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Dual‐[18FMISO + 18FLT] PET/CT and MRI imaging in glioblastoma.

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Title: Dual‐[18FMISO + 18FLT] PET/CT and MRI imaging in glioblastoma.
Authors: Nehmeh, Sadek A.1 (AUTHOR) sadek.nehmeh@gmail.com, Cui, Chang1 (AUTHOR), Magge, Rajiv1 (AUTHOR), Schwartz, Theodore H.1 (AUTHOR), Schwartz, Jazmin2 (AUTHOR), Liechty, Benjamin1 (AUTHOR), Schuck, Phelipi1 (AUTHOR), Guhlke, Stefaan1 (AUTHOR), Calimag, William1 (AUTHOR), Barajas, Ramon F3 (AUTHOR), Kadrmas, Dan4 (AUTHOR), Fine, Howard1 (AUTHOR), Ivanidze, Jana1 (AUTHOR)
Source: Medical Physics. Oct2025, Vol. 52 Issue 10, p1-11. 11p.
Subjects: Glioblastoma multiforme, Astrocytomas, Positron emission tomography computed tomography, Positron emission tomography, Magnetic resonance imaging, Tumor microenvironment, Physiology, Radiopharmaceuticals
Abstract: Background: Tumor hypoxia and proliferation are independent predictors of poor prognosis in glioblastoma and WHO grade 4 IDH‐mutant astrocytoma, and are closely linked and can synergistically contribute to local recurrence (LR) and poor overall survival (OS). These two hallmarks can be imaged using FMISO and FLT PET, but only on different days due to the PET intrinsic limitation, which jeopardizes the clinical feasibility and accuracy of multi‐parametric studies. Purpose: In this study, we assess the feasibility of dual‐[FMISO+FLT]‐PET in a cohort of patients with glioblastoma and WHO grade 4 IDH‐mutant astrocytoma. Methods: Eight patients underwent 90 min dynamic PET (dynPET) with staggered FMISO/FLT injections followed by two 10 min scans at 120 and 180 min post‐FMISO injection, respectively. The target volume (TV) was delineated on the 180‐min imageset. The FMISO input function (IF) was derived from dynPET images of the carotids using the first 50 min, and then extrapolated to the rest of dynPET using a 3‐exp fit. The IFFLT was deduced by subtracting the IFFMISO from IFFMISO+FLT over the range > 50 min. The FMISO and FLT kinetic rate constants (KRCs) of the TV and cerebellar cortex (reference tissue) were estimated using kinetic modeling (KM) with a parallel dual‐1‐tissue‐2‐compartment model. Results: Seven out of eight patients with a total of 13 lesions completed the study. All lesions were [FMISO+FLT]‐avid at 180 min post‐FMISO injection with a mean SUVR of 1.72 (range:1.26–3.23). IDH‐mutant WHO grade 4 astrocytomas showed reduced tumor hypoxia. Mean lesion KRCs were K1‐FMISO = 0.18 mL/cc/min (range:0.042–0.432), ki‐FMISO = 0.011 min−1 (range:0.00–0.039), K1‐FLT = 0.103 mL/cc/min (range: 0.004–0.357), and Ki‐FLT = 0.014 mL/min/g (range: 0.00–0.062). Cerebellar cortex KRCs were K1‐FMISO = 0.098 mL/cc/min (range:0.055–0.225), ki‐FMISO = 0.008 min−1 (range:0.002–0.014), K1‐FLT = 0.089 mL/cc/min (range: 0.001–0.299), and Ki‐FLT = 0.003 mL/min/g (range:0.00–0.007). Lesion perfusion and hypoxia were inversely correlated (R = 0.99). Conclusions: Dual‐[FMISO+FLT]‐PET can provide detailed characterization of tumor microenvironment and interaction of multiple hallmarks that yield radio‐resistance. This can improve the accuracy of image‐guided radiosurgery and radiotherapy, thereby improving clinical outcomes in patients with glioblastoma and IDH‐mutant WHO grade 4 astrocytoma. [ABSTRACT FROM AUTHOR]
Copyright of Medical Physics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Dual‐[<superscript>18</superscript>FMISO + <superscript>18</superscript>FLT] PET/CT and MRI imaging in glioblastoma.
