Cystic FibrosisNCT02606487
Hyperpolarized Xenon MRI in Cystic Fibrosis Pulmonary Exacerbations
An observational study of Cystic Fibrosis, run by The Hospital for Sick Children at 1 site in Canada.
Trial summary
The investigators aim to assess whether pulmonary MRI (hyperpolarised 129Xe ventilation imaging [Xe-MRI]) can detect changes in ventilation defects in patients with CF before and after treatment for a pulmonary exacerbation. Read more about this study
- Who is it for?
- Ages 8 to 18 years
- Conditions the study is for
- Cystic Fibrosis
- How many people
- 21 participants
- Where
- 1 siteCanada
- Study dates
- Nov 2015to Nov 2017
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 8 to 18 years
- All sexes
- No healthy volunteers
- Child, Adult
Study population: Patients aged 8-18 with cystic fibrosis admitted for inpatient treatment with a clinical diagnosis of pulmonary exacerbation
Who may be able to join
- Diagnosis of CF as defined by two or more clinical features of CF and a documented sweat chloride > 60mEq/L by quantitative pilocarpine iontophoresis test or a genotype showing two well characterized disease causing mutations
- Informed consent and verbal assent (as appropriate) provided by the subject's parent or legal guardian and the subject
- Ages 8-18 years and able to perform reproducible spirometry and achieve a breath hold duration sufficient for MRI acquisition
- Admission to the Hospital for Sick Children for a pulmonary exacerbation (based on clinical or pulmonary function assessment). Children who will be admitted and then discharged on home IV antibiotics may also be included in this study.
Who cannot join
- Inability to perform reproducible pulmonary function tests (spirometry, plethysmography or lung clearance index) or perform a breath-hold of sufficient duration for MRI acquisition
- Medical instability that would preclude the ability to undergo the required investigations
- FEV1 % predicted < 40%
- Use of supplementary oxygen
- Severe claustrophobia
- Pregnancy or lactation
- Presence of metal implants or other contraindications to MRI
Trial locations and contacts
1 site in 1 country.
About this study
The investigators aim to assess whether pulmonary MRI (hyperpolarised 129Xe ventilation imaging [Xe-MRI]) can detect changes in ventilation defects in patients with CF before and after treatment for a pulmonary exacerbation. The investigators will determine whether changes seen using pulmonary Xe-MRI are associated with changes in pulmonary function (spirometry, lung volumes, lung clearance index [LCI]) in patients with CF before and after pulmonary exacerbation.
Read the detailed description
Cystic fibrosis (CF) is one of the most common genetic diseases affecting children and young adults [1]. Lung disease is the primary cause of morbidity and mortality in these patients and sensitive markers of lung disease in CF are important for directing therapy in these patients.
LCI, measured by multiple breath washout (MBW), has been shown to be more sensitive than traditional pulmonary function tests (PFTs) for assessing the treatment effect of novel therapies in CF patients [2,3]. However, LCI provides no information regarding the spatial distribution of ventilation inhomogeneity within the lungs and improvements in mucus plugging of poorly ventilated regions can paradoxically worsen the LCI [4,5]. Thus an imaging technique that can capture regional changes in the distribution of ventilation might be better suited than LCI to detect treatment effects and could also help to better define the utility of LCI as a clinical tool.
Xe-MRI is a safe, non-ionizing modality for imaging the lungs, providing an accurate spatial representation of ventilation inhomogeneity [6]. Xe-MRI has been shown to be effective in imaging of adult patients with chronic obstructive pulmonary disease (COPD) and CF [6] however, there are no published studies using Xe-MRI in children.
The hypothesis of this study is that Xe-MRI and LCI will provide complimentary information when quantifying ventilation inhomogeneity in CF lung disease and that Xe-MRI will be able to define patients in whom LCI fails to capture positive effects of treatment. The ultimate goal is to develop more sensitive tools for longitudinal monitoring to direct the clinical care of CF patients in the future.
To accomplish this, the investigators will compare the ability of Xe-MRI and LCI to detect changes in ventilation inhomogeneity in patients with CF before and after treatment for a pulmonary exacerbation, a common pulmonary complication of CF.
