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Meeting ReportOncology: Clinical Therapy and Diagnosis

Complementary role and spatial relationship of 18F-FAZA PET/CT, perfusion and diffusion brain MRI for hypoxia characterization in high-grade glioma

Paola Mapelli, Paola Scifo, Federico Fallanca, Antonella Castellano, Elena Incerti, Gian Marco Conte, Valentino Bettinardi, Annarita Savi, Angela Coliva, Antonia Compierchio, Nicoletta Anzalone, Luigi Gianolli and Maria Picchio
Journal of Nuclear Medicine May 2020, 61 (supplement 1) 1300;
Paola Mapelli
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
1Vita-Salute San Raffaele University Milan Italy
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Paola Scifo
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Federico Fallanca
3Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milano Italy
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Antonella Castellano
1Vita-Salute San Raffaele University Milan Italy
4Neuroradiology Unit and CERMAC IRCCS San Raffaele Scientific Institute Milan Italy
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Elena Incerti
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Gian Marco Conte
1Vita-Salute San Raffaele University Milan Italy
4Neuroradiology Unit and CERMAC IRCCS San Raffaele Scientific Institute Milan Italy
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Valentino Bettinardi
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Annarita Savi
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Angela Coliva
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Antonia Compierchio
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Nicoletta Anzalone
1Vita-Salute San Raffaele University Milan Italy
4Neuroradiology Unit and CERMAC IRCCS San Raffaele Scientific Institute Milan Italy
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Luigi Gianolli
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Maria Picchio
1Vita-Salute San Raffaele University Milan Italy
2Nuclear Medicine Department IRCCS San Raffaele Scientific Institute Milan Italy
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Abstract

1300

Purpose: To define the complementary value of 18F-FAZA PET/CT, perfusion and diffusion weighted MRI in assessing the functional status of high-grade glioma, by assessing the mutual spatial relationship of co-registered separated PET and MR acquisitions. Patients and Methods: Prospective single Centre clinical study. Twenty patients with brain MRI suggestive for HGG have been enrolled. Eighteen out of 20 pts underwent pre-treatment 18F-FAZA PET/CT. For each 18-FAZA PET scan, standardized uptake values (SUV) have been derived. All patients underwent MRI (FLAIR, T2w, 3D-T1w pre- and post-contrast, diffusion and perfusion images), but only 11 of them have been considered for analysis with 18F-FAZA in this preliminary work. FAZA-PET, MR Perfusion and Diffusion images were firstly co-registered to 3D-T1 MR. Ktrans, Vp and CBV maps were calculated from Dynamic contrast enhanced (DCE) and Dynamic Susceptibility contrast (DSC) MR images. Mean Diffusivity (MD) has been calculated from Diffusion Tensor MR (DTI). 18F-FAZA SUV maps were divided by the muscle value uptake to calculate defined maps. A threshold of tumour-to-muscle (T/M) >1.2 was used to define FAZA-based VOIs (VOIsFAZA). By using these VOIsFAZA, Spearman correlations between FAZA SUV and perfusion parameters have been calculated for each subject. Furthermore, a second VOI has been defined in pw-maps and MD based on the Gd-enhanced regions on 3D T1 post contrast images (VOIsGd). Finally, the spatial coordinates of center-of-mass (CoM) of VOIGds in each single parametric map (Ktrans, Vp, CBV,MD, FAZA) were found and relative distances were calculated for each patient.

Results: By using a T/M threshold of 1.2 for FAZA SUV, and the 3D T1 Gd-enhancement, the mean values ± SD of the volumes were: 12.4 ± 12.3cc for VOIsFAZA and 26.6±22.1cc for VOIsGd respectively. The tumor volumes were significantly different between the two modalities (p<0.004). Using the FAZA and VOIsGd, mean values of Dice and Jaccard coefficients were 0,588±0,166 and 0,434±0,165, while volume overlap was 0,612±0,254. The CoMs of pw-maps and MD in the VOIsGd, were in different positions depending on the map. The relative distances from FAZA CoMs of some MR CoMs were significantly correlated, specifically: Ktrans and Vp (p=0.000), Vp and CBV (p=0.002), Vp and MD (p=0.007) and CBV and MD (p=0.002). No significant difference in the distances were found between the different CoMs, neither normalizing with the volume extension.

Conclusions: Low similarity indexes indicate that FAZA PET and Gd-MR enhancement provide different information regarding tumour hypoxia status, while the similar relative distances of MR CoMs from FAZA CoM suggest that all the MR parameters are more correlated among them compared to FAZA. This may imply that FAZA PET and MRl give complementary information in HGG patients.

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Journal of Nuclear Medicine
Vol. 61, Issue supplement 1
May 1, 2020
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Complementary role and spatial relationship of 18F-FAZA PET/CT, perfusion and diffusion brain MRI for hypoxia characterization in high-grade glioma
Paola Mapelli, Paola Scifo, Federico Fallanca, Antonella Castellano, Elena Incerti, Gian Marco Conte, Valentino Bettinardi, Annarita Savi, Angela Coliva, Antonia Compierchio, Nicoletta Anzalone, Luigi Gianolli, Maria Picchio
Journal of Nuclear Medicine May 2020, 61 (supplement 1) 1300;

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Complementary role and spatial relationship of 18F-FAZA PET/CT, perfusion and diffusion brain MRI for hypoxia characterization in high-grade glioma
Paola Mapelli, Paola Scifo, Federico Fallanca, Antonella Castellano, Elena Incerti, Gian Marco Conte, Valentino Bettinardi, Annarita Savi, Angela Coliva, Antonia Compierchio, Nicoletta Anzalone, Luigi Gianolli, Maria Picchio
Journal of Nuclear Medicine May 2020, 61 (supplement 1) 1300;
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