Praveen Jayapal

All Publications

• Improved Detection of Bone Metastases in Children and Young Adults with Ferumoxytol-enhanced MRI. Radiology. Imaging cancer Rashidi, A., Baratto, L., Theruvath, A. J., Greene, E. B., Jayapal, P., Hawk, K. E., Lu, R., Seekins, J., Spunt, S. L., Pribnow, A., Daldrup-Link, H. E. 2023; 5 (2): e220080

  Abstract

  Purpose To evaluate if ferumoxytol can improve the detection of bone marrow metastases at diffusion-weighted (DW) MRI in pediatric and young adult patients with cancer. Materials and Methods In this secondary analysis of a prospective institutional review board-approved study (ClinicalTrials.gov identifier NCT01542879), 26 children and young adults (age range: 2-25 years; 18 males) underwent unenhanced or ferumoxytol-enhanced whole-body DW MRI between 2015 and 2020. Two reviewers determined the presence of bone marrow metastases using a Likert scale. One additional reviewer measured signal-to-noise ratios (SNRs) and tumor-to-bone marrow contrast. Fluorine 18 (18F) fluorodeoxyglucose (FDG) PET and follow-up chest CT, abdominal and pelvic CT, and standard (non-ferumoxytol enhanced) MRI served as the reference standard. Results of different experimental groups were compared using generalized estimation equations, Wilcoxon rank sum test, and Wilcoxon signed rank test. Results The SNR of normal bone marrow was significantly lower at ferumoxytol-enhanced MRI compared with unenhanced MRI at baseline (21.380 ± 19.878 vs 102.621 ± 94.346, respectively; P = .03) and after chemotherapy (20.026 ± 7.664 vs 54.110 ± 48.022, respectively; P = .006). This led to an increased tumor-to-marrow contrast on ferumoxytol-enhanced MRI scans compared with unenhanced MRI scans at baseline (1397.474 ± 938.576 vs 665.364 ± 440.576, respectively; P = .07) and after chemotherapy (1099.205 ± 864.604 vs 500.758 ± 439.975, respectively; P = .007). Accordingly, the sensitivity and diagnostic accuracy for detecting bone marrow metastases were 96% (94 of 98) and 99% (293 of 297), respectively, with the use of ferumoxytol-enhanced MRI compared with 83% (106 of 127) and 95% (369 of 390) with the use of unenhanced MRI. Conclusion Use of ferumoxytol helped improve the detection of bone marrow metastases in children and young adults with cancer. Keywords: Pediatrics, Molecular Imaging-Cancer, Molecular Imaging-Nanoparticles, MR-Diffusion Weighted Imaging, MR Imaging, Skeletal-Appendicular, Skeletal-Axial, Bone Marrow, Comparative Studies, Cancer Imaging, Ferumoxytol, USPIO © RSNA, 2023 ClinicalTrials.gov registration no. NCT01542879 See also the commentary by Holter-Chakrabarty and Glover in this issue.

  View details for DOI 10.1148/rycan.220080

  View details for PubMedID 36999999

• A novel fetal MRI lung volume nomogram stratified by estimated fetal weight Gershnabel, S., Jayapal, P., Zalcman, M., Barth, R. A., Rubesova, E., Hintz, S., Zhang, J., Leonard, S. A., El-Sayed, Y. Y., Blumenfeld, Y. J. MOSBY-ELSEVIER. 2023: S577

  View details for Web of Science ID 000909337401449

• Detection of bone marrow metastases in children and young adults with solid cancers with diffusion-weighted MRI. Skeletal radiology Rashidi, A., Baratto, L., Jayapal, P., Theruvath, A. J., Greene, E. B., Lu, R., Spunt, S. L., Daldrup-Link, H. E. 2022

