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Influence of the scan time point when assessing hypoxia in 18F-fluoromisonidazole PET: 2 vs. 4 h

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Abstract

Purpose

18F-fluoromisonidazole (18F-FMISO) is the most widely used positron emission tomography (PET) tracer for imaging tumor hypoxia. Previous reports suggested that the time from injection to the scan may affect the assessment of 18F-FMISO uptake. Herein, we directly compared the images at 2 h and 4 h after a single injection of 18F-FMISO.

Methods

Twenty-three patients with or suspected of having a brain tumor were scanned twice at 2 and 4 h following an intravenous injection of 18F-FMISO. We estimated the mean standardized uptake value (SUV) of the gray matter and white matter and the gray-to-white matter ratio in the background brain tissue from the two scans. We also performed a semi-quantitative analysis using the SUVmax and maximum tumor-to-normal ratio (TNR) for the tumor.

Results

At 2 h, the SUVmean of gray matter was significantly higher than that of white matter (median 1.23, interquartile range (IQR) 1.10–1.32 vs. 1.04, IQR 0.95–1.16, p < 0.0001), whereas at 4 h, it significantly decreased to approach that of the white matter (1.10, IQR 1.00–1.23 vs. 1.02, IQR 0.93–1.13, p = NS). The gray-to-white matter ratio thus significantly declined from 1.17 (IQR 1.14–1.19) to 1.09 (IQR 1.07–1.10) (p < 0.0001). All 7 patients with glioblastoma showed significant increases in the SUVmax (2.20, IQR 1.67–3.32 at 2 h vs. 2.65, IQR 1.74–4.41 at 4 h, p = 0.016) and the TNR (1.75, IQR 1.40–2.38 at 2 h vs. 2.34, IQR 1.67–3.60 at 4 h, p = 0.016).

Conclusion

In the assessment of hypoxic tumors, 18F-FMISO PET for hypoxia imaging should be obtained at 4 h rather than 2 h after the injection.

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Acknowledgments

We thank the staff members of the Department of Nuclear Medicine, the Central Institute of Isotope Science, the Department of Cancer Pathology, Hokkaido University, and the Department of Radiology, Hokkaido University Hospital, for their support of this work.

Funding

This research was supported in part by a Grant-in-Aid for General Scientific Research from the Japan Society for the Promotion of Science (Ko.Ke., 19K17127).

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8638, Japan

    Kentaro Kobayashi, Osamu Manabe, Kenji Hirata, Sho Furuya & Tohru Shiga

  2. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Shigeru Yamaguchi

  3. Kashiwaba Neurosurgery Hospital, Sapporo, Japan

    Hiroyuki Kobayashi & Shunsuke Terasaka

  4. Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA

    Takuya Toyonaga

  5. Division of Medical Imaging and Technology, Hokkaido University Hospital, Sapporo, Japan

    Keiichi Magota

  6. Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan

    Yuji Kuge

  7. Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Kohsuke Kudo

  8. Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan

    Kohsuke Kudo

  9. Department of Radiology, Kyoto Prefectural University, Kyoto, Japan

    Nagara Tamaki

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  1. Kentaro Kobayashi
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Correspondence to Kenji Hirata.

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The authors declare that they have no conflict of interest.

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All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. A portion of our results were presented at the SNMMI 2018 Conference (J Nucl Med May 1, 2015, vol. 56 no. supplement 3373).

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Kobayashi, K., Manabe, O., Hirata, K. et al. Influence of the scan time point when assessing hypoxia in 18F-fluoromisonidazole PET: 2 vs. 4 h. Eur J Nucl Med Mol Imaging 47, 1833–1842 (2020). https://doi.org/10.1007/s00259-019-04626-8

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