This clinical trial studies dual energy computed tomography (CT) in finding cancer that has
spread from the original (primary) tumor to the bone (bone metastases) in patients with
cancer. Diagnostic procedures, such as dual energy CT, may help find and diagnose bone
metastases and may be more accurate compared to single energy CT alone.
I. Compare the accuracy of single energy CT (SECT) with virtual non-calcium (VNC) double
energy CT (DECT) to standard SECT alone in the detection of metastatic bone lesions using
positron emission tomography (PET)-CT as the reference standard.
Computed tomography (CT) scans are routinely used in the evaluation of oncologic patients for
initial diagnosis and subsequent disease staging. Detection of bone metastasis on standard
CT, however, is limited in sensitivity, particularly in case of osteolytic intramedullary
lesions. Recent studies have shown the ability to detect bone marrow edema using CT with the
use of a virtual non-calcium (VNC) dual energy CT (DECT) technique. Because bone marrow edema
is similar in composition to intramedullary bone metastases (i.e. both are of soft tissue
composition as opposed to calcium or fat), VNC DECT may also be helpful in the detection of
bone marrow metastasis. Cancer patients obtaining a Positron Emission Tomography (PET) CT and
a separate diagnostic CT scan as part of their routine clinical care will be enrolled into
the study. The diagnostic CT scan will be performed on a DECT scanner and the images will be
reconstructed as SECT images for routine clinical interpretation as well as VNC DECT images.
The SECT images alone will be evaluated and scored, and then the VNC DECT images will be
added to the SECT images for a second evaluation (consecutive reading session). Multiple
readers blinded to the PET-CT findings for detection of bony metastatic disease will
Researchers hypothesize the addition of VNC DECT to SECT will be more accurate in the
detection of metastatic bone marrow lesions compared to SECT alone.
- Patients being imaged with PET/CT for diagnosis and/or staging of disease at Case
Comprehensive Cancer Center
- Patients with bone metastases on PET/CT
- Patients without bone metastases on PET/CT
- All cancer types and both newly diagnosed and previously treated patients will be
- Patients with intervening treatment during the time between diagnostic CT and PET/CT
- Time between the diagnostic CT and PET/CT greater than 30 days