A Comparative Study of Noninvasive Hypoxia Imaging with 18F-Fluoroerythronitroimidazole and 18F-Fluoromisonidazole PET/CT in Patients with Lung Cancer.
OBJECTIVE
This is a clinical study to compare noninvasive hypoxia imaging using 18F-fluoroerythronitroimidazole (18F-FETNIM) and 18F-fluoromisonidazole (18F-FMISO) positron emission tomography/computed tomography (PET/CT) in patients with inoperable stages III-IV lung cancer.


METHODS
A total of forty-two patients with inoperable stages III-IV lung cancer underwent 18F-FETNIM PET/CT (n = 18) and 18F-FMISO PET/CT (n = 24) before chemo/radiation therapy. The standard uptake values (SUVs) of malignant and normal tissues depict 18F-FETNIM PET/CT and 18F-FMISO PET/CT uptake. Tumor-to-blood ratios (T/B) were used to quantify hypoxia.


RESULTS
All patients with lung cancer underwent 18F-FETNIM PET/CT and 18F-FMISO PET/CT successfully. Compared to 18F-FMISO, 18F-FETNIM showed similar uptake in muscle, thyroid, spleen, pancreas, heart, lung and different uptake in blood, liver, and kidney. Significantly higher SUV and T/B ratio with 18F-FMISO (2.56±0.77, 1.98±0.54), as compared to 18F-FETNIM (2.12±0.56, 1.42±0.33) were seen in tumor, P = 0.022, <0.001. For the patients with different histopathological subtypes, no significant difference of SUV (or T/B ratio) was observed both in 18F-FMISO and 18F-FETNIM in tumor. A significantly different SUV (or T/B ratio) was detected between < = 2cm, 2~5cm, and >5cm groups in 18F-FMISO PET/CT, P = 0.015 (or P = 0.029), whereas no difference was detected in 18F-FMISO PET/CT, P = 0.446 (or P = 0.707). Both 18F-FETNIM and 18F-FMISO showed significantly higher SUVs (or T/B ratios) in stage IV than stage III, P = 0.021, 0.013 (or P = 0.032, 0.02).


CONCLUSIONS
18F-FMISO showed significantly higher uptake than 18F-FETNIM in tumor/non-tumor ratio and might be a better hypoxia tracer in lung cancer.
School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China.|Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Yuchun
Y
Wei
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Wei
W
Zhao
Department of Nuclear Medicine, Shandong Cancer Hospital, Shandong University, Jinan, China.
Yong
Y
Huang
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Qingxi
Q
Yu
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Shouhui
S
Zhu
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Suzhen
S
Wang
Department of Nuclear Medicine, Shandong Cancer Hospital, Shandong University, Jinan, China.
Shuqiang
S
Zhao
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Xudong
X
Hu
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Jinming
J
Yu
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China.
Shuanghu
S
Yuan
D000328:Adult; D000368:Aged; D003710:Demography; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008920:Misonidazole / Q000031:analogs & derivatives* / Q000737:chemistry; D009593:Nitroimidazoles / Q000737:chemistry*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D014018:Tissue Distribution
D009593:Nitroimidazoles; C092114:fluoroerythronitroimidazole; C031843:fluoromisonidazole; D008920:Misonidazole