1
|
Gouel P, Decazes P, Vera P, Gardin I, Thureau S, Bohn P. Advances in PET and MRI imaging of tumor hypoxia. Front Med (Lausanne) 2023; 10:1055062. [PMID: 36844199 PMCID: PMC9947663 DOI: 10.3389/fmed.2023.1055062] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Tumor hypoxia is a complex and evolving phenomenon both in time and space. Molecular imaging allows to approach these variations, but the tracers used have their own limitations. PET imaging has the disadvantage of low resolution and must take into account molecular biodistribution, but has the advantage of high targeting accuracy. The relationship between the signal in MRI imaging and oxygen is complex but hopefully it would lead to the detection of truly oxygen-depleted tissue. Different ways of imaging hypoxia are discussed in this review, with nuclear medicine tracers such as [18F]-FMISO, [18F]-FAZA, or [64Cu]-ATSM but also with MRI techniques such as perfusion imaging, diffusion MRI or oxygen-enhanced MRI. Hypoxia is a pejorative factor regarding aggressiveness, tumor dissemination and resistance to treatments. Therefore, having accurate tools is particularly important.
Collapse
Affiliation(s)
- Pierrick Gouel
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Decazes
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Vera
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Isabelle Gardin
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Sébastien Thureau
- QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,Département de Radiothérapie, Centre Henri Becquerel, Rouen, France
| | - Pierre Bohn
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,*Correspondence: Pierre Bohn,
| |
Collapse
|
2
|
Huang Y, Fan J, Li Y, Fu S, Chen Y, Wu J. Imaging of Tumor Hypoxia With Radionuclide-Labeled Tracers for PET. Front Oncol 2021; 11:731503. [PMID: 34557414 PMCID: PMC8454408 DOI: 10.3389/fonc.2021.731503] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/19/2021] [Indexed: 01/27/2023] Open
Abstract
The hypoxic state in a solid tumor refers to the internal hypoxic environment that appears as the tumor volume increases (the maximum radius exceeds 180-200 microns). This state can promote angiogenesis, destroy the balance of the cell’s internal environment, and lead to resistance to radiotherapy and chemotherapy, as well as poor prognostic factors such as metastasis and recurrence. Therefore, accurate quantification, mapping, and monitoring of hypoxia, targeted therapy, and improvement of tumor hypoxia are of great significance for tumor treatment and improving patient survival. Despite many years of development, PET-based hypoxia imaging is still the most widely used evaluation method. This article provides a comprehensive overview of tumor hypoxia imaging using radionuclide-labeled PET tracers. We introduced the mechanism of tumor hypoxia and the reasons leading to the poor prognosis, and more comprehensively included the past, recent and ongoing studies of PET radiotracers for tumor hypoxia imaging. At the same time, the advantages and disadvantages of mainstream methods for detecting tumor hypoxia are summarized.
Collapse
Affiliation(s)
- Yuan Huang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Junying Fan
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yi Li
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shaozhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Oncology, Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| | - Yue Chen
- Department of Oncology, Academician (Expert) Workstation of Sichuan Province, Luzhou, China.,Nuclear Medicine and Molecular Imaging key Laboratory of Sichuan Province, Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Oncology, Academician (Expert) Workstation of Sichuan Province, Luzhou, China
| |
Collapse
|
3
|
Abstract
Over the last few years, cancer immunotherapy experienced tremendous developments and it is nowadays considered a promising strategy against many types of cancer. However, the exclusion of lymphocytes from the tumor nest is a common phenomenon that limits the efficiency of immunotherapy in solid tumors. Despite several mechanisms proposed during the years to explain the immune excluded phenotype, at present, there is no integrated understanding about the role played by different models of immune exclusion in human cancers. Hypoxia is a hallmark of most solid tumors and, being a multifaceted and complex condition, shapes in a unique way the tumor microenvironment, affecting gene transcription and chromatin remodeling. In this review, we speculate about an upstream role for hypoxia as a common biological determinant of immune exclusion in solid tumors. We also discuss the current state of ex vivo and in vivo imaging of hypoxic determinants in relation to T cell distribution that could mechanisms of immune exclusion and discover functional-morphological tumor features that could support clinical monitoring.
