title: Detection of hypoxia with 18F-fluoromisonidazole (18F-FMISO) PET/CT in suspected or proven pancreatic cancer.
abstract: OBJECTIVE
  Pancreatic carcinoma is known to demonstrate molecular features of hypoxia. The aim of this prospective pilot study is to analyze the hypoxia agent fluoromisonidazole (FMISO) using PET/CT in pancreatic carcinoma and to compare FMISO activity with glucose metabolism reflected by FDG.
  
  
  METHODS
  Ten patients with pancreatic carcinoma underwent FMISO and FDG PET scans. FMISO and FDG PET/CT scans were analyzed by 2 PET physicians. Regions of interest drawn on the FDG images were transposed to the FMISO images after study coregistration. The FDG SUVmax was used to quantify metabolic activity and FMISO SUVmax and tumor-to-background (muscle) ratio to quantify hypoxia.
  
  
  RESULTS
  Seven patients were diagnosed with pancreatic adenocarcinoma. The remaining patients had a neuroendocrine tumor, poorly differentiated/sarcomatoid carcinoma, and mucinous neoplasm. Visual analysis demonstrated increased FMISO activity in 2 pancreatic adenocarcinomas. All patients, however, had increased FDG activity at the tumor site. Mean FDG SUVmax was 6 (range: 3.8 to 9.5) compared to 2.3 for FMISO (range: 1 to 3.4). The 2 positive studies on visual analysis of FMISO did not correspond to the largest tumors, the studies with the highest FMISO or FDG SUVmax. There was no significant correlation between FMISO and FDG SUVmax values.
  
  
  CONCLUSIONS
  The hypoxia imaging agent, FMISO, demonstrates minimal activity in pancreatic tumors. If FMISO PET/CT is to be included in clinical trial protocols of hypoxia in pancreatic cancer, it would require correlation with other imaging modalities to localize the tumor and allow semiquantitative analysis.
authors.affiliation: Nuclear Medicine Department/WA PET Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, Australia. Tatiana.segard@health.wa.gov.au
authors.forename: Tatiana
authors.initials: T
authors.lastname: Segard
authors.forename: Peter D
authors.initials: PD
authors.lastname: Robins
authors.forename: Ian F
authors.initials: IF
authors.lastname: Yusoff
authors.forename: Hooi
authors.initials: H
authors.lastname: Ee
authors.forename: Laurence
authors.initials: L
authors.lastname: Morandeau
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Campbell
authors.forename: Roslyn J
authors.initials: RJ
authors.lastname: Francis
mesh_terms: D000328:Adult; D000368:Aged; D015687:Cell Hypoxia; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008920:Misonidazole / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D064847:Multimodal Imaging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: C031843:fluoromisonidazole; D019788:Fluorodeoxyglucose F18; D008920:Misonidazole