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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Objective: The aim of this study was to analyse early and delayed acquisition on copper-64 diacetyl-bisN4-methylthiosemicarbazone (64Cu-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 64Cu-ATSM PET/CT. Participants received an intravenous injection of 64Cu-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 64Cu-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 3 (range: 2.8-453.7) and a median HB of 161.5 cm 3 (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 64Cu-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
Externally publishedYes


  • copper-64 diacetyl-bis N 4-methylthiosemicarbazone
  • delayed imaging
  • early imaging
  • fractals
  • hypoxia imaging
  • image analysis
  • positron emission tomography/computed tomography


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