Collapse
|
4
|
Hypoxia PET imaging beyond 18F-FMISO in patients with high-grade glioma: 18F-FAZA and other hypoxia radiotracers. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00358-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
5
|
Correlation of hypoxia as measured by fluorine-18 fluoroerythronitroimidazole ( 18F-FETNIM) PET/CT and overall survival in glioma patients. Eur J Nucl Med Mol Imaging 2019; 47:1427-1434. [PMID: 31776634 DOI: 10.1007/s00259-019-04621-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/14/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Hypoxia is important in the biology of glioma in humans. Positron emission tomography/computed tomography (PET/CT) with a hypoxia tracer offers a noninvasive method to differentiate individual tumor biology and potentially modify treatment for patients with malignancies. The purpose of this study was to determine whether hypoxia, as measured by fluorine-18 fluoroerythronitroimidazole (18F-FETNIM) PET/CT, was associated with tumor grade, overall survival (OS), and immunohistochemical features related to hypoxia, proliferation, angiogenesis, and the invasion of gliomas. PROCEDURES Twenty-five patients with gliomas in whom gross maximal resection could be safely attempted were analyzed. All patients underwent 18F-FETNIM PET/CT studies before surgery. The maximum standardized uptake value (SUVmax) was obtained from the PET images of tumor tissues. Tumor specimens were stereotactically obtained for the immunohistochemical staining of hypoxia-inducible factor-1 alpha (HIF-1α), Ki-67, vascular endothelial growth factor (VEGF), and matrix metalloproteinase 9 (MMP-9). RESULTS A correlation between the SUVmax and glioma grade was found (r = 0.881, P < 0.001). The SUVmax was significantly correlated with the expression of HIF-1α, Ki-67, VEGF, and MMP-9 (r = 0.820, 0.747, 0.606, and 0.727; all P < 0.001). Patients with a high SUVmax had significantly worse 3-year OS than those with a low SUVmax (24.4% vs. 82.1%, P = 0.003). CONCLUSIONS 18F-FETNIM PET/CT provides an excellent noninvasive assessment of hypoxia in glioma. It can be used to understand the mechanisms by which hypoxia affects the OS of glioma patients.
Collapse
|
6
|
Lin CM, Yu CF, Huang HY, Chen FH, Hong JH, Chiang CS. Distinct Tumor Microenvironment at Tumor Edge as a Result of Astrocyte Activation Is Associated With Therapeutic Resistance for Brain Tumor. Front Oncol 2019; 9:307. [PMID: 31106146 PMCID: PMC6498880 DOI: 10.3389/fonc.2019.00307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/03/2019] [Indexed: 12/01/2022] Open
Abstract
Tumor vasculatures and hypoxia are critical tumor micro-environmental factors associated with tumor response to the therapy and heterogeneous in both time- and location-dependent manner. Using a murine orthotopic anaplastic astrocytoma model, ALTS1C1, this study showed that brain tumor edge had a very unique microenvironment, having higher microvascular density (MVD) and better vessel function than the tumor core, but on the other hand was also positive for hypoxia markers, such as pimonidazole (PIMO), hypoxia inducible factor-1α (HIF-1α), and carbonic anhydrase IV (CAIX). The hypoxia at tumor edge was transient, named as peripheral hypoxia, and caused by different mechanisms from the chronic hypoxia in tumor core. The correlation of CAIX staining with astrocyte activation marker, glial fibrillary acid protein (GFAP), at the tumor edge indicated the involvement of astrocyte activation on the development of peripheral hypoxia. Peripheral hypoxia was a specific trait of orthotopic brain tumors at tumor edge, regardless of tumor origin. The hypoxic cells were resistant to the therapy, regardless of their location. Surviving cells, particularly those at the hypoxic region of tumor edge, are likely the cause of tumor recurrence after the therapy. New therapeutic platform that targets cells in tumor edge is likely to achieve better treatment outcomes.
