title: Hypoxia and glucose metabolism in malignant tumors: evaluation by [18F]fluoromisonidazole and [18F]fluorodeoxyglucose positron emission tomography imaging.
abstract: OBJECTIVE
  The aim of this study is to compare glucose metabolism and hypoxia in four different tumor types using positron emission tomography (PET). (18)F-labeled fluorodeoxyglucose (FDG) evaluates energy metabolism, whereas the uptake of (18)F-labeled fluoromisonidazole (FMISO) is proportional to tissue hypoxia. Although acute hypoxia results in accelerated glycolysis, cellular metabolism is slowed in chronic hypoxia, prompting us to look for discordance between FMISO and FDG uptake.
  
  
  METHODS
  Forty-nine patients (26 with head and neck cancer, 11 with soft tissue sarcoma, 7 with breast cancer, and 5 with glioblastoma multiforme) who had both FMISO and FDG PET scans as part of research protocols through February 2003 were included in this study. The maximum standardized uptake value was used to depict FDG uptake, and hypoxic volume and maximum tissue:blood ratio were used to quantify hypoxia. Pixel-by-pixel correlation of radiotracer uptake was performed on coregistered images for each corresponding tumor plane.
  
  
  RESULTS
  Hypoxia was detected in all four patient groups. The mean correlation coefficients between FMISO and FDG uptake were 0.62 for head and neck cancer, 0.47 for breast cancer, 0.38 for glioblastoma multiforme, and 0.32 for soft tissue sarcoma. The correlation between the overall tumor maximum standardized uptake value for FDG and hypoxic volume was small (Spearman r = 0.24), with highly significant differences among the different tumor types (P < 0.005).
  
  
  CONCLUSIONS
  Hypoxia is a general factor affecting glucose metabolism; however, some hypoxic tumors can have modest glucose metabolism, whereas some highly metabolic tumors are not hypoxic, showing discordance in tracer uptake that can be tumor type specific.
authors.affiliation: Department of Radiology, University of Washington, Seattle, 98195, USA. rajan@u.washington.edu
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rajendran
authors.forename: David A
authors.initials: DA
authors.lastname: Mankoff
authors.forename: Finbarr
authors.initials: F
authors.lastname: O'Sullivan
authors.forename: Lanell M
authors.initials: LM
authors.lastname: Peterson
authors.forename: David L
authors.initials: DL
authors.lastname: Schwartz
authors.forename: Ernest U
authors.initials: EU
authors.lastname: Conrad
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Spence
authors.forename: Mark
authors.initials: M
authors.lastname: Muzi
authors.forename: D Greg
authors.initials: DG
authors.lastname: Farwell
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Krohn
mesh_terms: D045744:Cell Line, Tumor; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology*; D005947:Glucose / Q000378:metabolism*; D006019:Glycolysis; D006801:Humans; D000860:Hypoxia; D007091:Image Processing, Computer-Assisted; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000494:pharmacology*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose