Repeatability of hypoxia PET imaging using [18F]HX4 in lung and head and neck cancer patients: a prospective multicenter trial

Catharina M L Zegers, Wouter van Elmpt, Katrin Szardenings, Hartmuth Kolb, Alan Waxman, Rathan M. Subramaniam, Dae Hyuk Moon, Jacqueline C. Brunetti, Shyam M. Srinivas, Philippe Lambin, David Chien

Research output: Contribution to journalArticle

Abstract

Purpose: Hypoxia is an important factor influencing tumor progression and treatment efficacy. The aim of this study was to investigate the repeatability of hypoxia PET imaging with [18F]HX4 in patients with head and neck and lung cancer. Methods: Nine patients with lung cancer and ten with head and neck cancer were included in the analysis (NCT01075399). Two sequential pretreatment [18F]HX4 PET/CT scans were acquired within 1 week. The maximal and mean standardized uptake values (SUVmax and SUVmean) were defined and the tumor-to-background ratios (TBR) were calculated. In addition, hypoxic volumes were determined as the volume of the tumor with a TBR >1.2 (HV1.2). Bland Altman analysis of the uptake parameters was performed and coefficients of repeatability were calculated. To evaluate the spatial repeatability of the uptake, the PET/CT images were registered and a voxel-wise comparison of the uptake was performed, providing a correlation coefficient. Results: All parameters of [18F]HX4 uptake were significantly correlated between scans: SUVmax (r = 0.958, p <0.001), SUVmean (r = 0.946, p <0.001), TBRmax (r = 0.962, p <0.001) and HV1.2 (r = 0.995, p <0.001). The relative coefficients of repeatability were 15 % (SUVmean), 17 % (SUVmax) and 17 % (TBRmax). Voxel-wise analysis of the spatial uptake pattern within the tumors provided an average correlation of 0.65 ± 0.14. Conclusion: Repeated hypoxia PET scans with [18F]HX4 provide reproducible and spatially stable results in patients with head and neck cancer and patients with lung cancer. [18F]HX4 PET imaging can be used to assess the hypoxic status of tumors and has the potential to aid hypoxia-targeted treatments.

Original languageEnglish (US)
Pages (from-to)1840-1849
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume42
Issue number12
DOIs
StatePublished - Jul 2 2015

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Head and Neck Neoplasms
Multicenter Studies
Lung Neoplasms
Neoplasms
Spatial Analysis
Tumor Burden
Positron-Emission Tomography
3-fluoro-2-(4-((2-nitro-1H-imidazol-1-yl)methyl)-1H-1,2,3-triazol-1-yl)propan-1-ol
Hypoxia
Therapeutics

Keywords

  • Head and neck cancer
  • HX4
  • Hypoxia
  • Lung cancer
  • PET imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Repeatability of hypoxia PET imaging using [18F]HX4 in lung and head and neck cancer patients : a prospective multicenter trial. / Zegers, Catharina M L; van Elmpt, Wouter; Szardenings, Katrin; Kolb, Hartmuth; Waxman, Alan; Subramaniam, Rathan M.; Moon, Dae Hyuk; Brunetti, Jacqueline C.; Srinivas, Shyam M.; Lambin, Philippe; Chien, David.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 42, No. 12, 02.07.2015, p. 1840-1849.

