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Not yet recruitingNCT07848516Updated Sep 30, 2026

Change in Fat Fraction Quantification Before and After Treatment in Bone Metastases

An observational study in Neoplasm Metastasis / Bone and Bones, sponsored by Assiut University. Not yet recruiting. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-30.

Sponsored by Assiut University · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
84
Ages
18 Years and older
Sex
All
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Study summary

Bone metastases are a common and serious complication of cancer. Treatment response is currently judged mainly by delayed changes on CT scans or X-rays, a process that can take months and sometimes produces misleading results. The study investigates whether a specialized, radiation-free MRI technique called Dixon imaging can detect early signs of treatment response by measuring fat content within bone metastases before and after chemotherapy or radiotherapy. As tumor tissue within a bone lesion responds to treatment, the lesion is expected to be gradually replaced by fatty marrow, a change that can be quantified using the Dixon MRI method. Adult patients with a solid-tumor cancer and at least one lytic (bone-destroying) metastasis will undergo an MRI scan before starting treatment and a second MRI scan after completing chemotherapy or radiotherapy. Change in fat content within the lesion, and relative to normal marrow, will be measured and compared between patients receiving chemotherapy versus radiotherapy. The study does not involve additional radiation, contrast injection, or invasive procedures beyond standard MRI, and does not influence treatment decisions, which remain under the direction of the treating oncology team.

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Conditions studied

  • Neoplasm Metastasis / Bone and Bones

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Probability sample

Study population

Adult patients with solid-tumor malignancy with ≥1 lytic bone metastasis (≥1 cm)

Inclusion criteria

  • Solid-tumor malignancy with ≥1 lytic bone metastasis (≥1 cm) confirmed on CT. (When a patient has more than one qualifying lytic lesion, the largest and/or most accessible lesion (whichever allows more reliable, artifact-free ROI placement) will be selected for analysis.)
  • Scheduled for chemotherapy or radiotherapy to the involved region.
  • Age ≥18, able to undergo MRI,
  • Informed consent given.

Exclusion criteria

Exclusion Criteria:

  • Sclerotic/mixed lesions.
  • Prior focal treatment to the lesion.
  • Pathological fracture at the site.
  • Patients receiving concurrent bone-targeting therapy (bisphosphonates or denosumab) during the study period, as these independently alter marrow fat content.
  • MRI contraindications.
  • Inability to complete follow-up scan.
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Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
84 participants (estimated)
Target follow-up
3 Months
Patient registry
Yes

Interventions

  • Diagnostic testMRI Non-contrast

    Participants will undergo 1.5 Tesla MRI examinations including conventional T1/T2-weighted sequences and a T1-weighted Dixon sequence, performed at two time points: at baseline, within one week prior to initiation of chemotherapy or radiotherapy, and again after completion of the treatment course. Fat-only and water-only Dixon image sets will be generated, and regions of interest will be placed on the target lytic bone metastasis and on a reference region of normal-appearing marrow. Relative fat fraction (rFF) will be calculated within each region from the ratio of fat-signal intensity to combined fat-and-water signal intensity, and a normalized fat fraction ratio (FFR) will be derived as lesion rFF divided by reference-region rFF. Diffusion-weighted imaging and apparent diffusion coefficient values will be obtained where feasible as an exploratory measure. No contrast agent, radiotracer, or ionizing radiation is administered as part of the imaging procedure, and no additional invasive

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What researchers measure

Primary outcomes

  1. Change in Fat Fraction Ratio of Lytic Bone Metastases

    Change in the normalized fat fraction ratio (FFR, lesion rFF divided by reference-region rFF), calculated as the difference between pre-treatment and post-treatment values for each participant.

    Time frame: Baseline and a follow-up at 4 to 12 weeks after completion of the chemotherapy or radiotherapy course

Secondary outcomes

  1. Comparison of Change in Fat Fraction Ratio Between Chemotherapy and Radiotherapy Subgroups

    Comparison of change in the normalized fat fraction ratio (FFR) between participants receiving chemotherapy versus radiotherapy

    Time frame: Baseline and a follow-up at 4 to 12 weeks after completion of the chemotherapy or radiotherapy course

  2. Inter-observer Agreement for Fat Fraction Ratio Measurements

    Agreement between two independent observers' fat fraction ratio (FFR) measurements in a subset of re-measured lesions

    Time frame: Baseline and a follow-up at 4 to 12 weeks after completion of the chemotherapy or radiotherapy course

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Study locations

No study locations are listed for this record.

