title: Two or four hour [¹⁸F]FMISO-PET in HNSCC. When is the contrast best?
abstract: [¹⁸F]Fluoromisonidazole positron emission tomography (FMISO-PET) is a non invasive imaging technique that can assist detecting intra tumour regions of hypoxia. FMISO-PET evinces comparatively low signal-to-noise-ratio (SNR) and may be acquired dynamically or after different uptake times post injection (p.i.). The aim of this study was to identify, if static images acquired two hours (MISO2) or four hours (MISO4) p.i. reveal higher contrast.
  
  
  METHODS
  As part of a prospective trial, 23 patients with cancers of the head and neck underwent [¹⁸F]fluorodeoxyglucose (FDG) PET before and during curative radiochemotherapy. Additionally, FMISO-PET studies 2 h and 4 h p.i. were done before treatment and after a mean dose of 11Gy, 23 Gy and 57 Gy during RCT. After coregistration, a dedicated software was used to define the gross tumour volume (GTV) by FDG PET for the primary tumour. This volume was overlaid to the FMISO images and hypoxia within the GTV was determined. The contrast between hypoxia determined by MISO2 and by MISO4 was investigated and analysed with the Wilcoxon-matched-pairs test.
  
  
  RESULTS
  Mean SUVmax in tumours of all examinations was 2.2 (stdev: 0.4, min: 1.3, max: 3.4) after 2 h and 2.4 (stdev: 0.7, min: 1.1, max: 4.4) after 4 h. In the neck musculature the mean SUVmax was 1.5 at both time points and the mean SUVmean decreased from 1.2 after 2 h to 1.1 after 4 h, respectively. These effects resulted in significantly rising contrast ratios from MISO2 to MISO4. The differently defined contrasts revealed significantly higher values for examinations 4 h p.i. (p < 0.002).
  
  
  CONCLUSIONS
  Data acquisition of [¹⁸F]FMISO should be done 4 h p.i. to gather the optimal contrast, preferably allowing further analysis, e. g. hypoxic sub volume definition for therapy planning.
authors.affiliation: OncoRay-Molecular and Biological Imaging, National Center for Radiation Research in Oncology, Institut und Poliklinik für Radiologische Diagnostik, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Nasreddin.Abolmaali@tu-dresden.de
authors.forename: N
authors.initials: N
authors.lastname: Abolmaali
authors.forename: R
authors.initials: R
authors.lastname: Haase
authors.forename: A
authors.initials: A
authors.lastname: Koch
authors.forename: D
authors.initials: D
authors.lastname: Zips
authors.forename: J
authors.initials: J
authors.lastname: Steinbach
authors.forename: M
authors.initials: M
authors.lastname: Baumann
authors.forename: J
authors.initials: J
authors.lastname: Kotzerke
authors.forename: K
authors.initials: K
authors.lastname: Zöphel
mesh_terms: D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008920:Misonidazole / Q000008:administration & dosage / Q000031:analogs & derivatives*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D019275:Radiopharmaceuticals; C031843:fluoromisonidazole; D008920:Misonidazole