Neoplasms

Symptoms and General Pathology

All Conditions

Digestive System Diseases

Neoplasm Metastasis

Rectal Neoplasms

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Intestinal Diseases

Rectal Diseases

ct,mri and pet scans pre and post radiation

ct and mri scan preradiation and postradiation

ct and mri scans

ct, mri and pet scans preradiation and postradiation

ct, mri and pet scan

single arm with ct, mri and pet scans pre and post radiation

ct, mri and pet scans

Barbara J Fisher, MD

The purpose of this study is to evaluate the accuracy of Positron emission tomography, Computed Tomography perfusion and 3 Tesla MRI in the radiological down-staging of rectal cancer following neoadjuvant chemoradiation. The restaging result obtained by these imaging studies will be compared to standard imaging studies and the histopathology of the surgical specimen. We hypothesize that these 3 imaging modalities will detect lymph node metastases pretreatment better than standard pretreatment scans and will better determine the degree of response of the primary rectal tumor to preoperative chemoradiation.

Patient Recruitment:

30 consecutive patients with histologically-proven, non-mucinous rectal cancer will be recruited and stratified into three separate groups as follows:

* T2 tumors (requiring only surgery)
* Early T3 tumors (requiring preoperative standard course radiation therapy)
* Advanced T3 and T4 tumors (requiring preoperative chemoradiation)

Study Protocol:

The pretreatment imaging studies will be performed with a 3T MRI pelvis,PET-CT and CT-Perfusion of the pelvis. The patient will then receive standard treatment consisting of surgery,radiation therapy or a course of neoadjuvant chemoradiation.For patients with T3 and T4 tumors, repeat imaging using all three modalities outlined above will be performed post-treatment.

Histopathology \& data analysis

MRI Protocol:

All patients will be examined on a 3-T MRI unit (Siemens Medical, Germany) at St. Joseph's Hospital, London.

The MRI protocol is as follows:

* Buscopan 40 mg IM/IV prior to study
* Axial T2 TSE of the entire pelvis (aortic bifurcation to pubic symphysis)
* Sagittal T2 TSE (240 cm FOV) for detection of the rectal tumor
* Axial oblique T2 TSE (220 cm FOV) perpendicular to the rectal tumor
* 3 mm slice thickness
* Coronal T2 TSE (220 cm FOV)
* Axial DWI (B values 0, 500, 1000)
* ADC map

Unless otherwise specified, slice thickness is 4mm. Technique is free-breathing; no bowel preparation, intraluminal or intravascular contrast agents are administered.

PET-CT Protocol:

* Patient fasts for 6-12 hours prior to study, depending on timing of scan
* Patients to be scanned in the morning will fast overnight; those being scanned in the afternoon will fast for 6 hours following a light breakfast.
* Blood sugar level measurement prior to study (should be less than 11 mmol/L). Insulin dependent diabetics are scanned in the early afternoon following a light breakfast and routine morning insulin.
* Exclude pregnancy with urine/serum hCG
* Intravenous injection of 5MBq/kg of F-18 FDG)
* Intravenous injection of 20 mg Lasix, 10 minutes following F-18 FDG injection
* IV hydration with 250-500 mL of saline
* 60 minutes post-injection, acquire non contrast CT and positron emission tomography imaging of the pelvis

CT Perfusion Protocol:

All patients will undergo CT Perfusion with a 64-slice CT scanner (Discovery CT750 HD, GE Healthcare) at St. Joseph's Health Care, London.

The protocol is as follows:

* Preliminary non-contrast 2.5-mm-thick helical CT of the pelvic region (from the aortic bifurcation to the symphysis pubis) with free-breathing to locate a 8-cm section of the rectal tumor that was imaged in the MRI study.
* Prescribe a CT Perfusion study using the axial shuttle mode on the 8-cm section identified above. The perfusion study consists of two phases. The selected pelvic section is scanned every 2.8 s for 64.4 s (24 times) in the first phase and every 15 s for the next 120 s (8 times) in the second phase. The total duration of scanning is 184.4 s. The scanning parameters for both phases are: 120 kVp, 125 mA, 0.4 s rotation period, and 5 mm thick slices. All dynamic images will be reconstructed with adaptive statistical iterative reconstruction (ASIR) technique to reduce noise.
* Contrast injected at a rate of 3-4 ml/s will start at the same as the two-phase scanning, to allow for acquisition of 3-4 baseline volumes (before contrast arrives in the pelvis).
* Free-breathing is allowed during scanning.
* Contrast dose is 0.8ml/kg of body weight up to maximum of 70 ml of contrast at a concentration of 370 mg iodine/ml.
* The acquired dynamic contrast enhanced (DCE) images will be analyzed by CT Perfusion (GE Healthcare) to determine blood flow, blood volume, mean transit time and capillary permeability surface area of the tumor.