Research output: Contribution to journalArticle

Zegers, CML, van Elmpt, W, Szardenings, K, Kolb, H, Waxman, A, Subramaniam, RM, Moon, DH, Brunetti, JC, Srinivas, SM, Lambin, P & Chien, D 2015, 'Repeatability of hypoxia PET imaging using [18F]HX4 in lung and head and neck cancer patients: a prospective multicenter trial', European Journal of Nuclear Medicine and Molecular Imaging, vol. 42, no. 12, pp. 1840-1849. https://doi.org/10.1007/s00259-015-3100-z
Zegers, Catharina M L ; van Elmpt, Wouter ; Szardenings, Katrin ; Kolb, Hartmuth ; Waxman, Alan ; Subramaniam, Rathan M. ; Moon, Dae Hyuk ; Brunetti, Jacqueline C. ; Srinivas, Shyam M. ; Lambin, Philippe ; Chien, David. / Repeatability of hypoxia PET imaging using [18F]HX4 in lung and head and neck cancer patients : a prospective multicenter trial. In: European Journal of Nuclear Medicine and Molecular Imaging. 2015 ; Vol. 42, No. 12. pp. 1840-1849.
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abstract = "Purpose: Hypoxia is an important factor influencing tumor progression and treatment efficacy. The aim of this study was to investigate the repeatability of hypoxia PET imaging with [18F]HX4 in patients with head and neck and lung cancer. Methods: Nine patients with lung cancer and ten with head and neck cancer were included in the analysis (NCT01075399). Two sequential pretreatment [18F]HX4 PET/CT scans were acquired within 1 week. The maximal and mean standardized uptake values (SUVmax and SUVmean) were defined and the tumor-to-background ratios (TBR) were calculated. In addition, hypoxic volumes were determined as the volume of the tumor with a TBR >1.2 (HV1.2). Bland Altman analysis of the uptake parameters was performed and coefficients of repeatability were calculated. To evaluate the spatial repeatability of the uptake, the PET/CT images were registered and a voxel-wise comparison of the uptake was performed, providing a correlation coefficient. Results: All parameters of [18F]HX4 uptake were significantly correlated between scans: SUVmax (r = 0.958, p <0.001), SUVmean (r = 0.946, p <0.001), TBRmax (r = 0.962, p <0.001) and HV1.2 (r = 0.995, p <0.001). The relative coefficients of repeatability were 15 {\%} (SUVmean), 17 {\%} (SUVmax) and 17 {\%} (TBRmax). Voxel-wise analysis of the spatial uptake pattern within the tumors provided an average correlation of 0.65 ± 0.14. Conclusion: Repeated hypoxia PET scans with [18F]HX4 provide reproducible and spatially stable results in patients with head and neck cancer and patients with lung cancer. [18F]HX4 PET imaging can be used to assess the hypoxic status of tumors and has the potential to aid hypoxia-targeted treatments.",
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AU - van Elmpt, Wouter

AU - Szardenings, Katrin

AU - Kolb, Hartmuth

AU - Waxman, Alan

AU - Subramaniam, Rathan M.

AU - Moon, Dae Hyuk

AU - Brunetti, Jacqueline C.

AU - Srinivas, Shyam M.

AU - Lambin, Philippe

AU - Chien, David

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N2 - Purpose: Hypoxia is an important factor influencing tumor progression and treatment efficacy. The aim of this study was to investigate the repeatability of hypoxia PET imaging with [18F]HX4 in patients with head and neck and lung cancer. Methods: Nine patients with lung cancer and ten with head and neck cancer were included in the analysis (NCT01075399). Two sequential pretreatment [18F]HX4 PET/CT scans were acquired within 1 week. The maximal and mean standardized uptake values (SUVmax and SUVmean) were defined and the tumor-to-background ratios (TBR) were calculated. In addition, hypoxic volumes were determined as the volume of the tumor with a TBR >1.2 (HV1.2). Bland Altman analysis of the uptake parameters was performed and coefficients of repeatability were calculated. To evaluate the spatial repeatability of the uptake, the PET/CT images were registered and a voxel-wise comparison of the uptake was performed, providing a correlation coefficient. Results: All parameters of [18F]HX4 uptake were significantly correlated between scans: SUVmax (r = 0.958, p <0.001), SUVmean (r = 0.946, p <0.001), TBRmax (r = 0.962, p <0.001) and HV1.2 (r = 0.995, p <0.001). The relative coefficients of repeatability were 15 % (SUVmean), 17 % (SUVmax) and 17 % (TBRmax). Voxel-wise analysis of the spatial uptake pattern within the tumors provided an average correlation of 0.65 ± 0.14. Conclusion: Repeated hypoxia PET scans with [18F]HX4 provide reproducible and spatially stable results in patients with head and neck cancer and patients with lung cancer. [18F]HX4 PET imaging can be used to assess the hypoxic status of tumors and has the potential to aid hypoxia-targeted treatments.

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