- Conditions
- Cystic Fibrosis
- Keywords
- CF, Exacerbation, Hyerpolarized xenon MRI, Pediatrics, Lung Clearance Index
- Medical subject headings
- Cystic Fibrosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| CF pulmonary exacerbation group | Patients with cystic fibrosis admitted for inpatient treatment of a pulmonary exacerbation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Ventilation Defect Percentage (VDP)
VDP within 48h of initiation of inpatient treatment
Measured: Pre-treatment
Ventilation Defect Percentage (VDP)
VDP within 48h of completion of inpatient treatment
Measured: Post-treatment - within 48h of completion of inpatient treatment
Lung Clearance Index (LCI)
LCI within 48h of initiation of inpatient treatment
Measured: Pre-treatment
Lung Clearance Index (LCI)
LCI within 48h of completion of inpatient treatment
Measured: Post-treatment - within 48h of completion of inpatient treatment
Secondary outcomes (2)
Pulmonary function tests (PFTs)
PFTs within 48h of initiation of inpatient treatment
Measured: Pre-treatment
Pulmonary function tests (PFTs)
PFTs within 48h of completion of inpatient treatment
Measured: Post-treatment - within 48h of completion of inpatient treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Nov 2015 (estimated)
- Study startNov 2015
- Primary completionNov 2017
- Study completionNov 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Cystic FibrosisStudies of the same condition, open and under way.
- More trials run by The Hospital for Sick ChildrenThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case only
- Time perspective
- Prospective
- Enrolment
- 21 participants (actual)
Sponsor and investigators
- Lead sponsor
- The Hospital for Sick Children
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Felix Ratjen, The Hospital for Sick Children
- Investigators
- Felix Ratjen, MD PhD, Principal investigator, The Hospital for Sick Children
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02606487
- Sponsor's protocol ID
- 1000049033
- Status last verified
- Oct 2018
- First submitted
- 13 Nov 2015
- Last updated
- 4 Oct 2018
- Results posted
- No
- Data monitoring committee
- No
Publications
O'Sullivan BP, Freedman SD. Cystic fibrosis. Lancet. 2009 May 30;373(9678):1891-904. doi: 10.1016/S0140-6736(09)60327-5. Epub 2009 May 4.
PubMed 19403164Robinson PD, Latzin P, Verbanck S, Hall GL, Horsley A, Gappa M, Thamrin C, Arets HG, Aurora P, Fuchs SI, King GG, Lum S, Macleod K, Paiva M, Pillow JJ, Ranganathan S, Ratjen F, Singer F, Sonnappa S, Stocks J, Subbarao P, Thompson BR, Gustafsson PM. Consensus statement for inert gas washout measurement using multiple- and single- breath tests. Eur Respir J. 2013 Mar;41(3):507-22. doi: 10.1183/09031936.00069712. Epub 2013 Feb 8.
PubMed 23397305Davies J, Sheridan H, Bell N, Cunningham S, Davis SD, Elborn JS, Milla CE, Starner TD, Weiner DJ, Lee PS, Ratjen F. Assessment of clinical response to ivacaftor with lung clearance index in cystic fibrosis patients with a G551D-CFTR mutation and preserved spirometry: a randomised controlled trial. Lancet Respir Med. 2013 Oct;1(8):630-638. doi: 10.1016/S2213-2600(13)70182-6. Epub 2013 Sep 10.
PubMed 24461666Horsley AR, Davies JC, Gray RD, Macleod KA, Donovan J, Aziz ZA, Bell NJ, Rainer M, Mt-Isa S, Voase N, Dewar MH, Saunders C, Gibson JS, Parra-Leiton J, Larsen MD, Jeswiet S, Soussi S, Bakar Y, Meister MG, Tyler P, Doherty A, Hansell DM, Ashby D, Hyde SC, Gill DR, Greening AP, Porteous DJ, Innes JA, Boyd AC, Griesenbach U, Cunningham S, Alton EW. Changes in physiological, functional and structural markers of cystic fibrosis lung disease with treatment of a pulmonary exacerbation. Thorax. 2013 Jun;68(6):532-9. doi: 10.1136/thoraxjnl-2012-202538. Epub 2013 Feb 9.
PubMed 23396354Yammine S, Bigler A, Casaulta C, Singer F, Latzin P. Reasons for heterogeneous change in LCI in children with cystic fibrosis after antibiotic treatment. Thorax. 2014 Feb;69(2):183. doi: 10.1136/thoraxjnl-2013-204283. Epub 2013 Aug 29. No abstract available.
PubMed 23988751Shukla Y, Wheatley A, Kirby M, Svenningsen S, Farag A, Santyr GE, Paterson NA, McCormack DG, Parraga G. Hyperpolarized 129Xe magnetic resonance imaging: tolerability in healthy volunteers and subjects with pulmonary disease. Acad Radiol. 2012 Aug;19(8):941-51. doi: 10.1016/j.acra.2012.03.018. Epub 2012 May 15.
