title: 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.
abstract: 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.
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.|Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna,Vienna, Austria.|Department of Scientific Computing in Medicine, State University of Florida, Tallahassee, Florida, United States of America.
authors.forename: Katja
authors.identifier: 0000-0002-2722-7331
authors.initials: K
authors.lastname: Pinker
authors.affiliation: Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna,Vienna, Austria.|Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Piotr
authors.initials: P
authors.lastname: Andrzejewski
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.|Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna,Vienna, Austria.
authors.forename: Pascal
authors.initials: P
authors.lastname: Baltzer
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.|Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna,Vienna, Austria.
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Polanec
authors.affiliation: Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Alina
authors.initials: A
authors.lastname: Sturdza
authors.affiliation: Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna,Vienna, Austria.|Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Georg
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Helbich
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Georgios
authors.initials: G
authors.lastname: Karanikas
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.|Gynecologic Cancer Unit/Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Grimm
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.|Gynecologic Cancer Unit/Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Polterauer
authors.affiliation: Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Poetter
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wadsak
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Mitterhauser
authors.affiliation: Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna,Vienna, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Georg
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D008920:Misonidazole / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D012189:Retrospective Studies; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: C031843:fluoromisonidazole; D019788:Fluorodeoxyglucose F18; D008920:Misonidazole