PMC4678574_01
FMISO PET image fused with the corresponding CT displayed on a tumour-to-blood ratio (TBR) colour scale. Red regions depict a TBR greater than 1.4, indicating hypoxia, and no visible PET depicts a TBR below 1, indicating normoxia. This axial image shows the unexpected hypoxic bone metastasis indicated by the white arrow in addition to hypoxic nodal disease in the mediastinum.
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F1
A pre-treatment FMISO PET-CT scan identified an occult, asymptomatic scapular metastasis (Figure 1) undetectable on routine CT imaging (Figure 2a). The FMISO image (Figure 1) also shows hypoxia within mediastinal nodes.
CT contrast enhanced image reformatted using 1.25 mm axial thickness for (a) a bone reconstruction showing that the bone metastasis visible on FMISO PET is not visible on CT and (b) standard reconstruction showing the enlarged mediastinal nodal disease shown to be hypoxic on the FMISO PET
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F2
A pre-treatment FMISO PET-CT scan identified an occult, asymptomatic scapular metastasis (Figure 1) undetectable on routine CT imaging (Figure 2a). The enlarged nodes were seen on the routine CT imaging (Figure 2b) unlike the occult scapular metastasis.