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Imaging of Blood Flow and Hypoxia in Head and Neck Cancer: Initial Evaluation with [¹⁵O]H₂O and [¹⁸F]Fluoroerythronitroimidazole PET

Medicity Research Laboratory and Radiopharmaceutical Chemistry Laboratory, Turku PET Centre; Department of Oncology and Radiotherapy; and Department of Otorhinolaryngology and Head and Neck Surgery, Turku University Central Hospital, Turku, Finland

View larger version (10K): [in a new window]   FIGURE 1. Diagram of imaging protocol for [15O]H2O, [15O]CO2, and [18F]FETNIM PET shows 2-phase acquisition of [18F]FETNIM data, with scan 1 obtained at 0–120 min and scan 2 obtained at 160–180 min. For clarification, time scale is different on both sides of time 0.

View larger version (109K): [in a new window]   FIGURE 2. Multiple tomographic PET images of 2 untreated patients with head and neck cancer. Corresponding axial CT scans are depicted in upper left of both image sets. (A) Supraglottic laryngeal cancer (T1 N0) shows high uptake of [18F]FDG (top row, middle) and increased blood flow (bottom row, left). Early distribution pattern of [18F]FETNIM 5–8 min from injection allows easy delineation of tumor (bottom row, middle), whereas in later phase, 120 min from injection (bottom row, right), [18F]FETNIM is distributed more evenly between tumor and ambient tissues in neck and base of mouth. PET images also show transfer of ROI (red line circling tumor) from [18F]FDG image to other PET studies. (B) Right lingual cancer (T4 N1) likewise shows high uptake of [18F]FDG (top row, middle) and high blood flow (bottom row, left). Early [18F]FETNIM image obtained 5–8 min from injection (bottom row, middle) closely resembles that of corresponding perfusion image, whereas later phase [18F]FETNIM image at 120 min (bottom row, right) shows focal uptake, especially in apex of tumor. Tumor is hardly visible in [15O]CO blood volume images (top rows, right) of both (A) and (B).

View larger version (16K): [in a new window]   FIGURE 3. Time course of uptake of [18F]FETNIM in patient with hypopharyngeal carcinoma. Whole and maximum (max) tumor activity are shown separately.

View larger version (19K): [in a new window]   FIGURE 4. Time course of [18F]FETNIM uptake expressed as tumor-to-muscle SUV ratio. Numbers within frame refer to patients as numbered in Table 1.

View larger version (23K): [in a new window]   FIGURE 5. Relationship between DV of [18F]FETNIM and maximum (max) SUV in tumor at different times during dynamic study.

View larger version (25K): [in a new window]   FIGURE 6. Relationship between uptake of [18F]FETNIM expressed as maximum (max) SUV and blood flow at different times during dynamic study.