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Clinical Trial
. 2015 Nov;42(12):1840-9.
doi: 10.1007/s00259-015-3100-z. Epub 2015 Jul 2.

Repeatability of hypoxia PET imaging using [¹⁸F]HX4 in lung and head and neck cancer patients: a prospective multicenter trial

Catharina M L Zegers  1 , Wouter van Elmpt  2 , Katrin Szardenings  3 , Hartmuth Kolb  4 , Alan Waxman  5 , Rathan M Subramaniam  6   7 , Dae Hyuk Moon  8 , Jacqueline C Brunetti  9 , Shyam M Srinivas  10 , Philippe Lambin  2 , David Chien  4
Affiliations
Clinical Trial

Repeatability of hypoxia PET imaging using [¹⁸F]HX4 in lung and head and neck cancer patients: a prospective multicenter trial

Catharina M L Zegers et al. Eur J Nucl Med Mol Imaging. 2015 Nov.

Abstract

Purpose: Hypoxia is an important factor influencing tumor progression and treatment efficacy. The aim of this study was to investigate the repeatability of hypoxia PET imaging with [(18)F]HX4 in patients with head and neck and lung cancer.

Methods: Nine patients with lung cancer and ten with head and neck cancer were included in the analysis (NCT01075399). Two sequential pretreatment [(18)F]HX4 PET/CT scans were acquired within 1 week. The maximal and mean standardized uptake values (SUVmax and SUVmean) were defined and the tumor-to-background ratios (TBR) were calculated. In addition, hypoxic volumes were determined as the volume of the tumor with a TBR >1.2 (HV1.2). Bland Altman analysis of the uptake parameters was performed and coefficients of repeatability were calculated. To evaluate the spatial repeatability of the uptake, the PET/CT images were registered and a voxel-wise comparison of the uptake was performed, providing a correlation coefficient.

Results: All parameters of [(18)F]HX4 uptake were significantly correlated between scans: SUVmax (r = 0.958, p < 0.001), SUVmean (r = 0.946, p < 0.001), TBRmax (r = 0.962, p < 0.001) and HV1.2 (r = 0.995, p < 0.001). The relative coefficients of repeatability were 15 % (SUVmean), 17 % (SUVmax) and 17 % (TBRmax). Voxel-wise analysis of the spatial uptake pattern within the tumors provided an average correlation of 0.65 ± 0.14.

Conclusion: Repeated hypoxia PET scans with [(18)F]HX4 provide reproducible and spatially stable results in patients with head and neck cancer and patients with lung cancer. [(18)F]HX4 PET imaging can be used to assess the hypoxic status of tumors and has the potential to aid hypoxia-targeted treatments.

Keywords: HX4; Head and neck cancer; Hypoxia; Lung cancer; PET imaging.

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Figures

Fig. 1
Fig. 1
Correlation and Bland-Altman plots (including 95 % confidence intervals) of the image parameters SUVmax and TBRmax
Fig. 2
Fig. 2
Example of voxel-wise analysis in a patient with head and neck cancer (patient 12). The axial, coronal and sagittal planes of the first and the rigidly registered second [18F]HX4 PET/CT scan are shown. The gross tumor volume is delineated. The bottom row shows the correlation plot, the Bland-Altman and the histogram plot of the voxels within the gross tumor volume
Fig. 3
Fig. 3
Examples of voxel-wise analysis in patients with lung cancer (patients 1 and 4). The axial plane of the CT scans with the gross tumor volumes delineated in yellow, the first [18F]HX4 PET scan, the rigidly registered second [18F]HX4 PET scan and the difference map from the two scans are shown
See this image and copyright information in PMC

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