Surgical Resection and histopathological examination:

* Total mesorectal excision as per standardized surgical technique; orientation of surgical specimen according to pre-established regional lymph node map -Mapping of regional lymph nodes by pathologist into perirectal zones (anterior, posterior, left, right, superior, middle, inferior)
* Compare pre- and post-therapeutic imaging with histopathological findings.

Rectal Cancer: Local Staging, Re-staging and Assessment of Lymph Nodes Using Pet-Ct, CT-Perfusion and 3T MRI

Rectal Cancer: Local Staging, Re-staging and Assessment of Lymph Node Metastases Using PET-CT, CT-Perfusion and 3T MRI: A Prospective Feasibility Study

The patient will undergo imaging studies with PET, CT-perfusion and MRI before and after standard preoperative chemoradiation and these imaging studies will be compared with standard imaging and with the final pathology specimen in order to determine the accuracy of these 3 studies in detecting lymph node metastases and response of the primary tumour to treatment

London Health Sciences Centre

Doctor

Nervous System Diseases

Brain Neoplasms

Neoplastic Processes

Central Nervous System Neoplasms

Nervous System Neoplasms

Brain Diseases

Central Nervous System Diseases

Each patient will undergo a 3T MRI scan as well as a dynamic contrast-enhanced CT scan within one week prior to the start of treatment. Patients will also undergo a research 3T MRI scan and research dynamic contrast-enhanced CT scan at the one week post radiotherapy mark. An MRI scan during their 3 month post-treatment follow up visits will take place as per routine standard of care.

CT and MRI scans will occur before and after radiation therapy.

CT and MRI Scans

David Shultz, M.D., Ph. D

Catherine Coolens, Ph. D

David Shultz, MD

A biomarker is a measurable indicator of the severity or presence of some disease state. In this study, brain metastases patients who will be receiving radiation treatment, will undergo CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) scans prior to and after radiation treatment to measure these biomarkers. This is a single-center phase II study to validate the predictive abilities of biomarkers, in terms of determining how patients will respond to radiation treatment.

Advances in medical imaging can provide useful information to guide and look at the response to treatment. Previous studies suggest early changes in the tumor after radiation treatment may be detectable using special MRI (Magnetic Resonance Imaging), and CT (Computed Tomography) scans. A biomarker is a measureable indicator of the severity or presence of some disease state. Previous studies suggest that the change in several imaging biomarkers can predict who will respond to radiation treatment. In this study, patients will undergo CT and MRI scans prior to and after radiation treatment to measure these biomarkers. The purpose of this study is to validate the predictive abilities of biomarkers in terms of determining how patients will respond to radiation treatment. This is a single-center phase II study, which will be conducted at the Princess Margaret Cancer Center. The study will be enrolling up to a total of 90 patients who will be receiving radiation treatment for brain metastases. Patients will be asked to participate within this study for 2 years.

Participants will undergo CT and MRIs before and after radiation therapy.

Brain Imaging Biomarkers in Patients With Brain Metastasis

Imaging Trial of Biomarkers to Guide Individualized Therapy in Patients With Brain Metastasis Receiving Radiotherapy

Using RANO to validate imaging predictive biomarkers of response to radiotherapy

Using RECIST criteria to validate imaging predictive biomarkers of response to radiotherapy

Using PFS to validate imaging predictive biomarkers of response to radiotherapy

Defined as increase in volume of contrast uptake on MRI of \> 25% as measured by two perpendicular tumor diameters compared to the smallest measurement ever for the same lesion by the same technique.

Defined as stable or reduced volume of contrast uptake on MRI (i.e., all non-progression).

Defined as the time interval between the date of first treatment and the date of objective radiological progression of any one of the treated lesions.

Defined as the time interval between the date of first treatment and the date of new brain metastases, with or without progression of the treated lesions.

Defined as the time interval between the date of first treatment and the date of disease progression in the brain or death due to disease in the brain, whichever comes first.

AEs that are deemed by the PI to be possibly, probably or definitely attributable to the research MRI and/or CT will be reported according to CTCAE version 4.3.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Rectal Cancer: Local Staging, Re-staging and Assessment of Lymph Nodes Using Pet-Ct, CT-Perfusion and 3T MRI	NCT01525056	Rectal Cancer	ct and mri scan... ct, mri and pet... ct, mri and pet...	18 Years -	London Health Sciences Centre
Brain Imaging Biomarkers in Patients With Brain Metastasis	NCT04197297	Brain Metastase...	CT and MRI Scan...	18 Years -	University Health Network, Toronto

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