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Hypoxia in Human Gliomas: Demonstration by PET with Fluorine-18-Fluoromisonidazole

Lawrence Berkeley Laboratory, University of California, Berkeley
University of California School of Medicine, San Francisco, California

Correspondence: For reprints contact: Peter E. Valk, MD, Northern California PET Imaging Center, 3195 Folsom Blvd., Sacramento, CA 95816.

ABSTRACT

Positron emission tomography (PET) with the hypoxic-cell tracer [¹⁸F]fluoromisonidazole presents a possible means of noninvasively demonstrating tumor hypoxia. PET studies using this tracer were performed in three patients with malignant glioma, and in all patients the tumor was clearly seen at 5 min postinjection and initial tumor activity exceeded cortical activity. In one patient, there was no tumor retention of [¹⁸F] fluoromisonidazole and tumor activity fell while cortical activity increased, with the two tissues reaching equality at 40–50 min. The tumor-to-plasma ratio was 0.71 at 3 hr. The other two patients showed variable tumor retention of [¹⁸F]fluoromisonidazole, with tumor-to-plasma ratios of 1.10 and 1.49 at 2 and 3 hr. These results demonstrate the feasibility of using [¹⁸F]fluoromisonidazole PET to detect hypoxia in human gliomas in vivo. Clinical trials are needed to determine whether a relationship exists between [¹⁸F]fluoromisonidazole uptake and tumor radiation response.

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