A1 Refereed original research article in a scientific journal

Imaging of Tumor Hypoxia With F-18-EF5 PET/MRI in Cervical Cancer




AuthorsNarva Sara I., Seppänen Marko P., Raiko Juho R. H., Forsback Sarita J., Orte Katri J., Virtanen Johanna M., Hynninen Johanna, Hietanen Sakari

PublisherLIPPINCOTT WILLIAMS & WILKINS

Publication year2021

JournalClinical Nuclear Medicine

Journal name in sourceCLINICAL NUCLEAR MEDICINE

Journal acronymCLIN NUCL MED

Volume46

Issue12

First page 952

Last page957

Number of pages6

ISSN0363-9762

eISSN1536-0229

DOIhttps://doi.org/10.1097/RLU.0000000000003914(external)

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/67997614(external)


Abstract

Purpose of the Report
The aim of this study was to evaluate the distribution of hypoxia using 18F-EF5 as a hypoxia tracer in cervical cancer patients with PET/MRI. We investigated the association between this 18F-EF5-PET tracer and the immunohistochemical expression of endogenous hypoxia markers: HIF1α, CAIX, and GLUT1.

Patients and Methods
Nine patients with biopsy-proven primary squamous cell cervix carcinoma (FIGO 2018 radiological stages IB1–IIIC2r) were imaged with dual tracers 18F-EF5 and 18F-FDG using PET/MRI (Int J Gynaecol Obstet. 2019;145:129–135). 18F-EF5 images were analyzed by calculating the tumor-to-muscle ratio to determine the hypoxic tissue (T/M ratio >1.5) and further hypoxic subvolume (HSV) and percentage hypoxic area. These 18F-EF5 hypoxic parameters were correlated with the size and localization of tumors in 18F-FDG PET/MRI and the results of hypoxia immunohistochemistry.

Results
All primary tumors were clearly 18F-FDG and 18F-EF5 PET positive and heterogeneously hypoxic with multiple 18F-EF5–avid areas in locally advanced cancer and single areas in clinically stage I tumors. The location of hypoxia was detected mainly in the periphery of tumor. Hypoxia parameters 18F-EF5 max T/M ratio and HSV in primary tumors correlated independently with the advanced stage (P = 0.036 and P = 0.040, respectively), and HSV correlated with the tumor size (P = 0.027). The location of hypoxia in 18F-EF5 imaging was confirmed with a higher hypoxic marker expression HIF1α and CAIX in tumor fresh biopsies.

Conclusions
The 18F-EF5 imaging has promising potential in detecting areas of tumor hypoxia in cervical cancer.


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Last updated on 2024-26-11 at 18:12