PET/CT or PET/MRI in Measuring Tumors in Patients Undergoing Clinical Imaging or With Newly Diagnosed Breast Cancer

Not Applicable

Completed

Conditions: Breast Cancer
Unspecified Adult Solid Tumor, Protocol Specific

Interventions: Diagnostic Test: positron emission tomography/computed tomography
Diagnostic Test: PET/MRI
Device: Position Device

Registration Number: NCT01892540

Lead Sponsor: Case Comprehensive Cancer Center

Brief Summary: This clinical trial studies positron emission tomography (PET)/computed tomography (CT) or PET/magnetic resonance imaging (MRI) in measuring tumors in patients undergoing clinical imaging or with newly diagnosed breast cancer. New diagnostic procedures, such as PET/CT or PET/MRI, may be more effective than MRI alone in measuring tumors in patients undergoing clinical imaging or with newly diagnosed breast cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. To improve visualization of tumors by developing better image reconstruction and correction methods.

II. To revise the positioning devices and, if necessary, scanner table to fit a wider size range of women.

OUTLINE:

Patients undergo clinical fludeoxyglucose F-18 (FDG)-PET/CT followed by prone breast PET/CT and/or prone breast PET/MRI with or without gadopentetate dimeglumine (DTPA).

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 43

Inclusion Criteria

[Cohorts 1 and 2] Female patients who are referred by their physician to have a clinical PET/CT
[Cohort 3] Patients referred for clinical breast dynamic contrast-enhanced (DCE)-MRI for recently diagnosed breast cancer
Normal kidney function for subjects that will receive magnetic resonance (MR) contrast agent as part of their clinical imaging
For subjects for whom MR contrast agent is to be administered, University Hospitals (UH) policy 8.17.26 will be applied
- The following guidelines will be followed when a patient or patient representative responds "yes" to questions on the MRI history sheet 'Are you on dialysis, history of kidney failure, end stage renal disease, chronic liver disease, or are you a peri-liver transplant patient':
  - The patient must have a serum creatinine value available within three (3) weeks prior to the injection of gadolinium
  - Calculate an estimated glomerular filtration rate (eGFR) based on serum creatinine; if the eGFR is less than 30 the attending radiologist must discuss the risks and benefits of administering gadolinium with the referring physician and patient; the collective judgment of the patient, radiologist and referring physician must be in agreement to proceed with the injection of gadolinium
  - Calculated eGFR in range of 31-59 requires the judgment of the attending radiologist whether to discuss gadolinium administration with referring physician and patient or whether to directly use or hold the contrast agent
  - If an eGFR is greater than 60, gadolinium may be administered without further physician or patient discussion
  - Gadolinium administration is limited to single dose at 0.1mmol/kg; Omniscan should not be used
  - Technologist will document radiologist decision to administer gadolinium on the MRI history sheet; radiologist will document decision and consultation with the referring physician and patient in the MRI report
  - PERITONEAL DIALYSIS PATIENTS:
    - No gadolinium will be administered unless the patient has been scheduled for hemodialysis within 24 hours following the injection of gadolinium; technologist will determine eGFR and follow above guidelines; dialysis will be scheduled by the referring physician
  - HEMODIALYSIS PATIENTS:
    - No gadolinium will be administered unless the patient has been scheduled for hemodialysis within 24 hours following the injection of gadolinium; no determination of eGFR is necessary; radiologist will assume eGFR less than 30 and follow above guidelines; dialysis will be scheduled by the referring physician
Ability to provide informed consent

Exclusion Criteria

Subjects who do not meet all of the above inclusion criteria
Subjects unwilling or unable to sign the informed consent form
Subjects who are cognitively impaired and thus unable to give informed consent
Subjects unable to undergo MR scanning due to exclusion via University Hospitals Case Medical Center (UHCMC) MR restrictions (e.g. certain implanted metallic or electronic devices)
Subjects who are pregnant
Subjects that are too large to fit comfortably into the PET/MR on the breast coil; for cohort 1 only we will accept a maximum of 10 subjects that are too large for the PET/MRI to acquire a prone PET/CT but without the paired PET/MR

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Cohort 2: New positioning device	positron emission tomography/computed tomography	-
Cohort 3: Current positioning device until new is available	PET/MRI	-
Cohort 1: Standard positioning device	PET/MRI	Patients undergo clinical FDG-PET/CT followed by prone breast PET/CT and/or prone breast PET/MRI with or without DTPA.
Cohort 2: New positioning device	PET/MRI	-
Cohort 1: Standard positioning device	positron emission tomography/computed tomography	Patients undergo clinical FDG-PET/CT followed by prone breast PET/CT and/or prone breast PET/MRI with or without DTPA.
Cohort 2: New positioning device	Position Device	-
Cohort 3: Current positioning device until new is available	Position Device	-
Cohort 3: Current positioning device until new is available	positron emission tomography/computed tomography	-

Primary Outcome Measures

Name	Time	Method
Attenuation Correction for PET/CT, Assessed Using SUVs (Cohorts I & II)	1 yr from study start	Uptake and attenuation correction of PET/MRI and PET/CT will be examined by comparing SUVs of the two methods. The proportions of subjects with SUV of the PET/MR within 5%, 10%, and 20% of the SUV from PET/CT will be estimated with exact 95% confidence intervals.
Comparison of Specificity Rates of Fused FDG-PET/MRI (Cohort III)	1 yr from study start	McNemar's test or a generalized estimating equations logistic regression model with patient as the cluster used to compare specificity rates of the new technology versus current technology (MRI alone), restricting analysis to true negative lesions. Utilizing 3 different combinations of scan parameters to determine which combination has the highest specificity. Single parameter: DCE-MRI is the gold standard to which the two parameter and three parameter rows are compared. Combinations include: Single parameter: DCE-MRI Two Parameter A: DCE-MRI and DWI ADC Two Parameter B: DCE-MRI and FDG-PET Three Parameter: DCE-MRI, DWI ADC, FDG-PET
Sensitivity of PET/CT and PET/MRI (Cohort III)	1 yr from study start	McNemar's test or a generalized estimating equations logistic regression model with patient as the cluster used to compare sensitivity rates of the new technology versus current technology (MRI alone), restricting analysis to true negative lesions. Utilizing 3 different combinations of scan parameters to determine which combination has the highest sensitivity. Combinations include: Single parameter: DCE-MRI Two Parameter A: DCE-MRI and DWI ADC Two Parameter B: DCE-MRI and FDG-PET Three Parameter: DCE-MRI, DWI ADC, FDG-PET
Attenuation Correction for PET/MRI, Assessed Using Standard Uptake Values (SUVs) (Cohorts I & II)	1 yr from study start	Uptake and attenuation correction of PET/MRI and PET/CT will be examined by comparing SUVs of the two methods. The proportions of subjects with SUV of the PET/MR within 5%, 10%, and 20% of the SUV from PET/CT will be estimated with exact 95% confidence intervals.