Hypoxia and glucose metabolism in malignant tumors: evaluation by [18F]fluoromisonidazole and [18F]fluorodeoxyglucose positron emission tomography imaging.
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.
Rajendran
Joseph G
JG
Department of Radiology, University of Washington, Seattle, 98195, USA. rajan@u.washington.edu
Mankoff
David A
DA
O'Sullivan
Finbarr
F
Peterson
Lanell M
LM
Schwartz
David L
DL
Conrad
Ernest U
EU
Spence
Alexander M
AM
Muzi
Mark
M
Farwell
D Greg
DG
Krohn
Kenneth A
KA
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*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose