NIH Clinical Research Studies

Protocol Number: 03-C-0278

Active Accrual, Protocols Recruiting New Patients

Title:
A Comparative Study of Pediatric CNS Tumor Activity as Assessed by [18F-] FDG PET Imaging and Proton Magnetic Resonance Spectroscopic Imaging (1H-MRSI)
Number:
03-C-0278
Summary:
This study in children and young adults will compare two types of imaging, positron emission tomography ([18F]-DG PET) and proton magnetic resonance spectroscopy (1H-MRSI), to determine activity of a brain tumor or abnormal tissue in the brain following treatment for a brain tumor. Children with brain tumors are generally followed with magnetic resonance imaging (MRI) scans to evaluate response to treatment. However, because MRI only provides information on the structure of the brain, it may difficult to tell if an abnormal finding is due to tumor, swelling, scar tissue, or dead tissue. 1H-MRSI and [18F]-DG PET, on the other hand, provide information on the metabolic activity of brain lesions. These two methods will be compared and evaluated for their ability to provide important additional information on childhood brain tumors.

Patients between 4 and 21 years of age with a brain tumor or brain tissue abnormality following treatment for a brain tumor may be eligible for this study. Candidates will be screened with a medical history and physical examination, pregnancy test in women who are able to become pregnant, and a blood test for glucose.

Participants will undergo the following procedures:

1H-MRSI - This test is similar to MRI and is done in the same scanning machine. In MRI, scans of the brain are obtained by applying a strong magnetic field and then collecting the signals released from water after the magnetic field is changed. Pictures of the brain are then obtained by computer analysis of these signals. In 1H-MRSI, the computer blocks the signal from water to get information on brain chemicals that can indicate whether an abnormality is tumor or dead tissue. Both MRI and MRI and 1H-MRSI are done in this study.

For these tests, the child lies on a stretcher that moves into the scanner - a narrow metal cylinder with a strong magnetic field. The child's head is placed in a headrest to prevent movement during the scan. He or she will hear loud thumping noises caused by the electrical switching of the magnetic field. A contrast agent is given through an intravenous (IV) catheter (plastic tube placed in an arm vein) or through a central line if one is in place. The contrast material brightens the images to provide a clearer picture of abnormalities. Children who have difficulty holding still or being in a scanning machine are given medications by an anesthesiologist to make them sleep through the procedure. Children who are awake during the procedure can communicate with the MRI technician at all times and ask to be removed from the scanner at any time. The MRI and 1H-MRSI take 1-1/2 to 2 hours to complete.

[18F]-DG PET - For this test, [18F]-DG (a radioactive form of glucose) is injected into the patient's arm vein through a catheter, followed by the PET scan, similar to a very open MRI scan without the noise. The PET scan tells how active the patient's tumor is by tracking the radioactive glucose. All cells use glucose, but cells with increased metabolism, such as cancer cells, use more glucose than normal cells. After the glucose injection, the patient lies quietly in a darkened room for 30 minutes, after which he or she is asked to urinate to help reduce the dose of radiation to the bladder. Then, the scan begins. When the scan is finished (after about 1 hour), the child is asked to urinate again and then every 3 to 4 hours for the rest of the day.

Patients remain in the study for 2 years unless they withdraw, become pregnant, or require sedation but can no longer use an anesthetic. MRI and 1H-MRSI scans may be repeated every few months during the study period, if necessary. Only one PET scan is done each year.

Sponsoring Institute:
National Cancer Institute (NCI)
Recruitment Detail
Type: Active Accrual Of New Subjects
Gender: Male & Female
Referral Letter Required: No
Population Exclusion(s): None

Eligibility Criteria:
INCLUSION CRITERIA:

1) Age: greater than or equal to 4 years and less than or equal to 21 years.

2) Radiographic diagnosis: Patients must have a brain tumor (including, but not limited to high grade gliomas, low-grade gliomas, primitive neuroectodermal tumors, ependymomas) or residual abnormality (e.g. post-operatively or post-radiation) that is measurable or evaluable on standard MRI or CT.

3) All patients or their legal guardians (if the patient is less than 18 years of age) must sign a document of informed consent indicating their awareness of the investigational nature and the risks of this study. When appropriate, the minor patient will be asked for oral assent. The parent or guardian will sign the consent form on the designated line attesting to the fact that the minor has given assent.

4) Durable Power of Attorney (DPA): A DPA will be offered to all patients 18-21 years of age.

5) Prior treatment: Patients will be eligible for this study regardless of prior treatment, as long as they meet other eligibility criteria. Therefore, patients who are newly diagnosed, post-operative, post-radiation or post-chemotherapy are eligible.

EXCLUSION CRITERIA:

1) Patients under age 18 years who weigh greater than 70 kg are excluded because they would exceed the standard allowable dosimetry for pediatric patients (i.e. Effective Dose greater than 0.5 REM/year). In addition, patients who weigh greater than 136 kg are excluded, as this is the maximum weight allowable on PET scanner tables.

2) Pregnant women are excluded because the effects from the magnet on the fetus are unknown. In addition, gadolinium is not approved for use in pregnant women, because its teratogenic effects have not been studied and we wish to avoid radiation exposure to the fetus.

3) Any patient who is unable (either because of physical or psychological factors) to undergo imaging studies without sedation but is not considered an anesthesia candidate.

4) Any patient with a metallic MEI incompatible implant, including cardiac pacemakers, neural pacemakers, aneurysmal clips, shrapnel, cochlear implants or ferrous surgical clips.

5) Any patient with a history of a severe reaction (CTC v.2 Grade greater than or equal to 2) to Gadolinium or other contrast agents.

6) Any patient with Diabetes mellitus or steroid-induced hyperglycemia (fasting glucose greater than 150) because this may interfere with the interpretation of the [18F-]-FDG PET scan.

7) Any patient with permanent braces, permanent braces, permanent retainers or nonferrous implant that, in the judgement of the Principal Investigator, would interfere with obtaining spectroscopy in the area of the tumor.

Special Instructions: Currently Not Provided
Keywords:
Brain Tumor
Children
Metabolic
Spectroscopy
PET
Recruitment Keywords:
Brain Tumor
Children
Conditions:
Brain Neoplasms
Investigational Drug(s):
2-Flourodeoxyglucose
Investigational Device(s):
None

Contacts:
Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citations:
Sutton LN, Wang Z, Gusnard D, Lange B, Perilongo G, Bogdan AR, Detre JA, Rorke L, Zimmerman RA. Related Articles, Links Abstract Proton magnetic resonance spectroscopy of pediatric brain tumors. Neurosurgery. 1992 Aug;31(2):195-202.

PMID: 1513425

Tzika AA, Vigneron DB, Dunn RS, Nelson SJ, Ball WS Jr. Related Articles, Links Abstract Intracranial tumors in children: small single-voxel proton MR spectroscopy using short- and long-echo sequences. Neuroradiology. 1996 Apr;38(3):254-63.

PMID: 8741198

Fulham MJ, Bizzi A, Dietz MJ, Shih HH, Raman R, Sobering GS, Frank JA, Dwyer AJ, Alger JR, Di Chiro G. Related Articles, Links Abstract Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance. Radiology. 1992 Dec;185(3):675-86. PMID: 1438744

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