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Fractal Analysis of the Bone Tissue Status in Patients with Non-Hodgkin Lymphoma

Authors: Zhulkevych I., Uglyar T. - Ternopil State Medical University named after I.Ya. Gorbachevsky, Ternopil, Ukraine

Categories: Rheumatology, Traumatology and orthopedics

Sections: Medical forums

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Статья опубликована на с. 101

Introduction. The change in mineral bone tissue (BT) density in patients with solid tumors, acute and chronic leukemias is a known fact. However, very few studies are devoted to monitoring the dynamics of mineral density changes of BT in patients with non–Hodgkin lymphoma (NHL). According to research rare mineral density BT changes are observed in 30–35 % of patients, and the average age of patients is over 60 years.

Aim of the research is to explore the dynamic changes of BT in patients undergoing NHL chemotherapy stage of treatment using the method of virtual bone biopsy.

Materials and methods. The analysis of changes of mineral density by direct measurement of BT density (in Haunsfild units) in trabecular parts of vertebrae of thoracic and lumbar spine on computer axial tomograms at stages of diagnosis and after chemotherapy (4–6 courses of chemotherapy CHOP protocol) treatment. In order to standardize and stabilize images of trabecular vertebrae we used universal digital filter — «Mexican hat» wavelet. Densitometry of trabecular vertebrae layer in thoracic and lumbar spine was performed in the applications of mathematical analysis of medical images –DICOM — ClearCanvas Workstation and ImageJ with the BoneJ extension, freely distributed by the National Institute of Health (USA). Fractal dimension was observed by map–counting and box–counting algorithms.

Number of the patients was 30. 11 men and 19 women were among them. Average age was 64.51 ± 2.84 years. The diagnosis was established by the NHL world (NCCN, –ESMO) and national criteria for the diagnosis of compulsory morphological and immunohistochemical verification. In all patients there was B–macrocell, CD20 positive lymphoma.

Results. Based on the analysis of axial slices BT scans and measurements of vertebral trabecular density of thoracic and lumbar spine in the above terms we found negative trend changes in patients’ BT. Changes in density of BT at diagnosis of disease stage were seen in a decrease in trabecular density of the vertebrae in 7 (63.6 %) men and 16 (84.2 %) women. Registered changes were mostly found in women and the depth decrease of vertebral BT density in women was significantly higher than in men. After completing chemotherapy in all patients there was further decline in the density of BT, but the rate of decrease was detected in different gender groups. Densitometric and fractal analysis (according to map–counting and box–counting algorithms) of the state of vertebral trabecular BT showed direct positive and reliable connection between the above parameters.

Conclusions. 1. The reduce of vertebral BT density of thoracic and lumbar spine of patients with NHL requires monitoring BT at all stages of the management of patients with NHL. 2. The reduce of density of trabecular vertebrae in patients with NHL occurs at different rates for men and women at chemotherapy treatment stage. 3. There is a direct and reliable connection between densitometric characteristics and fractal dimensions (according to map–counting and box–counting algorithms) of state of trabecular vertebrae in patients with NHL. 4. The perspective for further research is to identify the causes of changes in BT density in patients with NHL and the main factors that lead to it, as well as inclusion of the modifiers of BT into the maintenance and correction therapy.

 


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