Strahlentherapie und Onkologie

, Volume 194, Issue 8, pp 719–726 | Cite as

Voxel-wise correlation of functional imaging parameters in HNSCC patients receiving PET/MRI in an irradiation setup

  • Kerstin Zwirner
  • Daniela Thorwarth
  • René M. Winter
  • Stefan Welz
  • Jakob Weiss
  • Nina F. Schwenzer
  • Holger Schmidt
  • Christian la Fougère
  • Konstantin Nikolaou
  • Daniel Zips
  • Sergios Gatidis
Original Article



The purpose of this study was to demonstrate the feasibility of voxel-wise multiparametric characterization of head and neck squamous cell carcinomas (HNSCC) using hybrid multiparametric magnetic resonance imaging and positron emission tomography with [18F]-fluorodesoxyglucose (FDG-PET/MRI) in a radiation treatment planning setup.


Ten patients with locally advanced HNSCC were examined with a combined FDG-PET/MRI in an irradiation planning setup. The multiparametric imaging protocol consisted of FDG-PET, T2-weighted transverse short tau inversion recovery sequence (STIR) and diffusion-weighted MRI (DWI). Primary tumours were manually segmented and quantitative imaging parameters were extracted. PET standardized uptake values (SUV) and DWI apparent diffusion coefficients (ADC) were correlated on a voxel-wise level.


Images acquired in this specialised radiotherapy planning setup achieved good diagnostic quality. Median tumour volume was 4.9 [1.1–42.1] ml. Mean PET SUV and ADC of the primary tumours were 5 ± 2.5 and 1.2 ± 0.3 10−3 mm2/s, respectively. In voxel-wise correlation between ADC values and corresponding FDG SUV of the tumours, a significant negative correlation was observed (r = −0.31 ± 0.27, p < 0.05).


Multiparametric voxel-wise characterization of HNSCC is feasible using combined PET/MRI in a radiation planning setup. This technique may provide novel insights into tumour biology with regard to radiation therapy in the future.


Magnetic Resonance Imaging Multimodal Imaging Positron-Emission Tomography Radiotherapy Head and Neck Neoplasms 

Voxelweise Korrelation funktioneller PET/MRT-Parameter in Bestrahlungslagerung bei Patienten mit Kopf-Hals-Tumoren



Ziel der Studie war es, die Realisierbarkeit einer voxelweisen multiparametrischen Charakterisierung von Kopf-Hals-Tumoren mittels kombinierter Magnetresonanztomographie und Positronen-Emissions-Tomographie mit [18F]-Fluordesoxyglukose (FDG-PET/MRT) in Bestrahlungsposition zu untersuchen.


Zehn Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren wurden mittels FDG-PET/MRT in Bestrahlungslagerung untersucht. Das multiparametrische Bildgebungsprotokoll beinhaltete FDG-PET, eine transversale T2-gewichtete STIR-Sequenz („short tau inversion recovery“) sowie eine verzerrungsoptimierte Diffusionsbildgebung (DWI). Die Primärtumoren wurden zunächst manuell segmentiert. Anschließend wurden die quantitativen Bildgebungsparameter extrahiert. PET-SUV (standardized uptake values) und DWI-ADC (apparent diffusion coefficients) wurden voxelweise korreliert.


Die Bildgebung, die in diesem speziellen radioonkologischen Setup erhoben wurde, erreichte gute diagnostische Qualität. Das mediane Tumorvolumen betrug 4,9 ml (Spanne 1,1–42,1 ml). Die jeweiligen durchschnittlichen PET-SUV- und ADC-Werte der Primärtumoren ergaben 5 ± 2,5 und 1,2 ± 0,3 103 mm2/s. Die voxelweise Korrelation zwischen ADC-Werten und den dazugehörigen PET-SUVs der Tumoren zeigte eine signifikante negative Korrelation (r = −0,31 ± 0,27; p < 0,05).


Multiparametrische voxelweise Charakterisierungen von Kopf-Hals-Tumoren mittels kombiniertem PET/MRT sind in der Bestrahlungslagerung realisierbar. Diese Technik könnte zukünftig neuartige Einblicke in die Tumorbiologie im Hinblick auf die Strahlentherapie ermöglichen.


Magnetresonanztomographie Multiparametrische Bildgebung Positronen-Emissions-Tomographie Strahlentherapie Kopf-Hals Tumore 



We would like to thank the “Zentrum für Personalisierte Medizin (ZPM)” Tübingen/Germany for funding this project. Kerstin Zwirner is supported by the Fortüne/PATE Program of the Medical Faculty, Eberhard Karls University Tübingen (funding number: 2447-0-0).

Compliance with ethical guidelines

Conflict of interest

D. Zips has received research grants from Elekta and Siemens. K. Zwirner, D. Thorwarth, R. M. Winter, S. Welz, J. Weiss, N. F. Schwenzer, H. Schmidt, C. la Fougère, K. Nikolaou and S. Gatidis declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kerstin Zwirner
    • 1
  • Daniela Thorwarth
    • 2
    • 3
  • René M. Winter
    • 2
  • Stefan Welz
    • 1
    • 3
  • Jakob Weiss
    • 4
  • Nina F. Schwenzer
    • 4
  • Holger Schmidt
    • 4
  • Christian la Fougère
    • 3
    • 5
  • Konstantin Nikolaou
    • 3
    • 4
  • Daniel Zips
    • 1
    • 3
  • Sergios Gatidis
    • 4
  1. 1.Department of Radiation Oncology, Medical Faculty and University HospitalEberhard Karls University TübingenTübingenGermany
  2. 2.Section for Biomedical Physics, Department of Radiation Oncology, Medical Faculty and University HospitalEberhard Karls University TübingenTübingenGermany
  3. 3.German Cancer Research Center (DKFZ) partner site TübingenGerman Cancer Consortium (DKTK)TübingenGermany
  4. 4.Department of Diagnostic and Interventional Radiology, Medical Faculty and University HospitalEberhard Karls University TübingenTübingenGermany
  5. 5.Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Medical Faculty and University HospitalEberhard Karls University TübingenTübingenGermany

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