Quantifying regional hypoxia in human tumors with positron emission tomography of [18F]fluoromisonidazole: A pretherapy study of 37 patients

Janet S. Rasey, Wui Jin Koh, Margaret L. Evans, Lanell M. Peterson, Thomas K. Lewellen, Michael M. Graham, Kenneth A. Krohn

Research output: Contribution to journalArticlepeer-review

525 Scopus citations


Purpose: To assess pretreatment hypoxia in a variety of tumors using positron emission tomography (PET) after injection of the hypoxia-binding radiopharmaceutical [18F]fluoromisonidazole ([18F]FMISO). Methods and Materials: Tumor fractional hypoxic volume (FHV) was determined in 21 nonsmall cell lung cancer patients, 7 head and neck cancer patients, 4 prostate cancer patients, and 5 patients with other malignancies by quantitative PET imaging after injection of [18F]FMISO (0.1 mCi/kg). The FHV was defined as the proportion of pixels in the intaged tumor volume with a tissue:blood [18F] activity ratio ≤ 1.4 at 120-160 min postinjection. A FHV > 0 was taken as evidence for tumor hypoxia. Results: Hypoxia was observed in 36 of 37 tumors studied with FMISO PET imaging; FHVs ranged from 0 to 94.7%. In nonsmall cell lung cancers (n = 21), the median FHV was 47.6% and the range, 1.3 to 94.7%. There was no correlation between tumor size and FHV. In the seven head and neck carcinomas, the median FHV was 8.8%, with a range from 0.2 to 18.9%. In the group of four prostate cancers, the median and range were 18.2% and 0 to 93.9%, while in a group of five tumors of different types the median FHV was 55.2% (range: 21.4 to 85.8%). Conclusions: Hypoxia was present in 97% of the tumors studied and the extent of hypoxia varied markedly between tumors in the same site or of the same histology. Hypoxia also was distributed heterogeneously between regions within a single tumor. These results are consistent with O2 electrode measures with other types of human tumors. The intra- and intertumor variability indicate the importance of making oxygenation measures in individual tumors and the necessity to sample as much of the tumor volume as possible.

Original languageEnglish (US)
Pages (from-to)417-428
Number of pages12
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number2
StatePublished - Sep 1 1996
Externally publishedYes


  • Hypoxia
  • Imaging
  • Positron emission tomography
  • [F]fluoromisonidazole

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


Dive into the research topics of 'Quantifying regional hypoxia in human tumors with positron emission tomography of [18F]fluoromisonidazole: A pretherapy study of 37 patients'. Together they form a unique fingerprint.

Cite this