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Cancer Imaging

Use of H₂¹⁵O-PET and DCE-MRI to Measure Tumor Blood Flow

Departments of ^aPulmonary Diseases, ^cPhysics and Medical Technology, and ^dNuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands; ^bDepartment of Pulmonary Diseases, Maastricht University Hospital, Maastricht, The Netherlands

Key Words. Positron emission tomography • Magnetic resonance imaging • Blood flow • Perfusion • Angiogenesis • Oncology

Correspondence: Mark Lubberink, Ph.D., Department of Nuclear Medicine & PET Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Telephone: 31-20-4444346; Fax: 31-20-4443090; e-mail: mark.lubberink{at}vumc.nl

Received November 29, 2007; accepted for publication April 9, 2008.

Disclosure: No potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Positron emission tomography (PET) with H₂¹⁵O and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) provide noninvasive measurements of tumor blood flow. Both tools offer the ability to monitor the direct target of antiangiogenic treatment, and their use is increasingly being studied in trials evaluating such drugs. Antiangiogenic therapy offers great potential and, to an increasing extent, benefit for oncological patients in a variety of palliative and curative settings. Because this type of targeted therapy frequently results in consolidation of the tumor mass instead of regression, monitoring treatment response with the standard volumetric approach (Response Evaluation Criteria in Solid Tumors) leads to underestimation of the response rate. Monitoring direct targets of anticancer therapy might be superior to indirect size changes. In addition, measures of tumor blood flow contribute to a better understanding of tumor biology.

This review shows that DCE-MRI and H₂¹⁵O-PET provide reliable measures of tumor perfusion, provided that a certain level of standardization is applied. Heterogeneity in scan acquisition and data analysis complicates the interpretation of study results. Also, limitations inherent to both techniques must be considered when interpreting DCE-MRI and H₂¹⁵O-PET results. This review focuses on the technical and physiological aspects of both techniques and aims to provide the essential information necessary to critically evaluate the use of DCE-MRI and H₂¹⁵O-PET in an oncological setting.