MRI for Screening and Monitoring Scleroderma ILD

Study Overview
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Brief Summary
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The purpose of this study is to test MRI methods for evaluating patients with Scleroderma-associated interstitial lung disease.

Detailed Description
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Quantify the sensitivity and specificity of UTE MRI in screening for scleroderma-associated interstitial lung disease. ILD is relatively common in SSc, but current clinical standards require screening using HRCT. UTE MRI can provide images of pulmonary structure with contrast and resolution approaching that of CT. We hypothesize that UTE MRI will have high sensitivity and specificity (>80%) to the presence of ILD as determined by HRCT. Aim Quantify treatment response in patients with SSc-ILD using hyperpolarized 129Xe MRI. The optimal treatment for SSc-ILD is not known, and it is challenging to assess the efficacy of therapy. Hyperpolarized 129Xe MRI is highly sensitive to the pathophysiology associated with ILD, which suggests that it may be more sensitive to treatment response than conventional methods. We hypothesize that hyperpolarized 129Xe MRI biomarkers will be sensitive to lung function improvement or decline earlier than standard clinical measures (6MWD, FVC, DLCO, Dyspnea score).

Official Title
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MRI for Screening and Monitoring Systemic Sclerosis Interstitial Lung Disease

Conditions
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Scleroderma

Intervention / Treatment
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* Diagnostic Test: MRI
* Drug: Hyperpolarized Xe129
* Diagnostic Test: HRCT


Participation Criteria
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Eligibility Criteria
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Arm 1 (UTE MRI in patients with Scleroderma) Inclusion Criteria: Age ≥ 18 years of age Subject has clinical diagnosis of scleroderma. Chest CT scan within 1 month prior to screening or Chest CT scan will be completed within 1 month post study enrollment. Ability to adhere to the study visit schedule, adhere, and comply with all protocol requirements. Ability to understand and provide written informed consent. Exclusion Criteria: Subject unable to undergo MRI based on MRI safety screening Pregnant or breastfeeding female subjects Prisoners or incarcerated individuals Any in-patient hospitalization (defined as greater than 23 hours) within 30 days of study enrollment Any major surgical procedure within 90 days prior to study enrollment or planned surgical procedure during the study period. Concomitant medical disorder, condition, or history, that in the opinion of the Investigator would impair the subject's ability to participate in or complete the requirements of the study Other medical or psychiatric condition which, in the opinion of the Investigator, would place the subject at increased risk or would preclude obtaining voluntary consent or would confound the objectives of the study Arm 2 (Hyperpolarized 129Xe MRI in Patients with Scleroderma ILD) Inclusion Criteria: Age ≥ 18 years of age Subject clinically diagnosed with SSc-ILD. Subject initiating background SSc-ILD therapy within ±30 days of visit 1. (i.e. patient cannot have begun therapy for SSc-ILD more than 30 days prior to visit 1, or must be clinically scheduled to initiate therapy within 30 days after visit 1). FVC % Predicted ≥45% pre-bronchodilator within 30 days prior to screening or at baseline. DLCO % Predicted ≥30% within 30 days prior to screening or at baseline. Oxygen saturation >87% on room air or with supplemental oxygen Ability to adhere to the study visit schedule, adhere, and comply with all protocol requirements. Ability to understand and provide written informed consent. Exclusion Criteria: Subject unable to undergo MRI based on MRI safety screening Diagnosis of IPF based on ATS/ERS/JRS/ALAT 2018 Guidelines Significant Pulmonary Arterial Hypertension (PAH) defined by any of the following: Previous clinical or echocardiographic evidence of significant right heart failure History of right heart catheterization showing a cardiac index ≤ 2 l/min/m² PAH requiring parenteral therapy with epoprostenol/treprostinil Primary obstructive airway physiology (pre-bronchodilator FEV1/FVC < 0.7 at Baseline). Pregnant or breastfeeding female subjects Prisoners or incarcerated individuals Any in-patient hospitalization (defined as greater than 23 hours) within 30 days of study enrollment Any major surgical procedure within 90 days prior to study enrollment or planned surgical procedure during the study period. Concomitant medical disorder, condition, or history, that in the opinion of the Investigator would impair the subject's ability to participate in or complete the requirements of the study Other medical or psychiatric condition which, in the opinion of the Investigator, would place the subject at increased risk or would preclude obtaining voluntary consent or would confound the objectives of the study Subject has been on therapy for SSc-ILD for >30 days prior to baseline MRI. Pregnancy (Visit 1 or Visit 2) or intention to become pregnant (Visit 2 only)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Scleroderma<br>Patients with Scleroderma will be imaged with UTE MRI to compare MRI with CT for identifying Interstitial Lung Disease | Diagnostic Test: MRI<br>* Patients will be imaged using MRI<br>Diagnostic Test: HRCT<br>* High Resolution Computer Tomography<br>|
| Scleroderma ILD<br>Patients with Scleroderma ILD who are initiating treatment will be imaged using hyperpolarized 129Xe MRI to assess treatment efficacy. | Diagnostic Test: MRI<br>* Patients will be imaged using MRI<br>Drug: Hyperpolarized Xe129<br>* Hyperpolarized Xe129 will be used to image the lungs of a subset of participants.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Presence of ILD on CT and MRI | An experienced radiologist will review MRI and CT images to assess whether ILD is present. | Baseline | 
| Change in RBC/Barrier Ratio | The change in hyperpolarized 129Xe RBC/Barrier ratio from baseline to follow-up imaging | 6 months |