Virtual Histology of the Bladder Wall for Bladder Cancer Staging

  • STATUS
    Recruiting
  • days left to enroll
    79
  • participants needed
    42
  • sponsor
    Jodi Maranchie
Updated on 21 March 2022
radical cystectomy
cancer
bladder cancer
transurethral resection
cystoscopy
bladder tumor
transurethral bladder excision
intravesical administration
bladder cancer stage

Summary

This is a phase Ib study of the safety and performance of a novel intravesical contrast-enhanced Magnetic Resonance Imaging protocol for determination of bladder cancer stage prior to transurethral resection of bladder tumor (21 subjects) or prior to radical cystectomy for muscle invasive disease (21 subjects). Subjects will undergo a single MRI study: a pre-contrast, single breath hold image followed by sterile placement of a temporary urethral catheter for instillation of a 50mL solution containing Gadobutrol (4 mM) plus ferumoxytol (5 mM) and then a second, post-contrast image. Images will be reviewed by two dedicated abdominal radiologists, who are blinded to the pathologic staging, for determination of tumor presence and depth of bladder wall penetration.

Description

Twenty one patients with at least one cystoscopically confirmed papillary bladder tumor, who have been scheduled for Transurethral Resection of Bladder Tumor (TURBT) for surgical extirpation and staging, and twenty-one patients with histologically confirmed, muscle invasive transitional cell carcinoma of the bladder who have been scheduled for definitive radical cystectomy with curative intent will be recruited for a single study Magnetic Resonance Imaging to be performed between 1 and 6 days prior to their scheduled procedure.

Magnetic Resonance Imaging of all the enrolled patients will be performed on a 60-cm, wide-bore, 3T scanner (Siemens AG, Erlangen, Germany) with a 32-channel pelvic phased-array coil placed over the bladder using radial k-space sampling technique for volumetric free breathing acquisition with NCM enhanced StarVIBE57. Un-enhanced fast spoiled gradient-echo images with fat suppression will be obtained prior aseptic instillation of 50cc of a novel contrast mixture (NCM) of Gadobutrol (4 mM) plus Ferumoxytol (5 mM) in sterile water through a temporary urethral catheter. The catheter will then be removed and the patient repositioned in the scanner to obtain post-contrast images. All the image datasets will be linearly registered to the subject to ensure that regions of interest represent the same anatomical location at all time points. Post-contrast T1, pre-contrast T1 and deltaT1 will be measured from the acquired images. Two radiologists blinded to the pathologic findings will evaluate the Magnetic Resonance images to assign a radiologic tumor stage that will be compared with the subsequent pathologic stage determined at time of surgery. Following the MRI study, subjects will proceed with their surgical procedure as scheduled per standard of care.

Details
Condition Urinary Bladder Neoplasms
Treatment magnetic resonance imaging, Gadobutrol intravesical administration (4mM), Ferumoxytol intravesical administration (5 mM)
Clinical Study IdentifierNCT04369560
SponsorJodi Maranchie
Last Modified on21 March 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

18 to 90 years of age
Able to understand and willing to sign a written informed consent document
A papillary tumor identified by cystoscopy that has been scheduled for TURBT OR histologically proven MIBC that is clinically localized and amenable to surgical resection with curative intent
Performance status of ECOG 0 or 1
Normal renal function as defined as creatinine less than 1.5 x institutional upper limit of normal (ULN) OR creatinine clearance greater than or equal to 50 mL/min/1.73 m2 by Cockcroft-Gault formula for subjects with creatinine levels greater than or equal to 1.5 x ULN

Exclusion Criteria

Severe hypersensitivity reaction to gadobutrol or ferumoxytol
Severe claustrophobia that will prevent completion of the MRI study
Any MRI-non-compatible implanted device, prosthetic or pacemaker
Known or suspected metastatic disease
Women with active pregnancy, lactation or plans to conceive
Untreated urinary tract infection
Known urethral stricture disease that would prohibit placement of foley catheter
Any other conditions considered as unacceptable risk by the treating physician
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