In Vivo Correlation of Glucose Metabolism, Cell Density and Microcirculatory Parameters in Patients with Head and Neck Cancer: Initial Results Using Simultaneous PET/MRI

Abstract

ObjectiveTo demonstrate the feasibility of simultaneous acquisition of 18F-FDG-PET, diffusion-weighted imaging (DWI) and T1-weighted dynamic contrast-enhanced MRI (T1w-DCE) in an integrated simultaneous PET/MRI in patients with head and neck squamous cell cancer (HNSCC) and to investigate possible correlations between these parameters.Methods17 patients that had given informed consent (15 male, 2 female) with biopsy-proven HNSCC underwent simultaneous 18F-FDG-PET/MRI including DWI and T1w-DCE. SUVmax, SUVmean, ADCmean, ADCmin and K trans, k ep and v e were measured for each tumour and correlated using Spearman’s ρ.ResultsSignificant correlations were observed between SUVmean and K trans (ρ = 0.43; p ≤ 0.05); SUVmean and k ep (ρ = 0.44; p ≤ 0.05); K trans and k ep (ρ = 0.53; p ≤ 0.05); and between k ep and v e (ρ = -0.74; p ≤ 0.01). There was a trend towards statistical significance when correlating SUVmax and ADCmin (ρ = -0.35; p = 0.08); SUVmax and K trans (ρ = 0.37; p = 0.07); SUVmax and k ep (ρ = 0.39; p = 0.06); and ADCmean and v e (ρ = 0.4; p = 0.06).ConclusionSimultaneous 18F-FDG-PET/MRI including DWI and T1w-DCE in patients with HNSCC is feasible and allows depiction of complex interactions between glucose metabolism, microcirculatory parameters and cellular density.

Multimodality functional imaging using DW-MRI and 18F-FDG-PET/CT during radiation therapy for human papillomavirus negative head and neck squamous cell carcinoma: Meixoeiro Hospital of Vigo Experience

“…We evaluated multimodality imaging in HPV- HNSCC patients for both primary and neck nodal metastases. Specifically, we observed that pretreatment tumor cellularity is inversely proportional to glucose metabolism in these tumors, which was consistent with the previous literature[15,25,26]. The survival status and functional metrics show different % change in ΔADC for the NED, AWD, and DOD survival groups, which would need to be validated in larger patient population studies.…”

Correlations Between DCE MRI and Histopathological Parameters in Head and Neck Squamous Cell Carcinoma

“…In all cases, dynamic contrast-enhanced (DCE) imaging was performed using T1w DCE sequences according to a protocol reported previously [17]. T1w DCE included 40 subsequent scans à 6 seconds.…”

“…The contrast application (0.1 mmol Gadobutrol per kg of bodyweight (Gadovist®, Bayer Healthcare, Leverkusen, Germany)) was started after the fifth scan at a rate of 3 ml per second and flushing with 10 ml of normal saline using a power injector (Spectris Solaris, Medrad, Bayer Healthcare, Leverkusen, Germany). The acquired images were transferred to a software module for tissue perfusion estimation (Tissue 4D, Siemens Medical Systems, Erlangen, Germany) as described previously [17], [18]. The software offers a population based approach for the arterial input function (AIF) and the best of three available AIF-options was chosen according to the result of the chi2-parameter, which serves as an error measure for the model fit [17].…”

“…The acquired images were transferred to a software module for tissue perfusion estimation (Tissue 4D, Siemens Medical Systems, Erlangen, Germany) as described previously [17], [18]. The software offers a population based approach for the arterial input function (AIF) and the best of three available AIF-options was chosen according to the result of the chi2-parameter, which serves as an error measure for the model fit [17]. The AIF was scaled in relation to the gadolinium dose and modeled according to the bi-exponential model of Tofts and Kermode [19].…”

“…The following pharmacokinetic parameters were calculated (for exemplary parameter images see Figure 1, A-E ) [17], [18]: K trans : volume transfer constant which estimates the diffusion of contrast medium from the plasma through the vessel wall into the interstitial space, representing vessel permeability; V e ; volume of the extravascular extracellular leakage space (EES); K ep : parameter for diffusion of contrast medium from the EES back to the plasma. It is in close relation with K trans and v e and is calculated by the formula k ep = K trans × V e −1 ;…”