Research ArticleClinical Investigation

Phenotyping of Tumor Biology in Patients by Multimodality Multiparametric Imaging: Relationship of Microcirculation, αvβ3 Expression, and Glucose Metabolism

Stephan Metz, Carl Ganter, Sylvie Lorenzen, Sandra van Marwick, Ken Herrmann, Florian Lordick, Stephan G. Nekolla, Ernst J. Rummeny, Hans-Jürgen Wester, Gunnar Brix, Markus Schwaiger and Ambros J. Beer
Journal of Nuclear Medicine November 2010, 51 (11) 1691-1698; DOI: https://doi.org/10.2967/jnumed.110.077719

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Image analysis using our custom software tool, showing large metastasis from NSCLC of right adrenal gland. (A) Different image sets are opened simultaneously in separate windows. After manual image fusion of 18F-FDG (multicolor scale) and 18F-galacto-RGD PET (blue–white scale), ROI covering total tumor area is defined in fused PET dataset (A: magenta line). (B) Scatterplot shows distribution of SUVs within this ROI on pixel-by-pixel basis. Different tumor areas are defined by preset thresholds for 18F-FDG and 18F-galacto-RGD uptake on x- and y-axes, respectively (blue: RGD−/FDG−, green: RGD+/FDG−, yellow: RGD−/FDG+, and red: RGD+/FDG+). (C) Different areas are then copied to MR image set (blue: RGD−/FDG−, green: RGD+/FDG−, yellow: RGD−/FDG+, and red: RGD+/FDG+; inset shows tumor without overlay of different color-coded areas). (D) Intensity–time curves of DCE MRI data are subsequently derived for these different tumor areas. Central blue area with low tracer uptake (FDG−/RGD−) shows only slight contrast enhancement (blue line), whereas areas with higher tracer uptake (yellow, green, and red lines) show more rapid and intense enhancement. Magenta line represents results for whole-tumor ROI.

  • FIGURE 2.
    FIGURE 2.

    Box-and-whisker graphs (central box: values from 25th to 75th percentiles, middle line: median) for functional MRI parameters, divided according to PET data into different tumor regions (combined analysis of 18F-FDG and 18F-galacto-RGD uptake using image fusion). Tumor regions with high uptake for both tracers (RGD+/FDG+) show higher functional MRI data than do less tracer-avid tumor regions (RGD−/FDG−); difference is significant for initial AUC and rBV (**P < 0.01).

  • FIGURE 3.
    FIGURE 3.

    Scatterplots and regression lines correlating SUVs from PET data with functional MRI parameters of different tumor ROIs (□ = NSCLC; • = other histologic types). Pearson correlation coefficients and P values of between-subject correlation (generalized-estimating-equation model) are shown in scatterplots. Significant correlation was found between molecular PET data and all functional MRI parameters, except for 18F-galacto-RGD vs. rBF.

Tables

  • TABLE 1

    Distribution of Primary Tumor Histology and Imaged Tumor Sites

    Patient no.SexAge (y)Primary tumorImaged tumor site
    1M62NSCLCPrimary
    2M52NSCLCPrimary
    3M71Rectal adenocarcinomaMetastasis to lung
    4F71NSCLCMetastasis to adrenal gland
    5M74NSCLCMetastasis to pelvic bone
    6F70NSCLCMetastasis to pelvic bone
    7F62NSCLCMetastasis to pelvic bone
    8F64Renal cell carcinomaLocal recurrence
    9M73Neuroendocrine carcinoma of lungMetastasis to liver
    10M68Neuroendocrine carcinoma of lungLymph node metastasis
    11M68NSCLCPrimary
    12M80NSCLCPrimary
    13M58NSCLCPrimary

    • Patients 12 and 13 were excluded because of movement or pulsation artifacts on MRI.

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