Collapse
Affiliation(s)
- Chiu-Min Lin
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Ching-Fang Yu
- Department of Radiation Oncology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.,Radiation Biology Research Center, Institute for Radiological Research, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Ya Huang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan.,Education & Medical Research National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Fang-Hsin Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.,Radiation Biology Research Center, Institute for Radiological Research, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.,Radiation Biology Research Center, Institute for Radiological Research, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Shiun Chiang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan.,Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu, Taiwan.,Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan
| |
Collapse
|
7
|
Resolution of Hypoxic Tissue in Cerebellar Hemispheres After Arterial Bypass Surgery in a Patient With Symptomatic Bilateral Vertebral Artery Occlusion: A 18F-FRP170 PET Study. Clin Nucl Med 2019; 44:295-296. [PMID: 30688740 DOI: 10.1097/rlu.0000000000002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 48-year-old man experienced recurrent vertigo refractory to antiplatelet medications. Cerebral angiography showed occlusion of bilateral vertebral arteries with poor collateral circulation. PET using O2 gas showed reduced blood flow and metabolic rate of oxygen and elevated oxygen extraction fraction in bilateral cerebellar hemispheres. Subsequent F-FRP170 (1-(2-F-fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole) PET, which depicts hypoxic but viable tissue, revealed elevated tracer uptake in the same regions. After superficial temporal artery-posterior cerebral artery anastomosis, O-gas PET showed normalization of blood flow, metabolic rate of oxygen, and oxygen extraction fraction in bilateral cerebellar hemispheres. Abnormally elevated F-FRP-170 uptake was also resolved in those regions.
Collapse
|
8
|
Gomez-Roman N, Stevenson K, Gilmour L, Hamilton G, Chalmers AJ. A novel 3D human glioblastoma cell culture system for modeling drug and radiation responses. Neuro Oncol 2017; 19:229-241. [PMID: 27576873 PMCID: PMC5463789 DOI: 10.1093/neuonc/now164] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Glioblastoma (GBM) is the most common primary brain tumor, with dismal prognosis. The failure of drug-radiation combinations with promising preclinical data to translate into effective clinical treatments may relate to the use of simplified 2-dimensional in vitro GBM cultures. Methods We developed a customized 3D GBM culture system based on a polystyrene scaffold (Alvetex) that recapitulates key histological features of GBM and compared it with conventional 2D cultures with respect to their response to radiation and to molecular targeted agents for which clinical data are available. Results In 3 patient-derived GBM lines, no difference in radiation sensitivity was observed between 2D and 3D cultures, as measured by clonogenic survival. Three different molecular targeted agents, for which robust clinical data are available were evaluated in 2D and 3D conditions: (i) temozolomide, which improves overall survival and is standard of care for GBM, exhibited statistically significant effects on clonogenic survival in both patient-derived cell lines when evaluated in the 3D model compared with only one cell line in 2D cells; (ii) bevacizumab, which has been shown to increase progression-free survival when added to standard chemoradiation in phase III clinical trials, exhibited marked radiosensitizing activity in our 3D model but had no effect on 2D cells; and (iii) erlotinib, which had no efficacy in clinical trials, displayed no activity in our 3D GBM model, but radiosensitized 2D cells. Conclusions Our 3D model reliably predicted clinical efficacy, strongly supporting its clinical relevance and potential value in preclinical evaluation of drug-radiation combinations for GBM.
Collapse
Affiliation(s)
- Natividad Gomez-Roman
- Wolfson Wohl Translational Cancer Research Center, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Katrina Stevenson
- Wolfson Wohl Translational Cancer Research Center, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Lesley Gilmour
- Wolfson Wohl Translational Cancer Research Center, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Graham Hamilton
- Wolfson Wohl Translational Cancer Research Center, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Anthony J Chalmers
- Wolfson Wohl Translational Cancer Research Center, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
9
|
Challapalli A, Carroll L, Aboagye EO. Molecular mechanisms of hypoxia in cancer. Clin Transl Imaging 2017; 5:225-253. [PMID: 28596947 PMCID: PMC5437135 DOI: 10.1007/s40336-017-0231-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/21/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Hypoxia is a condition of insufficient oxygen to support metabolism which occurs when the vascular supply is interrupted, or when a tumour outgrows its vascular supply. It is a negative prognostic factor due to its association with an aggressive tumour phenotype and therapeutic resistance. This review provides an overview of hypoxia imaging with Positron emission tomography (PET), with an emphasis on the biological relevance, mechanism of action, highlighting advantages, and limitations of the currently available hypoxia radiotracers. METHODS A comprehensive PubMed literature search was performed, identifying articles relating to biological significance and measurement of hypoxia, MRI methods, and PET imaging of hypoxia in preclinical and clinical settings, up to December 2016. RESULTS A variety of approaches have been explored over the years for detecting and monitoring changes in tumour hypoxia, including regional measurements with oxygen electrodes placed under CT guidance, MRI methods that measure either oxygenation or lactate production consequent to hypoxia, different nuclear medicine approaches that utilise imaging agents the accumulation of which is inversely related to oxygen tension, and optical methods. The advantages and disadvantages of these approaches are reviewed, along with individual strategies for validating different imaging methods. PET is the preferred method for imaging tumour hypoxia due to its high specificity and sensitivity to probe physiological processes in vivo, as well as the ability to provide information about intracellular oxygenation levels. CONCLUSION Even though hypoxia could have significant prognostic and predictive value in the clinic, the best method for hypoxia assessment has in our opinion not been realised.
