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. 2023 Mar 22;15(6):1918.
doi: 10.3390/cancers15061918.

Quantitative MRI to Characterize Hypoxic Tumors in Comparison to FMISO PET/CT for Radiotherapy in Oropharynx Cancers

Pierrick Gouel  1 , Françoise Callonnec  1 , Franchel-Raïs Obongo-Anga  2 , Pierre Bohn  1 , Emilie Lévêque  3 , David Gensanne  4 , Sébastien Hapdey  1 , Romain Modzelewski  1 , Pierre Vera  1 , Sébastien Thureau  1   2
Affiliations

Quantitative MRI to Characterize Hypoxic Tumors in Comparison to FMISO PET/CT for Radiotherapy in Oropharynx Cancers

Pierrick Gouel et al. Cancers (Basel). .

Abstract

Intratumoral hypoxia is associated with a poor prognosis and poor response to treatment in head and neck cancers. Its identification would allow for increasing the radiation dose to hypoxic tumor subvolumes. 18F-FMISO PET imaging is the gold standard; however, quantitative multiparametric MRI could show the presence of intratumoral hypoxia. Thus, 16 patients were prospectively included and underwent 18F-FDG PET/CT, 18F-FMISO PET/CT, and multiparametric quantitative MRI (DCE, diffusion and relaxometry T1 and T2 techniques) in the same position before treatment. PET and MRI sub-volumes were segmented and classified as hypoxic or non-hypoxic volumes to compare quantitative MRI parameters between normoxic and hypoxic volumes. In total, 13 patients had hypoxic lesions. The Dice, Jaccard, and overlap fraction similarity indices were 0.43, 0.28, and 0.71, respectively, between the FDG PET and MRI-measured lesion volumes, showing that the FDG PET tumor volume is partially contained within the MRI tumor volume. The results showed significant differences in the parameters of SUV in FDG and FMISO PET between patients with and without measurable hypoxic lesions. The quantitative MRI parameters of ADC, T1 max mapping and T2 max mapping were different between hypoxic and normoxic subvolumes. Quantitative MRI, based on free water diffusion and T1 and T2 mapping, seems to be able to identify intra-tumoral hypoxic sub-volumes for additional radiotherapy doses.

Keywords: DCE-MRI; FDG PET; FMISO PET; T1 mapping; T2 mapping; diffusion MRI; dose painting; head and neck cancer; hypoxia; quantitative MRI.

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Conflict of interest statement

The authors declare that they have no conflict of interest in relation to this article.

Figures

Figure A1
Figure A1
Box plots show evaluation of the difference in each quantitative MRI parameter as a function of tumor volume segmentation method between patients without (red) and with (blue) hypoxic volumes.
Figure A2
Figure A2
Wilcoxon non-parametric tests of quantitative MRI parameters in patients with an identified hypoxic lesion (n = 13). The reference hypoxic HsV_MRIuFDG segmentation is shown in blue and the normoxic MRI, FDG PET and MRIuFDG segmentations are shown in yellow, red and green, respectively.
Figure 1
Figure 1
Example of different segmentations obtained from a patient included in the RTEP8-Hyponeck study. Columns a, b, and c represent FDG PET (red), MRI (yellow), and the union of MRI and FDG PET (green), respectively. Lines 1, 2, and 3 represent the segmentations of the tumor lesion (TL; solid color), hypoxic (HsV; blue color), and normoxic (NsV; white color) subvolumes.
Figure 2
Figure 2
Multimodal PET/CT MRI images obtained from patients 1, 2, and 14 of the RETP8 population. For more details, see patient characteristics in Table 1. MRI tumor segmentation in yellow, FDG PET in red, and FMISO PET hypoxic subvolume in blue on each quantitative PET and MRI series.
Figure 3
Figure 3
Wilcoxon signed-rank tests between the hypoxic sub volumes HsV_FDG (light blue), HsV_MRI (south sea blue), and HsV_MRIuFDG (dark blue).
Figure 4
Figure 4
Pairwise Wilcoxon signed-rank tests of quantitative MRI parameters in patients with an identified hypoxic lesion (n = 13). The reference hypoxic HsV_MRIuFDG segmentation is shown in blue, and the normoxic MRI, FDG PET and MRIuFDG segmentations are shown in yellow, red and green, respectively.
See this image and copyright information in PMC

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