Predictive MRI Metrics for Tumor Aggressiveness in Papillary Thyroid Cancer
Predictive MRI Metrics for Tumor Aggressiveness in Papillary Thyroid Cancer
Magnetic resonance imaging (MRI) is a diagnostic technique that takes pictures of organs of
 the body. It uses magnetic fields and radio waves that cannot be felt. Perfusion MRI uses
 faster imaging. It also includes a contrast material that is given by vein. This makes
 specific organs, blood vessels, or tumors easier to see. Diffusion MRI lets us measure the
 motion of water in the tumor.

 Perfusion and diffusion MRI give extra information which is not available with the regular
 MRI. A regular MRI only shows pictures of the tumor. Thyroid MRI scans are not part of the
 current standard of care. The purpose of this study is to see if new MRI methods can give us
 more information about the tumor.
The aim of this pilot study clinical trial is to provide MRI biomarkers as quantitative
 (surrogate) biomarkers of aggressiveness in papillary thyroid cancer (PTC) including PMCs and
 to lay out the scientific basis for their translation into patient management. In this study
 we will perform specially designed diffusion weighted MRI (DW-MRI) and dynamic contrast agent
 MRI (DCE-MRI) protocols in the PTC patients.

 DW-MRI allows for quantifying water diffusion which has been shown to be related to tumor
 cellularity (29). Particularly, appropriate modeling with DW-MRI data acquired at multiple b
 values will enable quantifying tumor cellularity and vascularity simultaneously (30-32).
 DCE-MRI with proper compartmental modeling will yield metrics related to tumor-vessel
 permeability, tumor perfusion, and extracellular-extravascular volume fraction (33, 34).
 These facts provide the potential of DW-MRI and DCE-MRI metrics as quantitative imaging
 biomarkers of tumor aggressiveness in PTCs. The DW-MRI and DCE-MRI may ultimately help in
 personalized management approach, in which imaging biomarkers may be used to recommend either
 immediate surgery or active surveillance for PTC patients.
Inclusion Criteria:

 -  Biopsy proven Papillary Thyroid Cancer (regardless of genotype and including all
 subtypes such as follicular or mixed papillary follicular) or suspicious for Thyroid
 Cancer

 -  Thyroidectomy or lobectomy planned as definitive treatment for Thyroid Cancer or
 patients on active surveillance management approach

 -  Age ≥18 years

 Exclusion Criteria:

 -  Patient would require anesthesia for the study

 -  Patients who are claustrophobic Patients with tumor size greater than 5 cm in diameter
 as measured at imaging (ultrasonography or MRI) before treatment

 -  Patients who have presence of a known contraindication to MRI

 -  Pacemaker

 -  Aneurysmal clips

 -  Metal implants in field of view

 -  Pregnant

 -  Age and mental status wherein he/she is unable to cooperate for MRI study
 Patients who have presence of a known contraindication to DCE-MRI may not
 participate in that portion of the study

 -  Known reaction to Gd-DTPA, contrast agent

 -  Chronic kidney disease

 -  nursing women