‐planar imaging is the most common DW imaging technique. However, the presence of fat signal can severely affect DW‐echo planar imaging acquisitions because of the chemical shift artifact. Fat suppression is usually achieved through some form of chemical shift‐based fat saturation. Such methods effectively suppress the signal originating from aliphatic fat protons, but fail to suppress the signal from olefinic protons. Olefinic fat signal may result in significant distortions in the DW images, which bias the subsequently estimated diffusion parameters. This article introduces a method for removing olefinic fat signal from DW images, based on an echo time‐shifted acquisition. The method is developed and analyzed specifically in the context of single‐shot DW‐echo‐planar imaging, where image phase is generally unreliable. The proposed method is tested with phantom and in vivo datasets, and compared with a standard acquisition to demonstrate its performance. Magn Reson Med, 2011.