Michaela Daniel1, Piotr Andrzejewski1, Alina Sturdza2, Katarina Majercakova1, Pascal Baltzer3, Katja Pinker4, Wolfgang Wadsak5, Markus Mitterhauser6, Richard Pötter1, Petra Georg7, Thomas Helbich3, Dietmar Georg8. 1. Department of Radiotherapy, Medical University of Vienna/AKH Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria. 2. Department of Radiotherapy, Medical University of Vienna/AKH Vienna, Austria. 3. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria; Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria. 4. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria; Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria; Department of Radiology, Memorial Sloan Kettering Cancer Center, USA. 5. Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria; Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria. 6. Department of Biomedical Imaging and Image-Guided Therapy, Medical University and General Hospital of Vienna, Austria; Ludwig-Boltzmann Institute Applied Diagnostics, Vienna, Austria. 7. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria; EBG MedAustron GmbH, Wiener Neustadt, Austria. 8. Department of Radiotherapy, Medical University of Vienna/AKH Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria. Electronic address: dietmar.georg@akhwien.at.
Abstract
BACKGROUND AND PURPOSE: Multimodal tissue characterization by combined MRI and PET has high clinical potential in the context of sub-target definition for dose painting and response assessment but its clinical exploration is yet limited. The aim of this study was to prove the potential and feasibility of hybrid PET/MRI to non-invasively measure tumor hypoxia, perfusion and microstructure at one stop in tumors of the uterine cervix during chemoradiotherapy. MATERIAL AND METHODS: Ten cervix cancer patients were subjected to simultaneous multiparametric PET/MRI with [18F]fluoromisonidazole ([18F]FMISO). Imaging was scheduled before, twice during and after chemoradiotherapy. Intra- and inter-time point analyses of the extracted parameters (i.e. ADC, Ktrans, ABrix, [18F]FMISO-tumor to background ratio (TBR)) were performed. The [18F]FMISO uptake- and ADC-spatio-temporal changes were assessed. RESULTS: Patient averaged ADC values increased from baseline to follow up (1.03 ± 0.11/1.30 ± 0.13 × 10-3 mm2/s), while the TBR decreased (1.73 ± 0.24/1.36 ± 0.19), Ktrans dropped over time (0.17 ± 0.05/0.05 ± 0.05 min-1); for all above p < 0.05. None of these parameters correlated significantly on a voxel-by-voxel basis. Low-ADC regions spatially varied over time. There was pronounced reduction of the [18F]FMISO-avid volumes during treatment. CONCLUSIONS: The suggested hybrid PET/MRI protocol to non-invasively investigate tumor hypoxia, perfusion and microstructure at one stop was feasible, revealing spatio-temporal response patterns that could be utilized for comprehensive sub-target definition for dose painting and response assessment.
BACKGROUND AND PURPOSE: Multimodal tissue characterization by combined MRI and PET has high clinical potential in the context of sub-target definition for dose painting and response assessment but its clinical exploration is yet limited. The aim of this study was to prove the potential and feasibility of hybrid PET/MRI to non-invasively measure tumor hypoxia, perfusion and microstructure at one stop in tumors of the uterine cervix during chemoradiotherapy. MATERIAL AND METHODS: Ten cervix cancerpatients were subjected to simultaneous multiparametric PET/MRI with [18F]fluoromisonidazole ([18F]FMISO). Imaging was scheduled before, twice during and after chemoradiotherapy. Intra- and inter-time point analyses of the extracted parameters (i.e. ADC, Ktrans, ABrix, [18F]FMISO-tumor to background ratio (TBR)) were performed. The [18F]FMISO uptake- and ADC-spatio-temporal changes were assessed. RESULTS:Patient averaged ADC values increased from baseline to follow up (1.03 ± 0.11/1.30 ± 0.13 × 10-3 mm2/s), while the TBR decreased (1.73 ± 0.24/1.36 ± 0.19), Ktrans dropped over time (0.17 ± 0.05/0.05 ± 0.05 min-1); for all above p < 0.05. None of these parameters correlated significantly on a voxel-by-voxel basis. Low-ADC regions spatially varied over time. There was pronounced reduction of the [18F]FMISO-avid volumes during treatment. CONCLUSIONS: The suggested hybrid PET/MRI protocol to non-invasively investigate tumor hypoxia, perfusion and microstructure at one stop was feasible, revealing spatio-temporal response patterns that could be utilized for comprehensive sub-target definition for dose painting and response assessment.
Authors: Joseph Waller; Benjamin Onderdonk; Ann Flood; Harold Swartz; Jaffer Shah; Asghar Shah; Bulent Aydogan; Howard Halpern; Yasmin Hasan Journal: Br J Radiol Date: 2020-04-22 Impact factor: 3.039
Authors: Inna Gertsenshteyn; Boris Epel; Eugene Barth; Lara Leoni; Erica Markiewicz; Hsiu-Ming Tsai; Xiaobing Fan; Mihai Giurcanu; Darwin Bodero; Marta Zamora; Subramanian Sundramoorthy; Heejong Kim; Richard Freifelder; Mohammed Bhuiyan; Anna Kucharski; Gregory Karczmar; Chien-Min Kao; Howard Halpern; Chin-Tu Chen Journal: Radiol Imaging Cancer Date: 2021-03-26