title: Dynamic contrast-enhanced MRI for monitoring bisphosphonate therapy in Paget's disease of bone.
abstract: OBJECTIVE
  The purpose of this study was to evaluate changes in regional bone perfusion in Paget's disease (PD) following bisphosphonate therapy. We used dynamic contrast-enhanced MRI (DCE-MRI) for assessment of bone perfusion and compared MRI findings with alkaline phosphatase (AP) as a serum marker of bone turnover.
  
  
  METHODS
  We examined 20 patients (8 women, 12 men, 66 ± 11 years) with symptomatic PD of the axial skeleton. Patients were selected for infusion therapy with the bisphosphonate pamidronate. The most affected bone of lumbar spine or pelvis was examined by DCE-MRI prior to therapy and after a 6-month follow-up. The contrast uptake was evaluated using a two-compartment model with the parameters amplitude A and exchange rate constant K(ep). Color-coded parametric images were generated to visualize bone vascularization.
  
  
  RESULTS
  After a 6-month follow-up there was a significant decrease in alkaline phosphatase and in DCE-MRI parameters A and K(ep) (p < 0.0001). Patients without previous bisphosphonate treatment showed a significantly greater decrease in alkaline phosphatase and K(ep) (p < 0.001).
  
  
  CONCLUSIONS
  DCE-MRI shows a significant reduction in regional bone perfusion in PD following parenteral bisphosphonate treatment. Reduction in bone perfusion is greater in bisphosphonate-naïve patients than in those who had been previously treated.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Deaconess Hospital, Schwäbisch Hall, Germany. martin.libicher@urz.uni-heidelberg.de
authors.forename: Martin
authors.initials: M
authors.lastname: Libicher
authors.forename: C
authors.initials: C
authors.lastname: Kasperk
authors.forename: M
authors.initials: M
authors.lastname: Daniels-Wredenhagen
authors.forename: T
authors.initials: T
authors.lastname: Heye
authors.forename: H U
authors.initials: HU
authors.lastname: Kauczor
authors.forename: P
authors.initials: P
authors.lastname: Nawroth
authors.forename: S
authors.initials: S
authors.lastname: Delorme
authors.forename: W
authors.initials: W
authors.lastname: Hosch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D003287:Contrast Media; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010001:Osteitis Deformans / Q000175:diagnosis* / Q000188:drug therapy*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D003287:Contrast Media; D004164:Diphosphonates; D019786:Gadolinium DTPA