Measuring Fatty Acid Oxidation in Cerebral Metastases Using [18F]FPIA

24 evaluable patients with radiological evidence of cerebral metastases on MRI will be enrolled into the study (12 who are treatment naïve + 12 who have completed Stereotactic Radiosurgery (SRS)+/- combination therapy). The patients invited to participate in the study will provide written informed consent. [18F]FPIA PET/MRI imaging will only be performed once patients have satisfied the inclusion and exclusion criteria. Once these have been satisfied, eligible patients will proceed to [18F]FPIA PET/MRI.

On the day of imaging the patients will undergo a blood test to measure plasma concentrations of carnitine (approximately 6mls). During the scan, a single dose of [18F]FPIA (maximum, 370 MBq) IV will be administered to the participant followed by a whole brain dynamic PET/MRI scan over 66 minutes. During the MRI sequences, the patient will receive a 2 stage IV bolus of Gadolinium contrast medium administered through a peripheral venous cannula.

Inclusion criteria

A) Treatment naïve

or

B) SRS+/- combination treated - Patients that have completed the SRS part of a combination regime enabling a 4-8 week post-SRS treatment PET/MRI scan.

and

C) That fulfil the following criteria:

• Age ≥18.
• Target metastases size ≥ 1cm.
• WHO performance status 0 - 2.
• If female, the subject is either post-menopausal (at least 1 year), or surgically sterilized (has had a documented bilateral oophorectomy and/or documented hysterectomy for at least 2 years), or if of childbearing potential, must have a negative urine beta human chorionic gonadotropin (beta-hCG) pregnancy test done prior to tracer administration.
• The subject is able and willing to comply with study procedures, and signed and dated informed consent is obtained.
• The subject has a satisfactory medical history as judged by the investigator with no significant co-morbidities.
• The subject's clinical and laboratory tests are within normal limits and/or considered clinically insignificant.

Exclusion criteria

• The subject is pregnant or lactating.
• Any other chronic illness that will or musculoskeletal condition that would not allow comfortable performance of a PET study.
• Prior use within 14 days of enrolment or concurrent therapy with any other investigational agent.
• Unsatisfactory renal function (eGFR<30).
• The subject has non-MRI compatible devices (e.g.a pacemaker, an implantable cardioverter-defibrillator (ICD), a nerve stimulator, a cochlear implant or a drug pump) or implanted material (e.g. non-MRI compatible sternal wires, biostimulators, metals or alloys).