Evaluation of PET/MR and PET/CT Imaging for Bone Marrow Lesions
Condition: Multiple Myeloma; Disease of the Marrow; Osteoporosis
MeSH terms: Multiple Myeloma; Osteoporosis
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients diagnosed with Multiple Myeloma and that are referred for PET CT imaging.
      
Keywords: PET MR development and validation