Collapse
Affiliation(s)
- Amarnath Challapalli
- Department of Clinical Oncology, Bristol Cancer Institute, Horfield Road, Bristol, United Kingdom
| | - Laurence Carroll
- Department of Surgery and Cancer, Imperial College, GN1, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W120NN United Kingdom
| | - Eric O. Aboagye
- Department of Surgery and Cancer, Imperial College, GN1, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W120NN United Kingdom
| |
Collapse
|
10
|
Mallia MB, Mittal S, Sarma HD, Banerjee S. Modulation of in vivo distribution through chelator: Synthesis and evaluation of a 2-nitroimidazole–dipicolylamine–99mTc(CO)3 complex for detecting tumor hypoxia. Bioorg Med Chem Lett 2016; 26:46-50. [DOI: 10.1016/j.bmcl.2015.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/26/2015] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
|
11
|
Boonzaier NR, Piccirillo SGM, Watts C, Price SJ. Assessing and monitoring intratumor heterogeneity in glioblastoma: how far has multimodal imaging come? CNS Oncol 2015; 4:399-410. [PMID: 26497327 DOI: 10.2217/cns.15.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Glioblastoma demonstrates imaging features of intratumor heterogeneity that result from underlying heterogeneous biological properties. This stems from variations in cellular behavior that result from genetic mutations that either drive, or are driven by, heterogeneous microenvironment conditions. Among all imaging methods available, only T1-weighted contrast-enhancing and T2-weighted fluid-attenuated inversion recovery are used in standard clinical glioblastoma assessment and monitoring. Advanced imaging modalities are still considered emerging techniques as appropriate end points and robust methodologies are missing from clinical trials. Discovering how these images specifically relate to the underlying tumor biology may aid in improving quality of clinical trials and understanding the factors involved in regional responses to treatment, including variable drug uptake and effect of radiotherapy. Upon validation and standardization of emerging MR techniques, providing information based on the underlying tumor biology, these images may allow for clinical decision-making that is tailored to an individual's response to treatment.
Collapse
Affiliation(s)
- Natalie R Boonzaier
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Sara G M Piccirillo
- Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK
| | - Colin Watts
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Stephen J Price
- Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK
| |
Collapse
|
12
|
Saura H, Ogasawara K, Beppu T, Yoshida K, Kobayashi M, Yoshida K, Terasaki K, Takai Y, Ogawa A. Hypoxic viable tissue in human chronic cerebral ischemia because of unilateral major cerebral artery steno-occlusive disease. Stroke 2015; 46:1250-6. [PMID: 25873597 DOI: 10.1161/strokeaha.114.008238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/16/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Positron emission tomography (PET) with radiolabeled 2-nitroimidazoles directly detects hypoxic but viable tissue present in an acute ischemic area in the human brain. This study using PET with 1-(2-(18)F-fluoro-1-[hydroxymethyl]ethoxy) methyl-2-nitroimidazole ((18)F-FRP170) aimed to determine whether tissue with an abnormally elevated uptake of (18)F-FRP170 exists in human chronic cerebral ischemia because of unilateral atherosclerotic major cerebral artery steno-occlusive disease. METHODS (18)F-FRP170 PET was performed, and cerebral blood flow and metabolism were assessed using (15)O-gas PET in 20 healthy subjects and 52 patients. A region of interest (ROI) was automatically placed in 3 segments of the middle cerebral artery territory in both cerebral hemispheres with a 3-dimensional stereotaxic ROI template using SPM2, and each PET value was determined in each ROI. The ratio of values in the affected versus contralateral hemispheres was calculated for the (18)F-FRP170 PET image. RESULTS A significant correlation was observed between oxygen extraction fraction and (18)F-FRP170 ratios (ρ=0.509; P<0.0001) in a total of 156 ROIs in 52 patients. The specificity and positive-predictive value for a combination of an elevated oxygen extraction fraction and a moderately reduced cerebral oxygen metabolism for detection of an abnormally elevated (18)F-FRP170 ratio (19 ROIs: 12%) were significantly greater than those for the individual categories (elevated oxygen extraction fraction, moderately reduced cerebral oxygen metabolism, or reduced cerebral blood flow). CONCLUSIONS Tissues with abnormally elevated uptake of (18)F-FRP170 exist in human chronic cerebral ischemia characterized by a combination of misery perfusion and moderately reduced oxygen metabolism because of unilateral atherosclerotic major cerebral artery steno-occlusive disease.
