A measuring technique for intra-osseous pressure
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TECHNICAL REPORT
A measuring technique for intra-osseous pressure Connie Y. Chang 1
&
Kaitlyn J. Yeh 1 & Lauren A. Roller 2 & Martin Torriani 1
Received: 29 September 2020 / Revised: 5 November 2020 / Accepted: 8 November 2020 # ISS 2020
Abstract Objective Pulsatile intra-osseous pressures result in bone remodeling, and therefore may affect lesion growth and response to treatment. However, there is no known method used to measure intra-osseous pressures. The purpose of this study is to describe a novel image-guided technique for measuring intra-osseous pressures. Materials and methods This study was IRB-approved and HIPAA compliant. Written informed consent was obtained. Intraosseous pressure measurements were performed during a CT-guided bone marrow biopsy in eight patients (6 male, 2 female) with mean age 66 ± 13 years (median 72, range 45–87) and suspected or known bone marrow disease. Bone marrow pressure measurements were obtained connecting the biopsy needle to a dedicated monitor using a standard arterial line setup. Monitor data was collected at 5-s intervals in order to record continuous pressure measurements for 2 min. Results Pressure measurements were successfully performed in all 8 patients. The mean bone marrow pressures were 36.8 ± 7.2 mmHg (median 37.7, range 24.7–47.4). The peak and trough pressures varied by 11%, and the standard deviation of mean pressure measurement varied by 18%. Our findings for marrow pressure measures most closely approximate the pressure profile of the venous system. Conclusion We describe a novel and minimally invasive technique able to provide functional data of bone marrow. This technique has the potential to provide insights into normal and diseased bone marrow and may be helpful to evaluate features of cystic and vascular tumors that may be amenable to percutaneous treatments. Keywords Bone marrow . Pressure . Measuring
Introduction Previous studies have suggested that pulsatile intra-osseous pressures result in bone remodeling, and may also affect osteocyte production of alkaline phosphatase, a key enzyme for bone breakdown, and PGE2, a cell signaling hormone [1, 2]. Also, fluid pressure within bone may stimulate cells and transport substances to osteocytes (such as nutrients and hormones), and the pressure profiles themselves may stimulate the cells [3–10]. Taken together, pulsatile pressures within lytic lesions may promote faster growth of lesions and affect
* Connie Y. Chang [email protected] 1
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA 02114, USA
2
Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
bone remodeling and healing [1–10]. In particular, aneurysmal bone cysts have significant feeding blood vessels and blood flow, with presumably elevated intra-lesion pressure profiles; however, this feature remains uncertain [11, 12]. The intra-osseous pressure profile in a lytic lesion may affect not only its growth but also i
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