3T MRI Biomarkers of Glioma Treatment Response
3T MRI Biomarkers of Glioma Treatment Response
This pilot clinical trial studies advanced magnetic resonance imaging (MRI) techniques in
 measuring treatment response in patients with high-grade glioma. New diagnostic procedures,
 such as advanced MRI techniques at 3 Tesla, may be more effective than standard MRI in
 measuring treatment response in patients receiving treatment for high-grade gliomas.
PRIMARY OBJECTIVES:

 I. To correlate treatment-induced changes in quantitative MRI-based biomarkers-specifically,
 those sensitive to tumor protein content (amide proton transfer asymmetry [APTasym] from
 chemical exchange saturation transfer [CEST]), cellularity (apparent diffusion coefficient
 [ADC] from diffusion-weighted imaging [DWI]), and blood flow (volume transfer constant
 [K^trans] from dynamic contrast-enhanced [DCE]; cerebral blood flow [CBF] from dynamic
 susceptibility contrast [DSC])-with treatment-induced changes in tumor size, measured via
 standard anatomic MRI.

 II. To correlate treatment-induced changes in the above quantitative MRI endpoints with
 patient progression-free survival (PFS).

 OUTLINE:

 Patients undergo measurement of tumor protein content using CEST-MRI, cellularity using
 DWI-MRI, and blood flow using DCE-MRI and DSC-MRI within 2 weeks of treatment and at 2 and 4
 weeks after initiation of treatment.
Inclusion Criteria:

 -  Patients must sign an institutional review board (IRB)-approved informed consent
 document

 -  Patients must have been diagnosed with high-grade glioma:

 -  World Health Organization (WHO) grade III: anaplastic astrocytoma,
 oligodendroglioma, ependymoma, or oligoastrocytoma; OR

 -  WHO grade IV: glioblastoma multiforme; or neuroepithelial tumors of uncertain
 origin (polar spongioblastoma, astroblastoma, or gliomatosis cerebri)

 -  As measured by conventional high spatial resolution MRI, the minimum diameter of the
 primary lesion (short axis) should be at least 5 mm

 -  Patients must be scheduled to receive: 1) standard chemotherapy with/without radiation
 therapy; OR 2) single-agent bevacizumab (Avastin)

 Exclusion Criteria:

 -  Patients with low-grade (WHO grade I or II) glioma

 -  Patients with metastatic disease

 -  Patients who have any type of bioimplant activated by mechanical, electronic, or
 magnetic means (e.g., cochlear implants, pacemakers, neurostimulators, biostimulators,
 electronic infusion pumps, etc), because such devices may be displaced or malfunction

 -  Patients who have any type of ferromagnetic bioimplant that could potentially be
 displaced

 -  Patients who have cerebral aneurysm clips

 -  Patients who may have shrapnel imbedded in their bodies (such as from war wounds),
 metal workers and machinists (potential for metallic fragments in or near the eyes)

 -  Patients with inadequate renal function (creatinine >= 1.5 times upper limit of
 normal) or acute or chronic renal insufficiency (glomerular filtration rate < 20
 ml/min)

 -  Patients who are pregnant or breast feeding; urine pregnancy test will be performed on
 women of child bearing potential

 -  Patients who exhibit noticeable anxiety and/or claustrophobia or who exhibit severe
 vertigo when they are moved into the magnet bore

 -  Patients incapable of giving informed written consent, for the following reasons:

 -  Inability to adhere to the experimental protocols for any reason

 -  Inability to communicate with the research team

 -  Limited ability to give informed consent due to mental disability, altered mental
 status, confusion, cognitive impairment, or psychiatric disorders

 -  Patients scoring 14.5 or lower on the University of California at San Diego
 (UCSD) Brief Assessment of Consent Capacity (UBACC) Capacity to Consent
 Questionnaire will be excluded

 -  Prisoners or other individuals deemed to be susceptible to coercion

 -  For patients who have undergone surgical resection prior to joining the study, in whom
 baseline magnetic resonance (MR) images exhibit enough signal degradation (due to
 susceptibility artifact in the region of the surgical bed) such that the data are
 uninterpretable will be excluded