title: PET with 62Cu-ATSM and 62Cu-PTSM is a useful imaging tool for hypoxia and perfusion in pulmonary lesions.
abstract: OBJECTIVE
  Hypoxia is a characteristic of many tumors and portends a worse prognosis in lung, cervical, prostate, and rectal cancers. Unlike the others, lung cancers present a unique challenge in measuring hypoxia, with invasive biopsies and higher rates of complications. Noninvasive imaging studies detecting hypoxia using isotopes of copper-diacetyl-bis(N4-methylthiosemicarbazone) ((62)Cu-ATSM) have predicted prognosis and treatment outcomes in some small feasibility trials. These images, however, may not identify all areas of hypoxia. Hence, we hypothesize that the addition of another PET imaging agent, copper-pyruvaldehyde-bis(N4-methylthiosemicarbazone) ((62)Cu-PTSM), which can detect areas of perfusion, can augment the information obtained in (62)Cu-ATSM PET scans.
  
  
  METHODS
  To characterize tumors on the basis of both perfusion and hypoxia, 10 patients were studied using both (62)Cu-ATSM and (62)Cu-PTSM PET scans. In addition, proteomic arrays looking at specific proangiogenic, survival, and proinflammatory targets were assessed.
  
  
  RESULTS
  Six of 10 patients had evaluable PET scans. Our initial experience of characterizing lung tumor hypoxia using (62)Cu-ATSM and (62)Cu-PTSM PET scans showed that visualization of areas with hypoxia normalized for perfusion is feasible. All studied tumors exhibited some hypoxia. Despite the small sample size, a positive relationship was noted between epidermal growth factor levels and (62)Cu-ATSM-detected hypoxia.
  
  
  CONCLUSIONS
  This initial series of (62)Cu-ATSM and (62)Cu-PTSM PET scans shows that evaluating lung masses by visualizing hypoxia and perfusion is a feasible and novel technique to provide more information. Further investigation is warranted to assess the potential role of (62)Cu-ATSM and (62)Cu-PTSM PET techniques combined with proteomics as alternatives to invasive biopsy techniques in clinical care.
authors.affiliation: 1 Division of Medical Oncology, Department of Medicine, Duke University Hospital, Rm 047 Baker House, Trent Dr, DUMC 3624, Durham, NC 27710.
authors.forename: Tian
authors.initials: T
authors.lastname: Zhang
authors.forename: Shiva K
authors.initials: SK
authors.lastname: Das
authors.forename: Diane R
authors.initials: DR
authors.lastname: Fels
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Hansen
authors.forename: Terence Z
authors.initials: TZ
authors.lastname: Wong
authors.forename: Mark W
authors.initials: MW
authors.lastname: Dewhirst
authors.forename: Gordana
authors.initials: G
authors.lastname: Vlahovic
mesh_terms: D000368:Aged; D056831:Coordination Complexes; D016207:Cytokines / Q000097:blood; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D000860:Hypoxia; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D015996:Survival Rate; D013882:Thiosemicarbazones
chemical_list: D056831:Coordination Complexes; D016207:Cytokines; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D013882:Thiosemicarbazones; C089548:copper (II) diacetyl-di(N(4)-methylthiosemicarbazone); D019788:Fluorodeoxyglucose F18; C052629:copper pyruvaldehyde bis(N(4)-methylthiosemicarbazone) complex