Evaluation of PET/MR and PET/CT Imaging for Bone Marrow Lesions
| Status: | Completed |
|---|---|
| Conditions: | Osteoporosis, Blood Cancer, Hematology |
| Therapuetic Areas: | Hematology, Oncology, Rheumatology |
| Healthy: | No |
| Age Range: | 30 - 80 |
| Updated: | 12/3/2016 |
| Start Date: | January 2013 |
| End Date: | December 2016 |
Research Evaluation of PET/MR and PET/CT Imaging for Bone Marrow Lesions
Developing an MRI protocol at 1.5 T allowing quantification of the hematopoietic, fatty and
trabecular moieties of marrow. An ideal protocol would differentiate red marrow from
neoplastic cellular infiltration, and detect loss of trabecular bone. This study assesses
the feasibility of a multiple gradient echo sequence for differentiation of water and fat
constituents of marrow, combined with T2* mapping to interrogate the trabecular component
The investigators hypothesize that these techniques will allow better identification of
lesion type than routine MR sequences, and can be used to quantitatively characterize
myelomatous marrow replacement, with iliac crest biopsy (which is routinely performed in the
diagnosis of myeloma) as gold standard.
Fluoro-deoxyglucose (FDG)/PET CT imaging can detect FDG uptake in active myeloma and is
obtained routinely for certain cohorts of patients with myeloma. PET/CT is commonly used in
both initial whole body assessment and in monitoring remission. PET has been found to be
about 59% sensitive and 75% specific for detection of myeloma .
Myelomatous lesions are detected on MRI by the replacement of marrow fat. Routine MRI
however is limited by scope/field of view, usually evaluating marrow in a single anatomic
region (such as an extremity, the pelvis or spine). To assess the diffuse marrow involvement
in MM, whole body MRI imaging potentiates near global assessment of the marrow, which aids
in evaluating tumor burden, and may be useful in staging.
trabecular moieties of marrow. An ideal protocol would differentiate red marrow from
neoplastic cellular infiltration, and detect loss of trabecular bone. This study assesses
the feasibility of a multiple gradient echo sequence for differentiation of water and fat
constituents of marrow, combined with T2* mapping to interrogate the trabecular component
The investigators hypothesize that these techniques will allow better identification of
lesion type than routine MR sequences, and can be used to quantitatively characterize
myelomatous marrow replacement, with iliac crest biopsy (which is routinely performed in the
diagnosis of myeloma) as gold standard.
Fluoro-deoxyglucose (FDG)/PET CT imaging can detect FDG uptake in active myeloma and is
obtained routinely for certain cohorts of patients with myeloma. PET/CT is commonly used in
both initial whole body assessment and in monitoring remission. PET has been found to be
about 59% sensitive and 75% specific for detection of myeloma .
Myelomatous lesions are detected on MRI by the replacement of marrow fat. Routine MRI
however is limited by scope/field of view, usually evaluating marrow in a single anatomic
region (such as an extremity, the pelvis or spine). To assess the diffuse marrow involvement
in MM, whole body MRI imaging potentiates near global assessment of the marrow, which aids
in evaluating tumor burden, and may be useful in staging.
Imaging of the pelvis and bilateral femora at 1.5 Tesla in a 30 minute research time "slots"
at NYU-FPO MRI, Tisch Hospital, NYU Medical Center, Department of Radiology, HCC basement.
This protocol utilizes routine, Dixon sequences and multi-echo MR "spectroscopic" sequences,
allowing quantization of the fat water and trabecular moieties of marrow. The opposed phase
portion of a Dixon sequence can aid differentiation between dense red marrow and a
metastatic deposits by assaying for intravoxel fat. Diffusion sequences may also potentially
improve specificity by assessing mobility of water in hypercellular and hypocellular
portions of marrow, and will be added to the protocol if scan time permits.
The new sequences conform to FDA safety regulations regarding static magnetic field, time
varying magnetic fields, specific absorption rate, and acoustic noise levels. However, since
they have not been fully validated for diagnostic accuracy, the resulting images will be
analyzed for research purposes only and will not be used in the patient's diagnostic
assessment.
at NYU-FPO MRI, Tisch Hospital, NYU Medical Center, Department of Radiology, HCC basement.
This protocol utilizes routine, Dixon sequences and multi-echo MR "spectroscopic" sequences,
allowing quantization of the fat water and trabecular moieties of marrow. The opposed phase
portion of a Dixon sequence can aid differentiation between dense red marrow and a
metastatic deposits by assaying for intravoxel fat. Diffusion sequences may also potentially
improve specificity by assessing mobility of water in hypercellular and hypocellular
portions of marrow, and will be added to the protocol if scan time permits.
The new sequences conform to FDA safety regulations regarding static magnetic field, time
varying magnetic fields, specific absorption rate, and acoustic noise levels. However, since
they have not been fully validated for diagnostic accuracy, the resulting images will be
analyzed for research purposes only and will not be used in the patient's diagnostic
assessment.
Inclusion Criteria
- subjects who are schedule for PET CT
- subjects that are diagnosed with Multiple Myeloma.
- Healthy subjects will be enrolled to optimize imaging techniques
- subjects 30 - 80 years of age
Exclusion Criteria:
Exclusion criteria include all patients who are contraindicated for MR imaging in general.
Contraindications include:
- electrical implants such as cardiac pacemakers or perfusion pumps
- ferromagnetic implants such as aneurysm clips, surgical clips, prostheses, artificial
hearts, valves with steel parts, metal fragments, shrapnel, tattoos near the eye, or
steel implants
- ferromagnetic objects such as jewelry or metal clips in clothing
- pregnant subjects
- pre-existing medical conditions including a likelihood of developing seizures or
claustrophobic reactions, and any greater than normal potential for cardiac arrest.
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