Collapse
Affiliation(s)
- Hiroaki Saura
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.).
| | - Kuniaki Ogasawara
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| | - Takaaki Beppu
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| | - Koji Yoshida
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| | - Masakazu Kobayashi
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| | - Kenji Yoshida
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| | - Kazunori Terasaki
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| | - Yoshihiro Takai
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| | - Akira Ogawa
- From the Department of Neurosurgery (H.S., K.O., T.B., Koji Yoshida, M.K., Kenji Yoshida, A.O.) and Cyclotron Research Center (K.T.), School of Medicine, Iwate Medical University, Morioka, Japan; and Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan (Y.T.)
| |
Collapse
|
13
|
Shibahara I, Saito R, Zhang R, Chonan M, Shoji T, Kanamori M, Sonoda Y, Kumabe T, Kanehira M, Kikuchi T, So T, Watanabe T, Takahashi H, Iwabuchi E, Tanaka Y, Shibahara Y, Sasano H, Ishii N, Tominaga T. OX40 ligand expressed in glioblastoma modulates adaptive immunity depending on the microenvironment: a clue for successful immunotherapy. Mol Cancer 2015; 14:41. [PMID: 25744203 PMCID: PMC4339477 DOI: 10.1186/s12943-015-0307-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022] Open
Abstract
Background Glioblastoma is the most malignant human brain tumor and has a dismal prognosis; however, some patients show long-term survival. The interaction between the costimulatory molecule OX40 and its ligand OX40L generates key signals for T-cell activation. The augmentation of this interaction enhances antitumor immunity. In this present study, we explored whether OX40 signaling is responsible for antitumor adaptive immunity against glioblastoma and also established therapeutic antiglioma vaccination therapy. Methods Tumor specimens were obtained from patients with primary glioblastoma (n = 110) and grade III glioma (n = 34). Quantitative polymerase chain reaction (PCR), flow cytometry, and immunohistochemistry were used to analyze OX40L expression in human glioblastoma specimens. Functional consequences of OX40 signaling were studied using glioblastoma cell lines, mouse models of glioma, and T cells isolated from human subjects and mice. Cytokine production assay with mouse regulatory T cells was conducted under hypoxic conditions (1.5% O2). Results OX40L mRNA was expressed in glioblastoma specimens and higher levels were associated with prolonged progression-free survival of patients with glioblastoma, who had undergone gross total resection. In this regard, OX40L protein was expressed in A172 human glioblastoma cells and its expression was induced under hypoxia, which mimics the microenvironment of glioblastoma. Notably, human CD4 T cells were activated when cocultured in anti-CD3-coated plates with A172 cells expressing OX40L, as judged by the increased production of interferon-γ. To confirm the survival advantage of OX40L expression, we then used mouse glioma models. Mice bearing glioma cells forced to express OX40L did not die during the observed period after intracranial transplantation, whereas all mice bearing glioma cells lacking OX40L died. Such a survival benefit of OX40L was not detected in nude mice with an impaired immune system. Moreover, compared with systemic intraperitoneal injection, the subcutaneous injection of the OX40 agonist antibody together with glioma cell lysates elicited stronger antitumor immunity and prolonged the survival of mice bearing glioma or glioma-initiating cell-like cells. Finally, OX40 triggering activated regulatory T cells cultured under hypoxia led to the induction of the immunosuppressive cytokine IL10. Conclusion Glioblastoma directs immunostimulation or immunosuppression through OX40 signaling, depending on its microenvironment. Electronic supplementary material The online version of this article (doi:10.1186/s12943-015-0307-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ichiyo Shibahara
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Ryuta Saito
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Rong Zhang
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Masashi Chonan
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Takuhiro Shoji
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Yukihiko Sonoda
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Masahiko Kanehira
- Department of Respiratory Oncology and Molecular Medicine, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Toshiaki Kikuchi
- Department of Respiratory Oncology and Molecular Medicine, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Takanori So
- Department of Immunology, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Takashi Watanabe
- Department of Public Health, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Hiroaki Takahashi
- Department of Pathology, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Erina Iwabuchi
- Department of Pathology, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Yuetsu Tanaka
- Department of Immunology, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215, Japan.