PubMed 22591724Munidasa S, Couch MJ, Rayment JH, Voskrebenzev A, Seethamraju R, Vogel-Claussen J, Ratjen F, Santyr G. Free-breathing MRI for monitoring ventilation changes following antibiotic treatment of pulmonary exacerbations in paediatric cystic fibrosis. Eur Respir J. 2021 Apr 15;57(4):2003104. doi: 10.1183/13993003.03104-2020. Print 2021 Apr. No abstract available.
PubMed 33303537
Study at a glance
From the registry record, last updated by the sponsor on 4 Oct 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Hyperpolarized Xenon MRI in Cystic Fibrosis Pulmonary Exacerbations
- ClinicalTrials.gov ID
- NCT02606487
- Acronym / sponsor ID
- 1000049033
- Conditions
- Cystic Fibrosis
- Keywords
- CF, Exacerbation, Hyerpolarized xenon MRI, Pediatrics, Lung Clearance Index
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 21 participants (actual)
- Lead sponsor
- The Hospital for Sick ChildrenUniversity, hospital or other
- Study start
- Nov 2015
- Primary completion
- Nov 2017 (actual)
- Study completion
- Nov 2017 (actual)
- First posted
- 17 Nov 2015 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The investigators aim to assess whether pulmonary MRI (hyperpolarised 129Xe ventilation imaging [Xe-MRI]) can detect changes in ventilation defects in patients with CF before and after treatment for a pulmonary exacerbation. The investigators will determine whether changes seen using pulmonary Xe-MRI are associated with changes in pulmonary function (spirometry, lung volumes, lung clearance index [LCI]) in patients with CF before and after pulmonary exacerbation.
Detailed description
Cystic fibrosis (CF) is one of the most common genetic diseases affecting children and young adults [1]. Lung disease is the primary cause of morbidity and mortality in these patients and sensitive markers of lung disease in CF are important for directing therapy in these patients.
LCI, measured by multiple breath washout (MBW), has been shown to be more sensitive than traditional pulmonary function tests (PFTs) for assessing the treatment effect of novel therapies in CF patients [2,3]. However, LCI provides no information regarding the spatial distribution of ventilation inhomogeneity within the lungs and improvements in mucus plugging of poorly ventilated regions can paradoxically worsen the LCI [4,5]. Thus an imaging technique that can capture regional changes in the distribution of ventilation might be better suited than LCI to detect treatment effects and could also help to better define the utility of LCI as a clinical tool.
Xe-MRI is a safe, non-ionizing modality for imaging the lungs, providing an accurate spatial representation of ventilation inhomogeneity [6]. Xe-MRI has been shown to be effective in imaging of adult patients with chronic obstructive pulmonary disease (COPD) and CF [6] however, there are no published studies using Xe-MRI in children.
The hypothesis of this study is that Xe-MRI and LCI will provide complimentary information when quantifying ventilation inhomogeneity in CF lung disease and that Xe-MRI will be able to define patients in whom LCI fails to capture positive effects of treatment. The ultimate goal is to develop more sensitive tools for longitudinal monitoring to direct the clinical care of CF patients in the future.
To accomplish this, the investigators will compare the ability of Xe-MRI and LCI to detect changes in ventilation inhomogeneity in patients with CF before and after treatment for a pulmonary exacerbation, a common pulmonary complication of CF.
Study design
- Observational model
- Case only
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| CF pulmonary exacerbation group | – | –Patients with cystic fibrosis admitted for inpatient treatment of a pulmonary exacerbation |
Who may qualify
- Ages
- 8 to 18 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
- Study population
- Patients aged 8-18 with cystic fibrosis admitted for inpatient treatment with a clinical diagnosis of pulmonary exacerbation
Key inclusion criteria (4 listed)
- Diagnosis of CF as defined by two or more clinical features of CF and a documented sweat chloride > 60mEq/L by quantitative pilocarpine iontophoresis test or a genotype showing two well characterized disease causing mutations
- Informed consent and verbal assent (as appropriate) provided by the subject's parent or legal guardian and the subject
- Ages 8-18 years and able to perform reproducible spirometry and achieve a breath hold duration sufficient for MRI acquisition
- Admission to the Hospital for Sick Children for a pulmonary exacerbation (based on clinical or pulmonary function assessment). Children who will be admitted and then discharged on home IV antibiotics may also be included in this study.