  Abstract

  OBJECTIVE: To compare the diagnostic accuracy of diffusion-weighted (DW)-MRI with b-values of 50s/mm2 and 800s/mm2 for the detection of bone marrow metastases in children and young adults with solid malignancies.METHODS: In an institutional review board-approved prospective study, we performed 51 whole-body DW-MRI scans in 19 children and young adults (14 males, 5 females; age range: 1-25years) with metastasized cancers before (n=19 scans) and after (n=32 scans) chemotherapy. Two readers determined the presence of focal bone marrow lesions in 10 anatomical areas. A third reader measured ADC and SNR of focal lesions and normal marrow. Simultaneously acquired 18F-FDG-PET scans served as the standard of reference. Data of b=50s/mm2 and 800s/mm2 images were compared with the Wilcoxon signed-rank test. Inter-reader agreement was evaluated with weighted kappa statistics.RESULTS: The SNR of bone marrow metastases was significantly higher compared to normal bone marrow on b=50s/mm2 (mean±SD: 978.436±1239.436 vs. 108.881±109.813, p<0.001) and b=800s/mm2 DW-MRI (499.638±612.721 vs. 86.280±89.120; p<0.001). On 30 out of 32 post-treatment DW-MRI scans, reconverted marrow demonstrated low signal with low ADC values (0.385*10-3±0.168*10-3mm2/s). The same number of metastases (556/588; 94.6%; p>0.99) was detected on b=50s/mm2 and 800s/mm2 images. However, both normal marrow and metastases exhibited low signals on ADC maps, limiting the ability to delineate metastases. The inter-reader agreement was substantial, with a weighted kappa of 0.783 and 0.778, respectively.CONCLUSION: Bone marrow metastases in children and young adults can be equally well detected on b=50s/mm2 and 800s/mm2 images, but ADC values can be misleading.

  View details for DOI 10.1007/s00256-022-04240-0

  View details for PubMedID 36441237

• Ferumoxytol-Enhanced MRI in Children and Young Adults: State of the Art. AJR. American journal of roentgenology Adams, L. C., Jayapal, P., Ramasamy, S. K., Morakote, W., Yeom, K., Baratto, L., Daldrup-Link, H. E. 2022

  Abstract

  Ferumoxytol is an ultrasmall iron oxide nanoparticle, originally approved in 2009 by the FDA for IV treatment of iron deficiency in adults with chronic kidney disease. Subsequently, its off-label use as an MRI contrast agent has increased in clinical practice, particularly in pediatric patients in North America. Unlike conventional MRI contrast agents that are based on the rare earth metal gadolinium [gadolinium-based contrast agents (GBCAs)], ferumoxytol is biodegradable and carries no potential risk of nephrogenic systemic fibrosis. At FDA-approved doses, ferumoxytol demonstrates no long-term tissue retention in patients with intact iron metabolism. Ferumoxytol provides unique MRI properties including long-lasting vascular retention (facilitating high-quality vascular imaging) and retention in reticuloendothelial system tissues, thereby supporting a variety of applications beyond those possible with GBCAs. This Clinical Perspective describes clinical and early translational applications of ferumoxytol-enhanced MRI in children and young adults through off-label use for a variety of settings, including vascular, cardiac, and cancer imaging, drawing on the authors' institutional experience. In addition, we describe current preclinical and clinical research advances using ferumoxytol with regard to cellular and molecular imaging, and also as a novel potential cancer therapeutic agent.

  View details for DOI 10.2214/AJR.22.28453

  View details for PubMedID 36197052

• Predictive Patterns of Pediatric PTLD on PET/MRI Jayapal, P., Sandberg, J., Seekins, J., Nadel, H. SOC NUCLEAR MEDICINE INC. 2022

  View details for Web of Science ID 000893739700122

• Multiparametric CMR Findings in Mrna COVID-19 Vaccine-induced Myocarditis: A Case Series Espejo, M., Hogan, A. H., Toro-Salazar, O. H., Golden, A., Heyden, C., Salazar, J. C., Jayapal, P. AMER ACAD PEDIATRICS. 2022

  View details for Web of Science ID 000917782500346

• Magnetic resonance neurography techniques in the pediatric population. Pediatric radiology Jayapal, P., Alharthi, O., Young, V., Obi, C., Syed, A. B., Sandberg, J. K. 2023

  Abstract

  The use of magnetic resonance imaging (MRI) in the evaluation of the central extracranial nervous system, namely the brachial and lumbosacral plexuses, is well established and has been performed for many years. Only recently after numerous advances in MRI, has image quality been sufficient to properly visualize small structures, such as nerves in the extremities. Despite the advances, peripheral MR Neurography remains a complex and difficult examination to perform, especially in the pediatric patient population, in which the risk for motion artifact and compliance is always of concern. Thus, technical aspects of the MR imaging protocol must be flexible but robust, to balance image quality with scan time, in a patient population of varying sizes. An additional important step for reliably performing a successful MR Neurography examination is the non-technical pre-imaging preparation, which includes patient/family education and open communication with referring teams. This paper will discuss in detail the individual technical and non-technical/operational aspects of peripheral MR Neurography, to help guide in building a successful program in the pediatric population.

  View details for DOI 10.1007/s00247-023-05759-7

  View details for PubMedID 37710037