| | - Yukiko Shibahara
- Department of Pathology, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Naoto Ishii
- Department of Immunology, Tohoku University School of Medicine, Sendai, 980-8575, Miyagi, Japan.
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| |
Collapse
|
14
|
High-uptake areas on positron emission tomography with the hypoxic radiotracer (18)F-FRP170 in glioblastomas include regions retaining proliferative activity under hypoxia. Ann Nucl Med 2015; 29:336-41. [PMID: 25618012 PMCID: PMC4661197 DOI: 10.1007/s12149-015-0951-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/17/2015] [Indexed: 01/18/2023]
Abstract
Objective The aim was to evaluate the proliferative activity of high-uptake areas on positron emission tomography (PET) with the hypoxic cell radiotracer, 1-(2-[18F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole (FRP170). Methods Thirteen patients with glioblastoma underwent FRP170 PET before tumor resection. During surgery, tumor specimens were stereotaxically obtained from regions corresponding to high (high-uptake areas, HUAs) and relatively low (low-uptake areas, LUAs) accumulation of FRP170. We compared immunohistochemical staining for Ki-67 and hypoxia-inducible factor (HIF)-1α between HUA and LUA. Results HIF-1α index was significantly higher in HUAs than in LUAs. In contrast, mean Ki-67 indices did not differ significantly between HUAs and LUAs. Conclusions Findings for HIF-1α index clearly indicated that HUAs on FRP170 PET represented hypoxic regions in glioblastoma. However, findings of Ki-67 index suggest that HUAs on FRP170 PET include regions retaining proliferative activity regardless of tissue hypoxia.
Collapse
|
15
|
Fleming IN, Manavaki R, Blower PJ, West C, Williams KJ, Harris AL, Domarkas J, Lord S, Baldry C, Gilbert FJ. Imaging tumour hypoxia with positron emission tomography. Br J Cancer 2015; 112:238-50. [PMID: 25514380 PMCID: PMC4453462 DOI: 10.1038/bjc.2014.610] [Citation(s) in RCA: 234] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/30/2014] [Accepted: 11/10/2014] [Indexed: 01/02/2023] Open
Abstract
Hypoxia, a hallmark of most solid tumours, is a negative prognostic factor due to its association with an aggressive tumour phenotype and therapeutic resistance. Given its prominent role in oncology, accurate detection of hypoxia is important, as it impacts on prognosis and could influence treatment planning. A variety of approaches have been explored over the years for detecting and monitoring changes in hypoxia in tumours, including biological markers and noninvasive imaging techniques. Positron emission tomography (PET) is the preferred method for imaging tumour hypoxia due to its high specificity and sensitivity to probe physiological processes in vivo, as well as the ability to provide information about intracellular oxygenation levels. This review provides an overview of imaging hypoxia with PET, with an emphasis on the advantages and limitations of the currently available hypoxia radiotracers.
