Iona Collins, Richard Hugtenburg, Yuzhi Cai, Paola Griffiths, Amanda Davies and John Wagstaff
Abertawe Bro Morgannwg University Health Board
There is currently no predictive model for fracture associated with spinal metastases.
This project aims to introduce a novel MRI tool which directly measures the amount of bone material in a spinal metastasis. Using this information, the bone strength can be calculated.
Prudent Principles of fineSA® MRI:
- To enhance health and wellbeing by pre-empting and preventing harm to the patient.
- To introduce a low-cost tool which reduces the need for high-cost treatment of complications related to spinal metastases.
- To avoid harm, by offering low-risk treatment of high risk spinal metastases.
- To introduce fineSA® MRI once there is sufficient robust evidence to support its usefulness to patients.
fineSA® MRI Overview:
Fine structure analysis (fineSA®) MRI is a new technique which samples one line of k-space, resulting in a spatial spectrum for the chosen anatomic location, sampled in a specific orientation.
FineSA® is therefore a one dimensional spectrum representation of a structural “slice”, instead of conventional MRI which samples a larger area and creates a two dimensional image.
The advantage of fineSA® is that the data gained is approximately 10X higher resolution than standard MRI, in a scan time of 3 mins in vivo on current MRI 3T platforms, i.e. similar to the length of time for a DXA scan at one site but without the use of ionizing radiation.
Clinical Application of fineSA® MRI:
The purpose of this Bevan Commissioned study is to acquire data from vertebral bodies containing metastases, in order to ascertain whether it is possible to calculate the amount of loading required to cause a fracture, or calculation of fracture risk.
This is not a screening test, since the spinal metastases being analysed have already been diagnosed. The test is not designed to screen for fractures either, since the metastases must be asymptomatic for inclusion in this study.
Financial Benefits of fineSA® MRI:
The test costs £25, in addition to the standard cost of an MRI, which is approximately £225 i.e. a total cost of £250.
Once the diagnostic accuracy of this test has been established, it will be possible to compare the cost of testing a large number of people with asymptomatic metastases, in order to prevent the estimated cost of £14,023 per treated metastatic spinal cord compression(NICE 2008), which occurs in between 5-10% of people with advanced cancer. The prevalence of spinal metastases is estimated as between 3-5% of all people with cancer (NICE 2008).