Multiparametric imaging of tumor hypoxia and perfusion with (18)F-fluoromisonidazole dynamic PET in head and neck cancer Journal Article


Authors: Grkovski, M.; Schöder, H.; Lee, N. Y.; Carlin, S. D.; Beattie, B. J.; Riaz, N.; Leeman, J. E.; O'Donoghue, J. A.; Humm, J. L.
Article Title: Multiparametric imaging of tumor hypoxia and perfusion with (18)F-fluoromisonidazole dynamic PET in head and neck cancer
Abstract: Tumor hypoxia and perfusion are independent prognostic indicators of patient outcome. We developed the methodology for and investigated the utility of multiparametric imaging of tumor hypoxia and perfusion with 18F-fluoromisonidazole (18F-FMISO) dynamic PET (dPET) in head and neck cancer. Methods: One hundred twenty head and neck cancer patients underwent 0-to 30-min 18F-FMISO dPET in a customized immobilization mask, followed by 10-min static acquisitions starting at 93 6 6 and 160 6 13 min after injection. A total of 248 lesions ($2 cm3) were analyzed. Voxelwise pharmacokinetic modeling was conducted using an irreversible 1-plasma 2-tissuecompartment model to calculate surrogate biomarkers of tumor hypoxia (k3), perfusion (K1), and 18F-FMISO distribution volume. The analysis was repeated with truncated dPET datasets. Results: Substantial inter-and intratumor heterogeneity was observed for all investigated metrics. Equilibration between the blood and unbound 18F-FMISO was rapid in all tumors. 18F-FMISO distribution volume deviated from the expected value of unity, causing discrepancy between k3 maps and total 18F-FMISO uptake and reducing the dynamic range of total 18F-FMISO uptake for quantifying the degree of hypoxia. Both positive and negative trends between hypoxia and perfusion were observed in individual lesions. All investigated metrics were reproducible when calculated from a truncated 20-min dataset. Conclusion: 18F-FMISO dPET provides the data necessary to generate parametric maps of tumor hypoxia, perfusion, and radiotracer distribution volume. These data clarify the ambiguity in interpreting 18F-FMISO uptake and improve the characterization of lesions. We show total acquisition times can be reduced to 20 min, facilitating the translation of 18F-FMISO dPET into the clinic.
Keywords: hypoxia; head and neck cancer; dynamic pet; perfusion; 18f-fluoromisonidazole; fmiso
Journal Title: Journal of Nuclear Medicine
Volume: 58
Issue: 7
ISSN: 0161-5505
Publisher: Society of Nuclear Medicine  
Date Published: 2017-07-01
Start Page: 1072
End Page: 1080
Language: English
DOI: 10.2967/jnumed.116.188649
PROVIDER: scopus
PMCID: PMC5493008
PUBMED: 28183993
DOI/URL:
Notes: Article -- Export Date: 2 August 2017 -- Source: Scopus
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MSK Authors
  1. Nadeem Riaz
    271 Riaz
  2. Nancy Y. Lee
    634 Lee
  3. Heiko Schoder
    336 Schoder
  4. John Laurence Humm
    366 Humm
  5. Sean Denis Carlin
    83 Carlin
  6. Bradley Beattie
    117 Beattie
  7. Jonathan Eric Leeman
    76 Leeman