Collapse
Affiliation(s)
- I N Fleming
- Aberdeen Biomedical Imaging Centre, Lilian Sutton Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - R Manavaki
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218-Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - P J Blower
- Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, King's College London, 4th Floor, Lambeth Wing, London SE1 7EH, UK
| | - C West
- Manchester Academic Health Science Centre, Institute of Cancer Sciences, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK
| | - K J Williams
- Manchester Pharmacy School, Faculty of Medical and Human Sciences, University Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
- EPSRC and CRUK Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK
| | - A L Harris
- Molecular Oncology Laboratories, University Department of Medical Oncology, The Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK
| | - J Domarkas
- Centre for Cardiovascular and Metabolic Research, Respiratory Medicine, Hull-York Medical School, University of Hull, Hull HU16 5JQ, UK
| | - S Lord
- Molecular Oncology Laboratories, University Department of Medical Oncology, The Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK
| | - C Baldry
- Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, King's College London, 4th Floor, Lambeth Wing, London SE1 7EH, UK
| | - F J Gilbert
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218-Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- EPSRC and CRUK Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK
| |
Collapse
|
16
|
Standardized uptake value in high uptake area on positron emission tomography with 18F-FRP170 as a hypoxic cell tracer correlates with intratumoral oxygen pressure in glioblastoma. Mol Imaging Biol 2014; 16:127-35. [PMID: 23873661 DOI: 10.1007/s11307-013-0670-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to clarify the reliability of positron emission tomography (PET) using a new hypoxic cell tracer, 1-(2-[(18)F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole ((18)F-FRP170). PROCEDURES Twelve patients with glioblastoma underwent (18)F-FRP170 PET before tumor resection. Mean standardized uptake value (SUV) and normalized SUV were calculated at regions within a tumor showing high (high-uptake area) and relatively low (low-uptake area) accumulations of (18)F-FRP170. In these areas, intratumoral oxygen pressure (tpO2) was measured using microelectrodes during tumor resection. RESULTS Mean tpO2 was significantly lower in the high-uptake area than in the low-uptake area. A significant negative correlation was evident between normalized SUV and tpO2 in the high-uptake area. CONCLUSION The present findings suggest that high accumulation on (18)F-FRP170 PET represents viable hypoxic tissues in glioblastoma.
Collapse
|
17
|
Nguyen N, Montagnese J, Rogers LR, Sher A, Wolansky L. Positron emission tomography-magnetic resonance imaging in the evaluation of brain tumors: current status and future prospects. Semin Roentgenol 2014; 49:275-89. [PMID: 25497912 DOI: 10.1053/j.ro.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Nghi Nguyen
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jesse Montagnese
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lisa R Rogers
- Department of Neurology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Andrew Sher
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Leo Wolansky
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
| |
Collapse
|
18
|
Kelada OJ, Carlson DJ. Molecular imaging of tumor hypoxia with positron emission tomography. Radiat Res 2014; 181:335-49. [PMID: 24673257 DOI: 10.1667/rr13590.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The problem of tumor hypoxia has been recognized and studied by the oncology community for over 60 years. From radiation and chemotherapy resistance to the increased risk of metastasis, low oxygen concentrations in tumors have caused patients with many types of tumors to respond poorly to conventional cancer therapies. It is clear that patients with high levels of tumor hypoxia have a poorer overall treatment response and that the magnitude of hypoxia is an important prognostic factor. As a result, the development of methods to measure tumor hypoxia using invasive and noninvasive techniques has become desirable to the clinical oncology community. A variety of imaging modalities have been established to visualize hypoxia in vivo. Positron emission tomography (PET) imaging, in particular, has played a key role for imaging tumor hypoxia because of the development of hypoxia-specific radiolabelled agents. Consequently, this technique is increasingly used in the clinic for a wide variety of cancer types. Following a broad overview of the complexity of tumor hypoxia and measurement techniques to date, this article will focus specifically on the accuracy and reproducibility of PET imaging to quantify tumor hypoxia. Despite numerous advances in the field of PET imaging for hypoxia, we continue to search for the ideal hypoxia tracer to both qualitatively and quantitatively define the tumor hypoxic volume in a clinical setting to optimize treatments and predict response in cancer patients.
Collapse
Affiliation(s)
- Olivia J Kelada
- a Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut; and
| | | |
Collapse
|
19
|
Abstract
This review addresses the specific contributions of nuclear medicine techniques, and especially positron emission tomography (PET), for diagnosis and management of brain tumors. (18)F-Fluorodeoxyglucose PET has particular strengths in predicting prognosis and differentiating cerebral lymphoma from nonmalignant lesions. Amino acid tracers including (11)C-methionine, (18)F-fluoroethyltyrosine, and (18)F-L-3,4-dihydroxyphenylalanine provide high sensitivity, which is most useful for detecting recurrent or residual gliomas, including most low-grade gliomas. They also play an increasing role for planning and monitoring of therapy. (18)F-fluorothymidine can only be used in tumors with absent or broken blood-brain barrier and has potential for tumor grading and monitoring of therapy. Ligands for somatostatin receptors are of particular interest in pituitary adenomas and meningiomas. Tracers to image neovascularization, hypoxia, and phospholipid synthesis are under investigation for potential clinical use. All methods provide the maximum of information when used with image registration and fusion display with contrast-enhanced magnetic resonance imaging scans. Integration of PET and magnetic resonance imaging with stereotactic neuronavigation systems allows the targeting of stereotactic biopsies to obtain a more accurate histologic diagnosis and better planning of conformal and stereotactic radiotherapy.
