Combined 18F-NaF/18F-FDG PET/MRI for Detection of Skeletal Metastases

NCT ID: NCT00375830

Last Updated: 2023-12-12

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

114 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-01-31

Study Completion Date

2019-03-14

Brief Summary

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This clinical trial studies the use of sodium fluorine-18 (18F-NaF) plus fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/ whole body magnetic resonance imaging (WBMRI) to detect skeletal metastases in patients with stage III-IV breast cancer or stage II-IV prostate cancer.

Detailed Description

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Eligible participants had previously received a bone scan using the radiolabel 99mTc-methyl diphosphonate (t99-MDP) as part of their regular medical care.

18F-NaF and 18F-FDG are radioactive substances (radiolabels) that are absorbed by cancerous cells and allow for the cancer to be found using diagnostic procedures such as positron emission tomography (PET)/ whole body magnetic resonance imaging (WBMRI). PET/WBMRI is a combination procedure that combines the detailed PET images of areas inside the body from PET with the WBMRI scans, and may help find and diagnose skeletal metastases in patients with breast or prostate cancer. It is not yet known whether 18F-NaF/18F-FDG PET/WBMRI is better than standard imaging methods in detecting skeletal metastases.

Eligible participants diagnosed with breast/prostate cancers and who have had 99mTc MDP bone scanning as part of their routine care are recruited and enrolled. Participants then receive an 18F-NaF/18F-FDG positron emission tomography (PET)/ WBMRI combination scan.

The PET/MRI scans will be interpreted by 2 American Board Nuclear Medicine (ABNM)-certified physicians and 2 American Board of Radiology (ABR)-certified radiologists, all with significant clinical experience, who are blinded to the subjects' medical history and the results of other imaging modalities.

The scans will be analyzed and compared against each other, with a consensus read will be obtained for each scan. Characterization of lesions as true-positive, true-negative, false-positive or false-negative will be done through a combination of clinical follow-up, imaging follow-up and/or histopathology findings. An overall diagnosis based on each scan will be determined on a 5-point scale (1=benign, 2=likely benign, 3=uncertain, 4=likely malignant, 5=malignant) to conduct a receiver operating characteristic (ROC) analysis.

If the diagnosis is positive for metastases on any of the scans, the investigator will identify the number of lesions and locations of positivity, and record this information.

Clinical is obtained at about 12 months after the initial scans.

Conditions

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Cancer

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Cohort 1 Pilot-WB-MRI & Combined 18F-NaF-CT/18F-FDG-PET scans

Preliminary pilot assessment to confirm feasibility \& improved diagnostic accuracy of the combined 18F-NaF CT \& 18F-FDG PET scan procedures, as compared to the regular medical care procedure, 99mTc MDP bone scans.

Group Type EXPERIMENTAL

Bone scan

Intervention Type PROCEDURE

Scan to diagnose a number of bone conditions including cancer or metastasis

99mTc-methyl diphosphonate

Intervention Type DRUG

Radiolabel for bone scan procedures

Positron Emission Tomography (PET) scan

Intervention Type PROCEDURE

Scan to detect gamma rays emitted by a positron-emitting radioligand such as 18F

18F-Fludeoxyglucose (18F-FDG)

Intervention Type DRUG

Radiolabel for positron emission tomography scan procedures

Computed Tomography (CT) scan

Intervention Type PROCEDURE

Scan to detect \& analyze X-rays

18F-Sodium Fluoride (18F-NaF)

Intervention Type DRUG

Radiolabel for CT and PET scans, \& as a contrast agent for MRI scans.

Gadopentetate dimeglumine

Intervention Type DRUG

A gadolinium-based contrast agent for MRI

Cohort 2 WB-MRI & Combined 18F-NaF-CT/18F-FDG-PET scans

Assessment to define the accuracy of the combined 18F-NaF CT \& 18F-FDG PET/CT scan procedures compared to 99mTc MDP bone scan.

Group Type EXPERIMENTAL

Bone scan

Intervention Type PROCEDURE

Scan to diagnose a number of bone conditions including cancer or metastasis

99mTc-methyl diphosphonate

Intervention Type DRUG

Radiolabel for bone scan procedures

Positron Emission Tomography (PET) scan

Intervention Type PROCEDURE

Scan to detect gamma rays emitted by a positron-emitting radioligand such as 18F

18F-Fludeoxyglucose (18F-FDG)

Intervention Type DRUG

Radiolabel for positron emission tomography scan procedures

Computed Tomography (CT) scan

Intervention Type PROCEDURE

Scan to detect \& analyze X-rays

18F-Sodium Fluoride (18F-NaF)

Intervention Type DRUG

Radiolabel for CT and PET scans, \& as a contrast agent for MRI scans.

Whole Body Magnetic Resonance Imaging (WB-MRI) scan

Intervention Type PROCEDURE

Whole Body Magnetic Resonance Imaging (WB-MRI) scan: Scan that uses strong magnetic fields \& radio waves to generate images of the organs in the body.

Gadofosveset

Intervention Type DRUG

A gadolinium-based contrast agent for MRI

Gadobutrol

Intervention Type DRUG

A gadolinium-based contrast agent for MRI

Cohort 3 Combined 18F-NaF / 18F-FDG PET/WB-MRI scan

Assessment to define the utility of 18F-NaF \& 18F-FDG as the radiolabels in a single combined PET / WB-MRI procedure.

