An Investigational Scan (7T MRI) for the Imaging of Central Nervous System Tumors

Study Overview
=================
Brief Summary
-----------------
This trial investigates how well 7T MRI scan works in imaging central nervous system tumors. Diagnostic procedures, such as 7T MRI, may help find and diagnose central nervous system tumors and help measure a patient's response to earlier treatment. The goal of this trial is to learn if a new MRI system can provide better quality images than a standard MRI.

Detailed Description
-----------------
PRIMARY OBJECTIVE: I. To estimate the contrast-to-noise ratio (CNR) for several imaging modalities in brain malignancy as compared with normal brain parenchyma separately by type of malignancy and treatment status. SECONDARY OBJECTIVE: I. To assess the conspicuity of each imaging modality to differentiate radiation necrosis from progressive disease. EXPLORATORY OBJECTIVES: I. To assess patient experience in the 7 Tesla (7T) magnetic resonance imaging (MRI) system compared to their most recent MRI examination. II. To assess the typical significance values seen for areas of maximal brain activity associated with each functional MRI (fMRI) test. III. To assess the geometric distortion of a radiation planning sequence on a ultra-high field (UHF) system. OUTLINE: Patients undergo 7T MRI over 60 minutes.

Official Title
-----------------
Validation of a Multi-Parametric Ultra-High Field MRI Protocol for Central Nervous System Malignancy

Conditions
-----------------
Glioma, Central Nervous System Neoplasm, Metastatic Malignant Neoplasm in the Central Nervous System, Metastatic Malignant Solid Neoplasm

Intervention / Treatment
-----------------
* Procedure: 7 Tesla Magnetic Resonance Imaging
* Other: Questionnaire Administration


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adult patients must meet one set of inclusion criteria: Newly identified and untreated central nervous system glioma or metastasis of at least 5 mm or greater in size Suspected central nervous system neoplasms will require agreement from a study neuroradiologist and a study neurosurgeon or a radiation oncology that a lesion exists that is most likely either a glioma or a metastasis Patients with suspected brain metastasis must also have a history of solid organ malignancy History of central nervous system glioma or metastasis treated with surgery, radiation, chemotherapy, or immunotherapy with new or increasing signal on MR imaging that is suspicious for progressive disease (treatment failure) Suspected recurrent neoplasms will require agreement from a study neuroradiologist and a study neurosurgeon, radiation oncologist, or neuro-oncologist that lesion behavior is suspicious for recurrent disease Exclusion Criteria: Contraindication to MR imaging Absolute or relative contra-indication to 3T MRI due to metallic foreign bodies and devices and/or other conditions that are not MR safe, which include implants with unknown behavior in 3T MRI as well as: Electronically, magnetically, and mechanically activated implants Ferromagnetic or electronically operated active devices like automatic cardioverter defibrillators and cardiac pacemakers Metallic splinters in the eye Ferromagnetic hemostatic clips in the central nervous system (CNS) or body Cochlear implants Other pacemakers, e.g., for the carotid sinus Insulin pumps and nerve stimulators Non-MR safe lead wires Prosthetic heart valves (if dehiscence is suspected) Non-ferromagnetic stapedial implants Pregnancy Claustrophobia that does not readily respond to oral medication Known allergy to gadolinium-based contrast agents Renal failure as defined by a glomerular filtration rate (GFR) less than 30 or the use of hemodialysis Pregnant Interval treatment with radiation or surgery between the diagnostic MRI lesion identification and planned study MRI

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Diagnostic (7T MRI)<br>Patients undergo 7T MRI over 60 minutes. | Procedure: 7 Tesla Magnetic Resonance Imaging<br>* Undergo 7T MRI<br>* Other names: 7T MRI;Other: Questionnaire Administration<br>* Ancillary studies<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Contrast-to-noise ratio (CNR) | For each imaging modality, will calculate the CNR separately in the largest lesion/metastasis per patient as well as in all study lesions. The CNR for each imaging method will be determined and reported along with the corresponding 95% confidence interval. If enough follow-up images are obtained, will compare the CNR in lesions that respond to treatment to those that do not by using a Wilcoxon rank-sum test. Will compare the CNR between baseline and follow-up within patient by using a Wilcoxon signed-rank test. Also, for those lesions that initially respond, some will subsequently grow in size after the initial response. Of these, some will be considered radiation necrosis and some progressive disease. The CNR will be compared between lesions with necrosis and those that are progressive disease using a Wilcoxon rank-sum test. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Conspicuity of each imaging modality to differentiate radiation necrosis from progressive disease | The T1 sequence by MRI will be considered the gold standard, and will compare the conspicuity of each of the other methods to that of T1 sequencing by using McNemar's test. This analysis will first be performed in the largest lesion per patient, and then analyses will be repeated using all lesions. | After completion of magnetic resonance imaging (MRI) |