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References and documents

Publications

  • Park S, Do Huh J. Differentiation of bone metastases from benign red marrow depositions of the spine: the role of fat-suppressed T2-weighted imaging compared to fat fraction map. Eur Radiol. 2022 Oct;32(10):6730-6738. doi: 10.1007/s00330-022-08965-3. Epub 2022 Jul 7. PubMed 35798881 ↗
  • Takasu M, Kondo S, Akiyama Y, Takahashi Y, Maeda S, Baba Y, Kawase T, Ichinohe T, Awai K. Assessment of early treatment response on MRI in multiple myeloma: Comparative study of whole-body diffusion-weighted and lumbar spinal MRI. PLoS One. 2020 Feb 27;15(2):e0229607. doi: 10.1371/journal.pone.0229607. eCollection 2020. PubMed 32106239 ↗
  • Koutoulidis V, Terpos E, Papanikolaou N, Fontara S, Seimenis I, Gavriatopoulou M, Ntanasis-Stathopoulos I, Bourgioti C, Santinha J, Moreira JM, Kastritis E, Dimopoulos MA, Moulopoulos LA. Comparison of MRI Features of Fat Fraction and ADC for Early Treatment Response Assessment in Participants with Multiple Myeloma. Radiology. 2022 Jul;304(1):137-144. doi: 10.1148/radiol.211388. Epub 2022 Apr 5. PubMed 35380497 ↗
  • Schmeel FC, Vomweg T, Traber F, Gerhards A, Enkirch SJ, Faron A, Sprinkart AM, Schmeel LC, Luetkens JA, Thomas D, Kukuk GM. Proton density fat fraction MRI of vertebral bone marrow: Accuracy, repeatability, and reproducibility among readers, field strengths, and imaging platforms. J Magn Reson Imaging. 2019 Dec;50(6):1762-1772. doi: 10.1002/jmri.26748. Epub 2019 Apr 13. PubMed 30980694 ↗
  • Castagnoli F, Donners R, Tunariu N, Messiou C, Koh DM. Relative fat fraction of malignant bone lesions from breast cancer, prostate cancer and myeloma are significantly lower than normal bone marrow and shows excellent interobserver agreement. Br J Radiol. 2023 Dec;96(1152):20230240. doi: 10.1259/bjr.20230240. Epub 2023 Oct 31. PubMed 37750943 ↗
  • Azma YN, Boci N, Abramowicz K, Russo L, Orton MR, Tunariu N, Koh DM, Charles-Edwards G, Collins DJ, Winfield JM. Influence of imaging method on fat fraction estimation for assessing bone marrow in metastatic prostate cancer. Eur Radiol. 2025 Oct;35(10):6039-6051. doi: 10.1007/s00330-025-11564-7. Epub 2025 Apr 11. PubMed 40214737 ↗
  • Lecouvet FE, Taihi L, Kirchgesner T, Pasoglou V, Halut M, Tuba Sanal H, Gitto S, Martin-Noguerol T, Vasilevska-Nikodinovska V, Vanhoenacker F, Vilanova JC. ESR Essentials: bone marrow MRI in oncology-practice recommendations by the European Society of Musculoskeletal Radiology. Eur Radiol. 2026 Jul;36(7):5414-5428. doi: 10.1007/s00330-025-12307-4. Epub 2026 Feb 9. PubMed 41663831 ↗
  • Carmona R, Pritz J, Bydder M, Gulaya S, Zhu H, Williamson CW, Welch CS, Vaida F, Bydder G, Mell LK. Fat composition changes in bone marrow during chemotherapy and radiation therapy. Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):155-63. doi: 10.1016/j.ijrobp.2014.05.041. Epub 2014 Jul 8. PubMed 25015207 ↗
  • Latifoltojar A, Hall-Craggs M, Bainbridge A, Rabin N, Popat R, Rismani A, D'Sa S, Dikaios N, Sokolska M, Antonelli M, Ourselin S, Yong K, Taylor SA, Halligan S, Punwani S. Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction. Eur Radiol. 2017 Dec;27(12):5325-5336. doi: 10.1007/s00330-017-4907-8. Epub 2017 Jun 27. PubMed 28656463 ↗
  • Park S, Huh JD. Bone metastases with post-treatment intralesional fatty content of the spine: imaging features from T1-weighted imaging with CT finding correlations. Acta Radiol. 2023 Jan;64(1):153-163. doi: 10.1177/02841851211058930. Epub 2021 Dec 1. PubMed 34851180 ↗
  • Qin C, Goldberg O, Kakar G, Wan S, Haroon A, Azam A, Adeleke S. MRI fat fraction imaging of nodal and bone metastases in prostate cancer. Eur Radiol. 2023 Aug;33(8):5851-5855. doi: 10.1007/s00330-023-09527-x. Epub 2023 Mar 16. PubMed 36928564 ↗

Individual participant data

Plan to share: Undecided

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Registry details

Key details

Study ID
NCT07848516
Lead sponsor
Assiut University
Responsible party
Ibrahem Abdelnaser Ahmed Zohry (Radiology resident, Assiut University) — Principal investigator
First posted
Sep 30, 2026
Start date
Oct 1, 2026 (estimated)
Primary completion
Mar 1, 2029 (estimated)
Completion
Nov 1, 2029 (estimated)
Last update
Sep 30, 2026

Study contacts

Ibrahem Abdelnaser Zohry, MBBCh
Contact
ibrahim.18313355@med.aun.edu.eg
+201555433075
View the source record on ClinicalTrials.gov ↗

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