Group Type EXPERIMENTAL

Bone scan

Intervention Type PROCEDURE

Scan to diagnose a number of bone conditions including cancer or metastasis

99mTc-methyl diphosphonate

Intervention Type DRUG

Radiolabel for bone scan procedures

Positron Emission Tomography (PET) scan

Intervention Type PROCEDURE

Scan to detect gamma rays emitted by a positron-emitting radioligand such as 18F

18F-Fludeoxyglucose (18F-FDG)

Intervention Type DRUG

Radiolabel for positron emission tomography scan procedures

18F-Sodium Fluoride (18F-NaF)

Intervention Type DRUG

Radiolabel for CT and PET scans, \& as a contrast agent for MRI scans.

Whole Body Magnetic Resonance Imaging (WB-MRI) scan

Intervention Type PROCEDURE

Whole Body Magnetic Resonance Imaging (WB-MRI) scan: Scan that uses strong magnetic fields \& radio waves to generate images of the organs in the body.

Gadofosveset

Intervention Type DRUG

A gadolinium-based contrast agent for MRI

Gadobutrol

Intervention Type DRUG

A gadolinium-based contrast agent for MRI

Interventions

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Bone scan

Scan to diagnose a number of bone conditions including cancer or metastasis

Intervention Type PROCEDURE

99mTc-methyl diphosphonate

Radiolabel for bone scan procedures

Intervention Type DRUG

Positron Emission Tomography (PET) scan

Scan to detect gamma rays emitted by a positron-emitting radioligand such as 18F

Intervention Type PROCEDURE

18F-Fludeoxyglucose (18F-FDG)

Radiolabel for positron emission tomography scan procedures

Intervention Type DRUG

Computed Tomography (CT) scan

Scan to detect \& analyze X-rays

Intervention Type PROCEDURE

18F-Sodium Fluoride (18F-NaF)

Radiolabel for CT and PET scans, \& as a contrast agent for MRI scans.

Intervention Type DRUG

Whole Body Magnetic Resonance Imaging (WB-MRI) scan

Whole Body Magnetic Resonance Imaging (WB-MRI) scan: Scan that uses strong magnetic fields \& radio waves to generate images of the organs in the body.

Intervention Type PROCEDURE

Gadopentetate dimeglumine

A gadolinium-based contrast agent for MRI

Intervention Type DRUG

Gadofosveset

A gadolinium-based contrast agent for MRI

Intervention Type DRUG

Gadobutrol

A gadolinium-based contrast agent for MRI

Intervention Type DRUG

Other Intervention Names

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Bone scintigraphy 99mTc-methylene diphosphonate Technetium 99mTc medronate 99mTc-MDP t99-MDP 2-Deoxy-2-(18F)Fluoro-D-Glucose 2-F18-Fluoro-2-deoxy-D-glucose 2-F18-Fluoro-2-deoxyglucose 18F 2-Fluoro-2-deoxy-D-Glucose Fludeoxyglucose F-18 Fluorodeoxyglucose F18 Computerized Axial Tomograph (CAT) scan Computer-aided Tomography (CAT) scan 18F-Sodium Fluorine Magnevist Ablavar Gadavist

Eligibility Criteria

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Inclusion Criteria

* ≥ 18 years old at the time of the drug administration
* ≥ Stage 3 breast cancer OR ≥ stage 2 prostate cancer OR prostate-specific antigen (PSA) \> 10 micrograms/L OR recurrent breast or prostate cancer
* Capable of complying with study procedures
* Able to remain still for duration of imaging procedure (about one hour)
* Written informed consent

Exclusion Criteria

* Pregnant or nursing
* Metallic implants that contraindicate MRI
* Renal function impairment that contraindicates MRI
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Stanford University

OTHER

Sponsor Role lead

Responsible Party

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Andrei Iagaru

Professor of Radiology (Nuclear Medicine)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Andrei Iagaru, MD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

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Stanford University School of Medicine

Stanford, California, United States

Site Status

Countries

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United States

References

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Iagaru A, Young P, Mittra E, Dick DW, Herfkens R, Gambhir SS. Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clin Nucl Med. 2013 Jul;38(7):e290-6. doi: 10.1097/RLU.0b013e3182815f64.

Reference Type RESULT
PMID: 23455520 (View on PubMed)

Minamimoto R, Loening A, Jamali M, Barkhodari A, Mosci C, Jackson T, Obara P, Taviani V, Gambhir SS, Vasanawala S, Iagaru A. Prospective Comparison of 99mTc-MDP Scintigraphy, Combined 18F-NaF and 18F-FDG PET/CT, and Whole-Body MRI in Patients with Breast and Prostate Cancer. J Nucl Med. 2015 Dec;56(12):1862-8. doi: 10.2967/jnumed.115.162610. Epub 2015 Sep 24.

Reference Type RESULT
PMID: 26405167 (View on PubMed)

Iagaru A, Minamimoto R, Jamali M, Barkodhodari A, Gambhir SS, Vasanawala S. Imaging patients with breast and prostate cancers using combined 18F NaF/18F FDG and TOF simultaneous PET/ MRI. EJNMMI Phys. 2015 Dec;2(Suppl 1):A65. doi: 10.1186/2197-7364-2-S1-A65. No abstract available.

Reference Type RESULT
PMID: 26956325 (View on PubMed)

Sonni I, Minamimoto R, Baratto L, Gambhir SS, Loening AM, Vasanawala SS, Iagaru A. Simultaneous PET/MRI in the Evaluation of Breast and Prostate Cancer Using Combined Na[18F] F and [18F]FDG: a Focus on Skeletal Lesions. Mol Imaging Biol. 2020 Apr;22(2):397-406. doi: 10.1007/s11307-019-01392-9.

Reference Type RESULT
PMID: 31236756 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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96754

Identifier Type: OTHER

Identifier Source: secondary_id

BONE0001

Identifier Type: OTHER

Identifier Source: secondary_id

IRB-03778

Identifier Type: -

Identifier Source: org_study_id