Early and delayed evaluation of solid tumours with 64Cu-ATSM PET/CT: a pilot study on semiquantitative and computer-aided fractal geometry analysis

Egesta Lopci, Fabio Grizzi, Carlo Russo, Luca Toschi, Ilaria Grassi, Gianfranco Cicoria, Filippo Lodi, Sandro Mattioli, Stefano Fanti

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: The aim of this study was to analyse early and delayed acquisition on copper-64 diacetyl-bisN4-methylthiosemicarbazone (Cu-ATSM) PET/CT in a small cohort of patients by comparing semiquantitative and computer-aided fractal geometry analyses.

PATIENTS AND METHODS: Five cancer patients, including non-small-cell lung cancer and head and neck cancer, were investigated with Cu-ATSM PET/CT. Participants received an intravenous injection of Cu-ATSM according to body size and were imaged 60 min (early) and 16 h (delayed) later on hybrid PET/CT. Reconstructed images were visualized on advanced workstations for the definition of semiquantitative parameters: standardized uptake value (SUV)max, SUVratio-to-muscle, SUVmean, hypoxic volume (HV) and hypoxic burden (HB=HV×SUVmean). DICOM data retrieved from both scans were analysed using an ad-hoc computer program to determine the mean intensity value, SD, relative dispersion, three-dimensional histogram fractal dimension and three-dimensional fractal dimension.

RESULTS: All tumour lesions showed increased uptake of Cu-ATSM at early evaluation, with a median SUVratio-to-muscle of 4.42 (range: 1.58-5.62), a median SUVmax of 5.3 (range: 1.9-7.3), a median SUVmean of 2.8 (range: 1.5-3.9), a median HV of 41.6 cm (range: 2.8-453.7) and a median HB of 161.5 cm (range: 4.4-1112.5). All semiquantitative data obtained at 1 h were consistent with the parameters obtained on delayed imaging (P>0.05). A borderline statistically significant difference was found only for SUVmax of the muscle (P=0.045). Fractal geometry analysis on DICOM images showed that all parameters at early imaging showed no statistically significant difference with late acquisition (P>0.05).

CONCLUSION: Our findings support the consistency of Cu-ATSM PET/CT images obtained at early and delayed acquisition for the assessment of tumour lesions.

Original languageEnglish
Pages (from-to)340-346
Number of pages7
JournalNuclear Medicine Communications
Issue number4
Publication statusPublished - Apr 2017


  • Aged
  • Carcinoma, Non-Small-Cell Lung
  • Copper Radioisotopes
  • Female
  • Fractals
  • Head and Neck Neoplasms
  • Humans
  • Image Interpretation, Computer-Assisted
  • Lung Neoplasms
  • Male
  • Middle Aged
  • Organometallic Compounds
  • Pilot Projects
  • Positron Emission Tomography Computed Tomography
  • Radiopharmaceuticals
  • Thiosemicarbazones
  • Evaluation Studies
  • Journal Article


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