EDITORIAL
Editorial for “Preliminary Study of
Confounder-Corrected Fat Fraction and
R2* Mapping of Bone Marrow in Children
With Acute Leukemia
P ediatric marrow imaging is an important and very much
challenging as it is made up of the red marrow and the
conversion of the red marrow to fatty marrow will be going
on with the age.
Acute leukemia is an important condition associated with
the severe hypocellularity, causing severe pancytopenia and bone
marrow failure.1 The hemopoietic cells are being replaced to the
adipose tissue which will result in the excessive fatty marrow and
this needs to be differentiated from the normal marrow.
Various features of the leukemia are determined by altered
hematopoietic cells, genetic abnormalities, myelodysplasia, inef-
fective hematopoiesis, and low count of the peripheral blood
cell.2 Diagnosis will show low blood count with dysplasia, fat
cells.3 The diagnosis is commonly done with invasive procedures
like bone marrow aspiration, bone marrow biopsy, and cytoge-
netics to detect nonrandom chromosomal abnormalities.4,5
Magnetic resonance imaging (MRI) fat fraction (FF) is
an important noninvasive technique for the quantification of
fat. The MRI-FF uses the marrow composition correlating.
with the histological component of the bone marrow.
By using the concept of the decomposition of water and
fat with echo asymmetry and least-squares estimation quanti-
tation (IDEAL-IQ) of complex-based fat–water R2* MRI
this will be the main parameter for the estimation of the
FF. By using the multiple echo times (TE), with an iterative
least-squares decomposition algorithm the FF, water fraction,
and R26 can be done by the measurement of tissue fat, of T1
and T2* effects, and also the main magnetic field inhomoge-
neity.7 Recently, it has been used in many diagnostic studies
due to its noninvasive assessment capabilities.
The FF maps quantification was generated by the
Dixon method (FF = fat/water + fat = [in-phase out-of-
phase]/2 in-phase).8 The mean and standard deviation of
FF values within each ROI of each area of bone marrow were
recorded directly from the FF maps.
The accurate tissue fat quantification is quantified by
T2 signal decay, different field inhomogeneities, the spectral
1364 © 2023 International Society for Magnetic Resonance in Medicine.
complexity of the fat molecules, and T1 effects. The use of
the multi-echo Dixon VIBE sequence by using a low flip
angle will be reducing the T1 effects, leading to the spectral
complexity of the fat in the signal model, and utilizing
nonlinear fitting for simultaneous estimation of fat and
R2 (1/T2).
Further this imaging technique will allow the quantifica-
tion of the FF and simultaneous R2* evaluation in one acquisi-
tion. This is also useful for the anatomical evaluation of the
bone with very short imaging time.7,8 The various other causes
are the DNA damage by the chemotherapy, radiotherapy, and
various drugs like (nonsteroidal anti-inflammatory drugs and
antiepileptic drugs).9 This technique also can be useful for the
evaluation before and after the treatment.
Thus, with the use of the MRI with fat-fraction will
reduce the promising results for the diagnosis of hypercellular
marrow in our pilot study.10 This with this technique it is
easier for the evaluation of the malignant marrow replacement
process this will be of much help in the cases of the leukemia
in child with suspected leukemia.
Dr Sikandar Shaikh, DMRD, DNB, MNAMS, EDiR, FICR
Department of Radiology, Shadan Institute of Medical Sciences, Hyderabad,
India
E-mail: idrsikandar@gmail.com
References
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mal stem cell benefits observed in bone marrow failure and acquired
aplastic anaemia. Stem Cells Int 2017;2017:8076529.
3. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World
Health Organization classification of myeloid neoplasms and acute leu-
kaemia. Blood 2016;127(20):2391-2405.
4. Cazzola M. Myelodysplastic syndromes. N Engl J Med 2020;383(14):
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 15222586, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/jmri.28754 by Manager Information Resources Bond University Library, Wiley Online Library on [14/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Shaikh: Editorial

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