Simultaneous Multinuclear Metabolic MRI in Newly Diagnosed or Recurrent Glioma

PRIMARY OBJECTIVES:

I. Construct and test a novel multinuclear Na+-H+ metabolic MRI sequence with sensitivity to Sodium (Na+) concentration, Potential of Hydrogen (pH), and oxygen (O2).

II. Correlate Na+-, pH-, and O2-weighted MR image measurements with sodium-proton exchanger isoform-1 (NHE1) immunohistochemistry (IHC), bioenergetics, and gene expression using stereotactic image-guided biopsies from human brain tumors.

III. Quantify changes in Na+-, pH-, and O2-weighted MR images after neoadjuvant anti-PD-1 immunotherapy in recurrent glioblastoma (GBM) and explore associated changes in tumor biology.

OUTLINE:

AIM 1: Previous scan data from healthy subjects is collected and analyzed.

AIM 2: Patients undergo MRI. Patients also undergo collection of tissue samples for IHC analysis.

AIM 3: Patients undergo multinuclear metabolic imaging before and after immunotherapy and prior to surgical resection.

Inclusion criteria

• AIM 1: Healthy volunteers with no evidence of brain tumors or neurologic disease
• AIM 1: Age 18+
• AIM 2: Newly diagnosed or recurrent suspected or confirmed glioma (low or high grade)
• AIM 2: 10 IDH mutant and 10 IDH wild type gliomas
• AIM 2: Clinically indicated for resective surgery or biopsy
• AIM 2: Age 18+
• AIM 2: Tumor size > 1x1x1 cm (measurable)
• AIM 3: Recurrent glioma enrolled in an immunotherapy trial or clinically indicated to receive immunotherapy including anti-PD1
• AIM 3: Age 18+

Exclusion criteria

• AIM 1: Cannot safely perform an MRI
• AIM 1: Age < 18
• AIM 2: Cannot safely perform an MRI or use of MRI contrast agents
• AIM 2: Age < 18
• AIM 3: Cannot safely perform an MRI or use of MRI contrast agents
• AIM 3: Age < 18