10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 6-8 November 2008, London, UK

BONE MARROW MAGNETIC RESONANCE IMAGING CHANGES IN HIV-INFECTED SUBJECTS WITH LIPODYSTROPHY

Antiviral Therapy 2008; 13(Suppl. 4):A40 (abstract no. P-25)

AI García¹, A Milinkovic², X Tomás¹, J Rios³, S Vidal⁴, J Pomés¹, M Del Amo¹ and J Mallolas^2
1Radiology, Hospital Clinic, Barcelona, Spain; ²Infections and Immunology, Hospital Clinic, Barcelona, Spain; ³Statistical, Hospital Clinic, Barcelona, Spain; ⁴Nuclear Medicine, Hospital Clinic, Barcelona, Spain

BACKGROUND: We have noted unusual serous-like bone marrow pattern in the legs on magnetic resonance (MR) studies of HIV-infected patients with lipodystrophy, probably related to a decrease in the bone marrow fat. Our aim is to present these imaging findings, to determine correlation with clinical parameters, and to show the evolution of the lesions after switching from thymidine analogues (TA) to tenofovir disoproxil fumarate (TDF).

METHODS: Two radiologists in consensus determined three bone marrow patterns (serous-like, less intensity yellow marrow or normal fat marrow) in T1-W SE axial MR images in 28 HIV-infected patients with lipodystrophy syndrome on TA and 13 HIV-negative volunteers. We confirmed a serous-like pattern with T2-W fat-suppressed and T1-W fat-suppressed images without and with gadolinium, including whole-body MR study (T1-W and STIR images) to evaluate the distribution, and whole-body SPECT bone scans with Tc-99m sulfur colloid and skeletal X-ray exam to exclude other pathologies. MR images and clinical evaluation were performed at 6 months to assess changes after switching from TA to TDF.

We correlated patterns with demographic characteristics of the patients, metabolic profile, body composition measurements (fat, lean mass and bone meneral density–dual energy X-ray absorptiometry, visceral and subcutaneous fat-CT image at L4).

RESULTS: Four patients (14.28%) presented foci of serous- like pattern, four (14.28%) a focal or diffuse less intensity, and the rest of patients (71.42%) and volunteers a normal bone marrow fat-signal. Serous-like lesions were in tibias, fibulas and distal femurs, and scattered in ankles (one case) and humerus (two cases). Non-malignancy, infection, haematological disorders or bone pain was observed. Serous-like group at the baseline showed lower fat and higher lean mass than no serous-like group, although only peripheral and total fat were significantly lower statistically (P<0.05). There were no significant differences between serous-like and less-intensity, and less-intensity and normal pattern group.

No changes in MR images at 6 months were observed, and the serous-like group showed higher recovery of the peripheral fat than the no serous-like group, although not significantly (P>0.005).

CONCLUSION: HIV-infected patients with lipodystrophy syndrome may present no malignant bone marrow MR changes in the peripheral skeletal, especially legs, in correlation with the peripheral lipoatrophy. These findings may be related to a decrease in the fat bone marrow component, which probably needs more time to recover after switching from TA to TDF. It is important to be aware of these findings to avoid diagnostic mistakes.

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2008-11-06
P-25

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