Praveen Jayapal

All Publications

• 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