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  Data: <searchLink fieldCode="AR" term="%22Nehmeh%2C+Sadek+A%2E%22">Nehmeh, Sadek A.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> sadek.nehmeh@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Cui%2C+Chang%22">Cui, Chang</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Magge%2C+Rajiv%22">Magge, Rajiv</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schwartz%2C+Theodore+H%2E%22">Schwartz, Theodore H.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schwartz%2C+Jazmin%22">Schwartz, Jazmin</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Liechty%2C+Benjamin%22">Liechty, Benjamin</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schuck%2C+Phelipi%22">Schuck, Phelipi</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Guhlke%2C+Stefaan%22">Guhlke, Stefaan</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Calimag%2C+William%22">Calimag, William</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Barajas%2C+Ramon+F%22">Barajas, Ramon F</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kadrmas%2C+Dan%22">Kadrmas, Dan</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fine%2C+Howard%22">Fine, Howard</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ivanidze%2C+Jana%22">Ivanidze, Jana</searchLink><relatesTo>1</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Medical+Physics%22">Medical Physics</searchLink>. Oct2025, Vol. 52 Issue 10, p1-11. 11p.
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  Data: <searchLink fieldCode="DE" term="%22Glioblastoma+multiforme%22">Glioblastoma multiforme</searchLink><br /><searchLink fieldCode="DE" term="%22Astrocytomas%22">Astrocytomas</searchLink><br /><searchLink fieldCode="DE" term="%22Positron+emission+tomography+computed+tomography%22">Positron emission tomography computed tomography</searchLink><br /><searchLink fieldCode="DE" term="%22Positron+emission+tomography%22">Positron emission tomography</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Tumor+microenvironment%22">Tumor microenvironment</searchLink><br /><searchLink fieldCode="DE" term="%22Physiology%22">Physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Radiopharmaceuticals%22">Radiopharmaceuticals</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Tumor hypoxia and proliferation are independent predictors of poor prognosis in glioblastoma and WHO grade 4 IDH‐mutant astrocytoma, and are closely linked and can synergistically contribute to local recurrence (LR) and poor overall survival (OS). These two hallmarks can be imaged using FMISO and FLT PET, but only on different days due to the PET intrinsic limitation, which jeopardizes the clinical feasibility and accuracy of multi‐parametric studies. Purpose: In this study, we assess the feasibility of dual‐[FMISO+FLT]‐PET in a cohort of patients with glioblastoma and WHO grade 4 IDH‐mutant astrocytoma. Methods: Eight patients underwent 90 min dynamic PET (dynPET) with staggered FMISO/FLT injections followed by two 10 min scans at 120 and 180 min post‐FMISO injection, respectively. The target volume (TV) was delineated on the 180‐min imageset. The FMISO input function (IF) was derived from dynPET images of the carotids using the first 50 min, and then extrapolated to the rest of dynPET using a 3‐exp fit. The IFFLT was deduced by subtracting the IFFMISO from IFFMISO+FLT over the range > 50 min. The FMISO and FLT kinetic rate constants (KRCs) of the TV and cerebellar cortex (reference tissue) were estimated using kinetic modeling (KM) with a parallel dual‐1‐tissue‐2‐compartment model. Results: Seven out of eight patients with a total of 13 lesions completed the study. All lesions were [FMISO+FLT]‐avid at 180 min post‐FMISO injection with a mean SUVR of 1.72 (range:1.26–3.23). IDH‐mutant WHO grade 4 astrocytomas showed reduced tumor hypoxia. Mean lesion KRCs were K1‐FMISO = 0.18 mL/cc/min (range:0.042–0.432), ki‐FMISO = 0.011 min−1 (range:0.00–0.039), K1‐FLT = 0.103 mL/cc/min (range: 0.004–0.357), and Ki‐FLT = 0.014 mL/min/g (range: 0.00–0.062). Cerebellar cortex KRCs were K1‐FMISO = 0.098 mL/cc/min (range:0.055–0.225), ki‐FMISO = 0.008 min−1 (range:0.002–0.014), K1‐FLT = 0.089 mL/cc/min (range: 0.001–0.299), and Ki‐FLT = 0.003 mL/min/g (range:0.00–0.007). Lesion perfusion and hypoxia were inversely correlated (R = 0.99). Conclusions: Dual‐[FMISO+FLT]‐PET can provide detailed characterization of tumor microenvironment and interaction of multiple hallmarks that yield radio‐resistance. This can improve the accuracy of image‐guided radiosurgery and radiotherapy, thereby improving clinical outcomes in patients with glioblastoma and IDH‐mutant WHO grade 4 astrocytoma. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of Medical Physics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1002/mp.18124
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        Text: English
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    Subjects:
      – SubjectFull: Glioblastoma multiforme
        Type: general
      – SubjectFull: Astrocytomas
        Type: general
      – SubjectFull: Positron emission tomography computed tomography
        Type: general
      – SubjectFull: Positron emission tomography
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      – SubjectFull: Magnetic resonance imaging
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      – SubjectFull: Tumor microenvironment
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      – SubjectFull: Physiology
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      – SubjectFull: Radiopharmaceuticals
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      – TitleFull: Dual‐[18FMISO + 18FLT] PET/CT and MRI imaging in glioblastoma.
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              M: 10
              Text: Oct2025
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