Katja Pinker-Domenig MD, Presenter: Nothing to Disclose

Pascal Andreas Thomas Baltzer MD, Abstract Co-Author: Nothing to Disclose

Stephan Helmuth Polanec MD, Abstract Co-Author: Nothing to Disclose

Heinrich Magometschnigg, Abstract Co-Author: Nothing to Disclose

Piotr Andrezejewski PhD, Abstract Co-Author: Nothing to Disclose

Dietmar Georg PhD, Abstract Co-Author: Nothing to Disclose

Thomas Hans Helbich MD, Abstract Co-Author: Research Grant, Medicor, Inc Research Grant, Siemens AG Research Grant, C. R. Bard, Inc

Georgios Karanikas MD, Abstract Co-Author: Nothing to Disclose

Alina Sturdza MD, Abstract Co-Author: Nothing to Disclose

Stephan Polterauer MD, Abstract Co-Author: Nothing to Disclose

Alexander Reinthaller MD, Abstract Co-Author: Nothing to Disclose

Richard Poetter MD, Abstract Co-Author: Nothing to Disclose

Petra Georg MD, Abstract Co-Author: Nothing to Disclose

To demonstrate the feasibility of molecular imaging of cervix cancer with combined multiparametric PET-MRI using T2-weighted, dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), the tracer 18fluoro-desoxy-glucose (18FDG) for the detection of increased glycolysis and the tracer 18 fluoromisonidazole (18FMISO) for detection of tumor hypoxia at 3T.

In this IRB approved study five patients with cervix cancer underwent combined 3T MP 18FDG/18FMISO PET-MRI. The MRI protocol consisted of an isotropic T2-weighted SPACE (TR/TE 89/4630; SI 3mm isotropic; matrix 384 x 384, TA 3min 40sec), a DWI EPI sequence (TR/TE = 82/x6300s; SI 5mm; b-values 50 and 850 sec/mm²; matrix 192 x 156; TA 2min 20 sec) and an axial T1 VIBE with fat-sat (TR/TE 1.4/3.4 SI 3mm; matrix 480 x 360; TA 4min) before and after application of a standard dose Gd-DOTA (Dotarem). Patients were injected with approx. 300-700 MBq 18FDG and 330 MBq and subjected to 18FDG/18FMISO -PET-CT scanning (Siemens Biograph). CT data was used for attenuation correction. Co-registration of imaging data and image fusion were performed. Tumor size, enhancement-kinetics, restricted diffusivity and 18FDG/18FMISO –avidity was assessed. 

3T MP 18FDG/18FMISO PET-MRI was successfully performed in all patients. Tumor volumes ranged from 111.3-440cc (median: 213.2cc). Tumors demonstrated restricted diffusivity (ADC values 0.56-0.82 x 10-2 mm2/sec; median 0.72 x 10-2 mm2/sec). 4 tumors demonstrated initial strong enhancement followed by a wash-out (type III) and one tumor demonstrated initial strong enhancement and followed by a plateau (type II). Tumors were highly 18FDG-avid with SUVmax values ranging from 11.9-25.6 (median 18.2). None of the tumors were highly 18FMISO-avid (SUVmax 1.3-2.4, median 1.87). In two patients 18FMISO PET identified 18FMISO-avid spots (SUVmax 2 and 2.4) within the 18FDG-avid lesion indicative of areas of tumor hypoxia (cf Fig)

Molecular imaging with MP PET/MRI at 3T using T2-weighted, DCE-MRI, DWI, 18FDG and 18FMISO at 3T in patients with cervix cancer is feasible. 3T MP 18FDG/18FMISO PET-MRI provides unique information on tumor morphology and biology.

3T MP 18FDG/18FMISO PET-MRI identifies areas of tumor hypoxia, which are more resistant to radiation therapy and necessitate dose-escalation and thus enables an improved therapy planning.

Pinker-Domenig, K, Baltzer, P, Polanec, S, Magometschnigg, H, Andrezejewski, P, Georg, D, Helbich, T, Karanikas, G, Sturdza, A, Polterauer, S, Reinthaller, A, Poetter, R, Georg, P, Molecular Imaging of Cervix Cancer with Multiparametric 18FDG/18FMISO PET-MRI at 3Tesla: Proof of Concept.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005204.html