Article Figures & Data
Figures
- FIGURE 1.
Delimitation of different ROIs. T1Gd images (A) were used to calculate the following ROIs: classic tumor region (B, cyan), radiologic necrosis region (T1Gd central hyposignal; B, magenta), and, by subtraction, CE region (C). FLAIR images (D) were used to calculate the total tumor region (D, yellow) and exclusive FLAIR region (D, region between yellow and cyan). ROIs have been transposed on modalities (E and F) for calculating parameters. Then, a semiautomatic segmentation was performed for high-CBV (G) and –18F-FMISO uptake (H) volumes.
- FIGURE 2.
Right occipital glioblastoma. (A) MRI T1Gd sequence, illustrating typical appearance of glioblastoma with peripheral hypersignal reflecting extravasation of gadolinium, associated with central hyposignal (radiologic necrosis). (B) FLAIR sequence showing hyperintensity that far exceeds volume of CE. (C) 18F-FMISO PET image (T/B) revealing significant uptake within tumor. Yellow outline shows automatic thresholding by contralateral 95 centile, which yielded hypoxic tumor volume. (D) CBV map also shows widespread tumor vascularization. Cyan outline represents threshold by contralateral 95 centile, which has produced hypervascularized tumor volume. (E) Representation of different volumes on T1Gd sequence after coregistration of all modalities. White area represents CE compartment, and brown zone represents exclusive FLAIR region. (F–H) Automatic thresholding on same images of C, D, and E of volume of maximal tumor hypoxia (F) and volume of maximal tumor vascularization (G) by tumoral 95 centile (5% of most intense pixels).
- FIGURE 3.
Scatterplot with linear regression lines illustrating relationship between uptake of 18F-FMISO and vascularization. (A) Correlation between maximum values of 18F-FMISO uptake expressed as T/B and rCBV in glioblastomas (classic tumor volume). (B) Relationship between hypoxic tumor volume (18F-FMISO uptake thresholded by contralateral 95 centile) and hypervascularized tumor volume (high CBV thresholded by contralateral 95 centile).
- FIGURE 4.
Venn diagram representing relationship between hypoxic (18F-FMISO uptake), hypervascularized (high CBV), and permeable (CE) tumor volumes of study population. Numbers and colored areas indicate proportions between different volumes and overlap rates (Table 2). There is greater volume of 18F-FMISO uptake, with large overlap with both CBV and permeable tumor volume. There is also overlap between hypervascularized and permeable tumor volumes, corresponding to almost 50% of these volumes.
Tables
Total tumor regions Classic tumor regions Parameter r P r P Maximal and mean value T/Bmax vs. rCBVmax 0.61 0.002† 0.77 <0.001† T/Bmean vs. rCBVmean 0.29 0.185 0.38 0.079 Volume Hypoxic tumor volume vs. hypervascularized tumor volume 0.91 <0.001† Hypoxic tumor volume vs. permeable tumor volume 0.93 <0.001† Hypervascularized tumor volume vs. permeable tumor volume 0.88 <0.001† ↵* Pearson correlation coefficients (r) with corresponding P values.
↵† P values are statistically significant.
Hypoxic tumor volume = 18F-FMISO uptake volume thresholded by contralateral 95 centile; hypervascularized tumor volume = high CBV thresholded by contralateral 95 centile; permeable tumor volume = volume of CE region.
Recovery of By Mean % Hypoxic tumor volume Hypervascularized tumor volume 48.8 Permeable tumor volume 44.3 Volume of maximal tumor hypoxia Hypervascularized tumor volume 68.0 Permeable tumor volume 60.8 Volume of maximal tumor vascularization 18.0 Hypervascularized tumor volume Hypoxic tumor volume 81.3 Permeable tumor volume 46.5 Hypoxic tumor volume =18F-FMISO uptake volume thresholded by contralateral 95 centile; hypervascularized tumor volume = high CBV thresholded by contralateral 95 centile; permeable tumor volume = volume of CE region; volume of maximal tumor hypoxia = 18F-FMISO uptake volume thresholded by tumoral 95 centile (most intense 5% pixels); volume of maximal tumor vascularization = high CBV thresholded by tumoral 95 centile.
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