Key exclusion criteria (7 listed)
- Inability to perform reproducible pulmonary function tests (spirometry, plethysmography or lung clearance index) or perform a breath-hold of sufficient duration for MRI acquisition
- Medical instability that would preclude the ability to undergo the required investigations
- FEV1 % predicted < 40%
- Use of supplementary oxygen
- Severe claustrophobia
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Ventilation Defect Percentage (VDP)
Time frame: Pre-treatment
VDP within 48h of initiation of inpatient treatment
Ventilation Defect Percentage (VDP)
Time frame: Post-treatment - within 48h of completion of inpatient treatment
VDP within 48h of completion of inpatient treatment
Lung Clearance Index (LCI)
Time frame: Pre-treatment
LCI within 48h of initiation of inpatient treatment
Lung Clearance Index (LCI)
Time frame: Post-treatment - within 48h of completion of inpatient treatment
LCI within 48h of completion of inpatient treatment
2 secondary outcomes
Pulmonary function tests (PFTs)
Time frame: Pre-treatment
Pulmonary function tests (PFTs)
Time frame: Post-treatment - within 48h of completion of inpatient treatment
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Oct 2018.
- Background: PubMed 19403164O'Sullivan BP, Freedman SD. Cystic fibrosis. Lancet. 2009 May 30;373(9678):1891-904. doi: 10.1016/S0140-6736(09)60327-5. Epub 2009 May 4.
- Background: PubMed 23397305Robinson PD, Latzin P, Verbanck S, Hall GL, Horsley A, Gappa M, Thamrin C, Arets HG, Aurora P, Fuchs SI, King GG, Lum S, Macleod K, Paiva M, Pillow JJ, Ranganathan S, Ratjen F, Singer F, Sonnappa S, Stocks J, Subbarao P, Thompson BR, Gustafsson PM. Consensus statement for inert gas washout measurement using multiple- and single- breath tests. Eur Respir J. 2013 Mar;41(3):507-22. doi: 10.1183/09031936.00069712. Epub 2013 Feb 8.
- Background: PubMed 24461666Davies J, Sheridan H, Bell N, Cunningham S, Davis SD, Elborn JS, Milla CE, Starner TD, Weiner DJ, Lee PS, Ratjen F. Assessment of clinical response to ivacaftor with lung clearance index in cystic fibrosis patients with a G551D-CFTR mutation and preserved spirometry: a randomised controlled trial. Lancet Respir Med. 2013 Oct;1(8):630-638. doi: 10.1016/S2213-2600(13)70182-6. Epub 2013 Sep 10.
- Background: PubMed 23396354Horsley AR, Davies JC, Gray RD, Macleod KA, Donovan J, Aziz ZA, Bell NJ, Rainer M, Mt-Isa S, Voase N, Dewar MH, Saunders C, Gibson JS, Parra-Leiton J, Larsen MD, Jeswiet S, Soussi S, Bakar Y, Meister MG, Tyler P, Doherty A, Hansell DM, Ashby D, Hyde SC, Gill DR, Greening AP, Porteous DJ, Innes JA, Boyd AC, Griesenbach U, Cunningham S, Alton EW. Changes in physiological, functional and structural markers of cystic fibrosis lung disease with treatment of a pulmonary exacerbation. Thorax. 2013 Jun;68(6):532-9. doi: 10.1136/thoraxjnl-2012-202538. Epub 2013 Feb 9.
- Background: PubMed 23988751Yammine S, Bigler A, Casaulta C, Singer F, Latzin P. Reasons for heterogeneous change in LCI in children with cystic fibrosis after antibiotic treatment. Thorax. 2014 Feb;69(2):183. doi: 10.1136/thoraxjnl-2013-204283. Epub 2013 Aug 29. No abstract available.
- Background: PubMed 22591724Shukla Y, Wheatley A, Kirby M, Svenningsen S, Farag A, Santyr GE, Paterson NA, McCormack DG, Parraga G. Hyperpolarized 129Xe magnetic resonance imaging: tolerability in healthy volunteers and subjects with pulmonary disease. Acad Radiol. 2012 Aug;19(8):941-51. doi: 10.1016/j.acra.2012.03.018. Epub 2012 May 15.
- Derived from this study: PubMed 33303537Munidasa S, Couch MJ, Rayment JH, Voskrebenzev A, Seethamraju R, Vogel-Claussen J, Ratjen F, Santyr G. Free-breathing MRI for monitoring ventilation changes following antibiotic treatment of pulmonary exacerbations in paediatric cystic fibrosis. Eur Respir J. 2021 Apr 15;57(4):2003104. doi: 10.1183/13993003.03104-2020. Print 2021 Apr. No abstract available.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Felix Ratjen, MD PhD principal investigator
The Hospital for Sick Children
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Cystic Fibrosis, run by The Hospital for Sick Children at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Oct 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Ventilation Defect Percentage (VDP) (time frame: Pre-treatment). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02606487, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Oct 2018.