Collapse
Affiliation(s)
- Karl Herholz
- School of Cancer and Enabling Sciences, The University of Manchester, Wolfson Molecular Imaging Centre, Manchester, England.
| | | | | | | |
Collapse
|
20
|
Tateishi K, Tateishi U, Sato M, Yamanaka S, Kanno H, Murata H, Inoue T, Kawahara N. Application of 62Cu-diacetyl-bis (N4-methylthiosemicarbazone) PET imaging to predict highly malignant tumor grades and hypoxia-inducible factor-1α expression in patients with glioma. AJNR Am J Neuroradiol 2013; 34:92-9. [PMID: 22700754 DOI: 10.3174/ajnr.a3159] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Hypoxic tissue evaluation in glioma is important for predicting treatment response and establishing antihypoxia therapy. In this preliminary study, (62)Cu-ATSM PET was used to determine its validity as a biomarker for distinguishing tumor grade and tissue hypoxia. MATERIALS AND METHODS (62)Cu-ATSM PET was performed in 22 patients with glioma, and the (62)Cu-ATSM SUV(max) and T/B ratio were semiquantitatively evaluated. (62)Cu-ATSM uptake distribution was qualitatively evaluated and compared with MR imaging findings. HIF-1α expression, a hypoxia marker, was compared with (62)Cu-ATSM uptake values. RESULTS The (62)Cu-ATSM SUV(max) and T/B ratio were significantly higher in grade IV than in grade III gliomas (P = .014 and .018, respectively), whereas no significant differences were found between grade III and grade II gliomas. At a T/B ratio cutoff threshold of 1.8, (62)Cu-ATSM uptake was predictive of HIF-1α expression, with 92.3% sensitivity and 88.9% specificity. The mean T/B ratio was also significantly higher in HIF-1α-positive glioma tissue than in HIF-1α-negative tissue (P = .001). Using this optimal threshold of T/B ratio, (62)Cu-ATSM PET showed regional uptake in 61.9% (13/21) of tumors within the contrast-enhanced region on MR imaging, which was significantly correlated with presence of a necrotic component (P = .002). CONCLUSIONS Our results demonstrated that (62)Cu-ATSM uptake is relatively high in grade IV gliomas and correlates with the MR imaging findings of necrosis. Moreover, the (62)Cu-ATSM T/B ratio showed significant correlation with HIF-1α expression. Thus, (62)Cu-ATSM appears to be a suitable biomarker for predicting highly malignant grades and tissue hypoxia in patients with glioma.
Collapse
Affiliation(s)
- K Tateishi
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
Hypoxia plays a central role in tumour development, angiogenesis, growth and resistance to treatment. Owing to constant developments in medical imaging technology, significant advances have been made towards in vitro and in vivo imaging of hypoxia in a variety of tumours, including gliomas of the central nervous system. The aim of this article is to review the literature on imaging approaches currently available for measuring hypoxia in human gliomas and provide an insight into recent advances and future directions in this field. After a brief overview of hypoxia and its importance in gliomas, several methods of measuring hypoxia will be presented. These range from invasive monitoring by Eppendorf polarographic O(2) microelectrodes, positron electron tomography (PET) tracers based on 2-nitroimidazole compounds [(18)F-labelled fluoro-misonidazole ((18)F-MISO) or 1-(2-[((18))F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole (FRP-170)], (64)Cu-ATSM Cu-diacetyl-bis(N4-methylthiosemicarbazone) (Cu-ATSM) or (99m)Tc- and (68)Ga-labelled metronidazole (MN) agents to advanced MRI methods, such as blood oxygenation level dependent (BOLD) MRI, oxygen-enhanced MRI, diffusion-weighted MRI (DWI-MRI), dynamic contrast-enhanced MRI (DCE-MRI) and (1)H-magnetic resonance spectroscopy.
Collapse
Affiliation(s)
- I Mendichovszky
- Wolfson Molecular Imaging Centre, University of Manchester, Withington, Manchester, UK
| | | |
Collapse
|