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Dynamic Whole Body Positron Emission Tomography/Computed Tomography Imaging

2019-07-17 10:04:59 | BioPortfolio

Summary

Quantitative parameters obtained with dynamic whole body imaging using positron emission tomography (PET) can provide additional and complementary information to standard PET. Dynamic imaging allows for better understanding of the behavior of the radio-pharmaceutical because it can be followed over time. Thought to be difficult to perform with currently available clinical equipment that can affect the clinical workflow, it has recently shown to be feasible. We want to test the feasibility of this imaging technique and evaluate its utility in identifying lesions with three different radio-pharmaceuticals as compared to standard static PET.

This study will also determine the clinical impact of DWB PET on participant management by comparing the overall qualitative assessment performed by nuclear medicine physicians between the standard PET images and the DWB ones.

Description

This is a prospective single cohort study to evaluate the feasibility of dynamic whole body PET/CT in identifying and quantifying lesions where standard static PET has been negative or equivocal.

18F-FDG PET/CT - Participants that have been chosen and consented to participate in the optional DWB PET/CT scan sub-study will undergo an extra 18F-FDG PET/CT procedure. 18F-FDG is considered standard care and has been approved by Health Canada. A fasting period of 6 hours is required before the scan. Diabetic participants should withhold short acting insulin during the fasting interval, and discuss with their physician whether to reduce long acting insulin the morning of the examination. Participants will also be instructed to drink 3 to 4 glasses of water within two hours prior to their scan appointment in order to promote hydration and facilitate urinary clearance of background radiopharmaceutical.

Prior to the 18F-FDG PET/CT procedure, participants will be instructed to take their usual medications as prescribed by their physician.

After providing informed written consent subjects will complete a medical history questionnaire.

The PET dynamic scan will start 30 minutes after the 18F-FDG injection. This will be followed by several whole body static acquisitions for a total scan time that will not be longer than 32 minutes.

After the DWB scan is finished, participants will be given the option to go to the washroom again. After this, a new PET/CT acquisition, as specified in the 18F-FDG PET/CT scan protocol, will immediately follow. Upon completion of the second PET scan, participants will be free to leave the department and will be encouraged to drink 3 - 4 extra glasses of water by the end of the day to promote further clearance of the remaining tracer in the urinary tract.

68Ga-DOTATOC PET/CT - Participants that have been chosen and consented to participate in the optional DWB PET/CT scan sub-study will undergo an extra 68Ga-DOTATOC PET/CT procedure. The 68Ga-DOTATOC radioactive tracer is manufactured for this study under a Clinical Trial Application filed with Health Canada. Prior to the 68Ga-DOTATOC PET/CT procedure, participants will be instructed to take their usual medications as prescribed by their physician. After providing informed written consent subjects will complete a medical history questionnaire. Participants will not be encouraged to drink additional water due to the requirement to stay on the scanner for up to 90 minutes (60 min DWB followed by standard PET acquisitions). There are no dietary restrictions.

After the DWB scan is finished, participants will be given the option to go to the washroom again and their vital signs will be recorded one more time. For this sub-study the vital signs will not be collected after the radiotracer injection to accommodate for the DWB protocol. After this, a new PET/CT acquisition, as specified in the 68Ga-DOTATOC PET/CT protocol, will immediately follow. Upon completion of the second PET scan, participants will be free to leave the department and will be encouraged to drink 3 - 4 extra glasses of water by the end of the day to promote further clearance of the remaining tracer in the urinary tract.

18F-DCFPyL PET/CT - Participants that have been chosen and consented to participate in the optional DWB PET/CT scan sub-study will undergo an extra 18F-DCFPyL PET/CT procedure. The 18F-DCFPyL radioactive tracer is manufactured for this study under a Clinical Trial Application filed with Health Canada.After providing informed written consent subjects will complete a medical history questionnaire. Prior to the 18F-DCFPyL PET/CT procedure, participants will be instructed to take their usual medications as prescribed by their physician. Participants will not be encouraged to drink additional water due to the requirement to stay on the scanner for 90 minutes of the DWB acquisition. They will be unable to use the washroom during this time. As with the main study, participants will be instructed to fast for 4 hours prior to their appointment. The participant will receive a bolus intravenous dose of 18F-DCFPyL from an approved supplier, at a dose of approximately 296 MBq followed by a 5 to 20 mL normal saline flush and simultaneously a 6 minute dynamic acquisition of the heart will be started. This will then be followed by several whole body static acquisitions for a total scan time that will not be longer than 90 minutes.After the DWB scan is finished, the participant will be allowed to rest in a comfortable chair or bed for 30 minutes. During this time the vital signs will be recorded again. For this sub-study the vital signs will be measured before the radiotracer injection and again after the DWB PET scan to accommodate the DWB protocol. The participants will then be taken to a designated washroom and asked to void prior to the standard PET scan to clear excreted 18F-DCFPyL activity from the urinary tract.The participants will return to the scanner room and undergo the planned PET/CT imaging described in the main study.

Participant adverse event monitoring will be completed as part of regular standard of care (18F-FDG) or according to the main study protocols.

Follow-up Assessments - Follow-up information will be collected from the patient's medical records for up to 5 years following the PET/CT scan to obtain confirmatory information (from pathology and additional imaging showing progression or regression under treatment) about the status of known lesions.

The study is expected to take approximately 4 years for accrual.

Study Design

Conditions

Neuroendocrine Tumors

Intervention

18F-FDG PET/CT, 68Ga-DOTATOC PET/CT, 18F-DCFPyL PET/CT

Location

BC Cancer
Vancouver
British Columbia
Canada
V5Z 4E6

Status

Not yet recruiting

Source

British Columbia Cancer Agency

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-07-17T10:04:59-0400

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Medical and Biotech [MESH] Definitions

Tumors whose cells possess secretory granules and originate from the neuroectoderm, i.e., the cells of the ectoblast or epiblast that program the neuroendocrine system. Common properties across most neuroendocrine tumors include ectopic hormone production (often via APUD CELLS), the presence of tumor-associated antigens, and isozyme composition.

A group of carcinomas which share a characteristic morphology, often being composed of clusters and trabecular sheets of round "blue cells", granular chromatin, and an attenuated rim of poorly demarcated cytoplasm. Neuroendocrine tumors include carcinoids, small ("oat") cell carcinomas, medullary carcinoma of the thyroid, Merkel cell tumor, cutaneous neuroendocrine carcinoma, pancreatic islet cell tumors, and pheochromocytoma. Neurosecretory granules are found within the tumor cells. (Segen, Dictionary of Modern Medicine, 1992)

A 38-kDa integral membrane glycoprotein of the presynaptic vesicles in neuron and neuroendocrine cells. It is expressed by a variety of normal and neoplastic neuroendocrine cells and is therefore used as an immunocytochemical marker for neuroendocrine differentiation in various tumors. In ALZHEIMER DISEASE and other dementing disorders, there is an important synapse loss due in part to a decrease of synaptophysin in the presynaptic vesicles.

An acidic protein found in the NEUROENDOCRINE SYSTEM that functions as a molecular chaperone for PROPROTEIN CONVERTASE 2.

A usually small, slow-growing neoplasm composed of islands of rounded, oxyphilic, or spindle-shaped cells of medium size, with moderately small vesicular nuclei, and covered by intact mucosa with a yellow cut surface. The tumor can occur anywhere in the gastrointestinal tract (and in the lungs and other sites); approximately 90% arise in the appendix. It is now established that these tumors are of neuroendocrine origin and derive from a primitive stem cell. (From Stedman, 25th ed & Holland et al., Cancer Medicine, 3d ed, p1182)

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