Feasibility of FMISO in Brain Tumors

PRIMARY OBJECTIVES: I. Determine the feasibility of obtaining 18F-fluoromisonidazole (FMISO) PET (hypoxic volume and tumor to blood background values \[T/B\]) and dynamic susceptibility contrast enhanced (DSC), diffusion-weighted imaging (DWI), \& segregation \& extravascular localization of ferumoxytol imaging (SELFI) MRI measures in patients with intracranial brain tumors. II. Determine if MRI contrast-enhancement and hypoxic volume are imaging profiles of glioblastoma immunotherapy-mediated pseudoprogression or true progression in a clinical trial. III. Determine if SELFI hypoxic fraction are imaging biomarkers of glioblastoma neuroinflammation. SECONDARY OBJECTIVES: I. Determine the feasibility of baseline and follow-up ferumoxytol (Fe)-enhanced FMISO PET and MR imaging co-registration. II. Assess diagnostic performance of imaging metrics to identify failed therapy at earlier imaging timepoints before presumed progression. III. Determine the reliability of the pre-therapy FMISO PET imaging metrics as assessed by baseline "test" and "retest experiments. IV. Compare the diagnostic performance of SELFI hypoxic fraction to Modified Response Assessment in Neuro-Oncology (mRANO) criteria. V. Determine the sensitivity and specificity of SELFI hypoxic fraction for the diagnosis of neuroinflammation and recurrent disease. VI. Assess progression free survival. VII. Assess overall survival. VIII. Determine change in imaging metrics from post-therapy and disease progression in differentiating neuroinflammation from recurrent disease. IX. Determine optimal SELFI hypoxic fraction imaging parameters. X. Correlate SELFI hypoxic fraction with innate immune phenotype and hypoxia expression. TERTIARY OBJECTIVE: I. Determine the reproducibility of the baseline FMISO PET imaging metrics as assessed by baseline "test" and "retest" experiments. OUTLINE: Participants receive FMISO and/or FE IV. Patients also undergo dynamic PET/computed tomography (CT) or PET/MRI over 120 minutes beginning 1 minute prior to FMISO injection, and static PET/CT or PET/MRI over 20-40 minutes approximately 90 minutes after FMISO injection. Participants may then receive FMISO and/or Fe IV and gadolinium IV and undergo PET/MRI scan, followed by an additional PET/MRI scan without FMISO and/or Fe and gadolinium the following day. These scans may repeat every 4 weeks up to 4 times. Supplemental oxygen may be administered to affect MRI signal change. After conclusion of the diagnostic tests, participants are followed for up to 5 years.