Hyperpolarized Xenon MRI for Assessment of Pulmonary Function in Lung Resection

Study Overview
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Brief Summary
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This study compares the equivalence of hyperpolarized 129Xe MRI as compared to 133Xe scintigraphy for the evaluation of pulmonary function in patients being evaluated for lung resection.

Detailed Description
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This is a multicenter, randomized, open-label, cross-over Phase 3 study evaluating hyperpolarized 129Xe gas MRI as compared to 133Xe scintigraphy for the evaluation of pulmonary function. This study will enroll subjects being evaluated for possible lung resection surgery (i.e. segmentectomy, lobectomy, or pneumonectomy). Subjects will have both a 129Xe MRI and 133Xe scintigraphy image. The vast differences in technique for obtaining hyperpolarized 129Xe MRI as compared to 133Xe scintigraphy make it impossible to blind study procedures. However, all image interpretation will be performed by personnel blinded to the subject's medical history and all study assessments.

Official Title
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Evaluation of Hyperpolarized 129Xe MRI as Compared to 133Xe Scintigraphy for the Assessment of Pulmonary Function in Patients Being Evaluated for Possible Lung Resection Surgery

Conditions
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Pulmonary Surgical Procedures

Intervention / Treatment
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* Drug: 129Xe MRI
* Drug: 133 Xe scintigraphy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female subjects ≥18 years of age. Subject is being evaluated for possible lung resection (e.g., segmentectomy, lobectomy, or pneumonectomy). Subject is able to undergo MRI imaging and able to fit in the MRI coil. Subject is willing and able to comply with all study procedures. Subject must understand and voluntarily sign an informed consent form (ICF) prior to any study specific assessments or procedures. Exclusion Criteria: Baseline blood oxygen saturation (SpO2) <90% at rest. For patients requiring routine supplemental oxygen, SpO2 measurements should be taken with the patient's normal oxygen supplementation. Female subjects of childbearing potential with a positive serum pregnancy test at screening, or who are not taking (or not willing to take) acceptable birth control measures through the Follow-up Period. Adequate birth control methods include with a monogamous partner who was sterilized more than 6 months prior to screening, or measures with a Pearl index of <1 used consistently and correctly (including intrauterine devices, or implantable, injectable, oral, or transdermal contraceptives). Women are not considered to be of childbearing potential if they meet at least 1 of the following 2 criteria as documented by the Investigator: They have had a hysterectomy, bilateral salpingectomy, or bilateral oophorectomy at a minimum of 1 menstrual cycle prior to signing the ICF; or They are post-menopausal: for women ≥55 years of age, defined as ≥1 year since their last menstrual period, or for women <55 years of age, defined as ≥1 year since their last menstrual period and have a follicle-stimulating hormone (FSH) level in the laboratory's normal range for post-menopausal phase. Women who are lactating and insist on breast feeding. Subjects who have received any other investigational therapy within 4 weeks prior to Screening. Subjects who require anesthesia or heavy sedation to undergo MRI testing. Mild sedation could be acceptable (i.e. a low dose oral acting anxiolytic medication such as alprazolam) as long as, in the opinion of the investigator, the subject meets Inclusion Criteria #4 and #5.

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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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Open label crossover study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Arm 1<br>Subjects will undergo hyperpolarized 129Xe MRI first, followed by 133Xe scintigraphy | Drug: 129Xe MRI<br>* Evaluation of pulmonary function<br>* Other names: 129Xenon scintigraphy;Drug: 133 Xe scintigraphy<br>* Evaluation of pulmonary function<br>* Other names: 133Xenon scintigraphy;|
| Active Comparator: Arm 2<br>Subjects will undergo 133Xe scintigraphy first, followed by hyperpolarized 129Xe MRI | Drug: 129Xe MRI<br>* Evaluation of pulmonary function<br>* Other names: 129Xenon scintigraphy;Drug: 133 Xe scintigraphy<br>* Evaluation of pulmonary function<br>* Other names: 133Xenon scintigraphy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predicted Percentage of Remaining Pulmonary Function | Predicted percentage of remaining pulmonary function is a pre-specified section of lung were to be removed. Investigators indicated which portions of lung were likely to be resected. Remaining percentage of pulmonary function was determined by subtracting the percentage of pulmonary function contributed by the planned zone of resection from the total pulmonary function using a standard 6-zone image analysis of the lung. The difference between predicted percentage of remaining pulmonary function was calculated by subtracting the value derived from the 133Xe scintigraphy image from the value derived from the 129Xe MRI image (e.g. 129Xe - 133Xe). | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predicted Versus Measured FEV1 | The difference between the scan-predicted post-operative FEV1 and the measured post-operative FEV1 | 3 months | 
| Measured Percentage of Total Ventilation Contributed by the Lower Left Lung Zone. | The fraction of total ventilation contributed by the lower left lung zone on 6-zone analysis. | 48 hours | 
| Measured Percentage of Total Ventilation Contributed by the Upper Left Lung Zone. | The fraction of total ventilation contributed by the upper left lung zone on 6-zone analysis. | 48 hours | 
| Measured Percentage of Total Ventilation Contributed by the Middle Left Lung Zone. | The fraction of total ventilation contributed by the middle left lung zone on 6-zone analysis. | 48 hours | 
| Measured Percentage of Total Ventilation Contributed by the Upper Right Lung Zone. | The fraction of total ventilation contributed by the upper right lung zone on 6-zone analysis. | 48 hours | 
| Measured Percentage of Total Ventilation Contributed by the Middle Right Lung Zone. | The fraction of total ventilation contributed by the middle right lung zone on 6-zone analysis. | 48 hours | 
| Measured Percentage of Total Ventilation Contributed by the Lower Right Lung Zone. | The fraction of total ventilation contributed by the lower right lung zone on 6-zone analysis. | 48 hours |