Multiparametric [18F]Fluorodeoxyglucose/ [18F]Fluoromisonidazole Positron Emission Tomography/ Magnetic Resonance Imaging of Locally Advanced Cervical Cancer for the Non-Invasive Detection of Tumor Heterogeneity: A Pilot Study

• Published in: PloS one Vol. 11; no. 5; p. e0155333
• Main Authors: Pinker, Katja, Andrzejewski, Piotr, Baltzer, Pascal, Polanec, Stephan H., Sturdza, Alina, Georg, Dietmar, Helbich, Thomas H., Karanikas, Georgios, Grimm, Christoph, Polterauer, Stephan, Poetter, Richard, Wadsak, Wolfgang, Mitterhauser, Markus, Georg, Petra
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.05.2016; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Angiogenesis; Avidity; Biology and Life Sciences; Cancer; Cancer therapies; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Care and treatment; Cervical cancer; Correlation; Correlation analysis; Data acquisition; Diagnosis; Diffusivity; Disease Progression; Emission analysis; Emissions; Feasibility studies; Female; Fluorodeoxyglucose F18 - pharmacokinetics; Gender; Gynecology; Heterogeneity; Humans; Hypoxia; Image Interpretation, Computer-Assisted; Kinetics; Laboratories; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Median (statistics); Medical imaging; Medicine and Health Sciences; Metabolism; Middle Aged; Misonidazole - analogs & derivatives; Misonidazole - pharmacokinetics; Multimodal Imaging - methods; Neoplasm Staging; NMR; Nuclear magnetic resonance; Nuclear medicine; Obstetrics; Oncology; Patients; Political aspects; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Radiation; Radiation therapy; Radioactive tracers; Research and Analysis Methods; Resonance; Retrospective Studies; Squamous cell carcinoma; Statistical analysis; Tomography; Tumor Burden; Tumors; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0155333

To investigate fused multiparametric positron emission tomography/magnetic resonance imaging (MP PET/MRI) at 3T in patients with locally advanced cervical cancer, using high-resolution T2-weighted, contrast-enhanced MRI (CE-MRI), diffusion-weighted imaging (DWI), and the radiotracers [18F]fluorodeoxyglucose ([18F]FDG) and [18F]fluoromisonidazol ([18F]FMISO) for the non-invasive detection of tumor heterogeneity for an improved planning of chemo-radiation therapy (CRT). Sixteen patients with locally advanced cervix were enrolled in this IRB approved and were examined with fused MP [18F]FDG/ [18F]FMISO PET/MRI and in eleven patients complete data sets were acquired. MP PET/MRI was assessed for tumor volume, enhancement (EH)-kinetics, diffusivity, and [18F]FDG/ [18F]FMISO-avidity. Descriptive statistics and voxel-by-voxel analysis of MRI and PET parameters were performed. Correlations were assessed using multiple correlation analysis. All tumors displayed imaging parameters concordant with cervix cancer, i.e. type II/III EH-kinetics, restricted diffusivity (median ADC 0.80x10-3mm2/sec), [18F]FDG- (median SUVmax16.2) and [18F]FMISO-avidity (median SUVmax3.1). In all patients, [18F]FMISO PET identified the hypoxic tumor subvolume, which was independent of tumor volume. A voxel-by-voxel analysis revealed only weak correlations between the MRI and PET parameters (0.05-0.22), indicating that each individual parameter yields independent information and the presence of tumor heterogeneity. MP [18F]FDG/ [18F]FMISO PET/MRI in patients with cervical cancer facilitates the acquisition of independent predictive and prognostic imaging parameters. MP [18F]FDG/ [18F]FMISO PET/MRI enables insights into tumor biology on multiple levels and provides information on tumor heterogeneity, which has the potential to improve the planning of CRT.