Rajendran Joseph G, Mankoff David A, O'Sullivan Finbarr, Peterson Lanell M, Schwartz David L, Conrad Ernest U, Spence Alexander M, Muzi Mark, Farwell D Greg, Krohn Kenneth A
Department of Radiology, University of Washington, Seattle, 98195, USA.
Clin Cancer Res. 2004 Apr 1;10(7):2245-52. doi: 10.1158/1078-0432.ccr-0688-3.
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.
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.
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).
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.
本研究旨在使用正电子发射断层扫描（PET）比较四种不同肿瘤类型中的葡萄糖代谢和缺氧情况。（18）F标记的氟脱氧葡萄糖（FDG）评估能量代谢，而（18）F标记的氟米索硝唑（FMISO）的摄取与组织缺氧成正比。尽管急性缺氧会导致糖酵解加速，但在慢性缺氧中细胞代谢会减慢，这促使我们寻找FMISO和FDG摄取之间的不一致性。
本研究纳入了49例患者（26例头颈部癌、11例软组织肉瘤、7例乳腺癌和5例多形性胶质母细胞瘤），这些患者在2003年2月之前作为研究方案的一部分接受了FMISO和FDG PET扫描。最大标准化摄取值用于描述FDG摄取，缺氧体积和最大组织：血液比值用于量化缺氧情况。对每个相应肿瘤平面的配准图像进行放射性示踪剂摄取的逐像素相关性分析。
在所有四个患者组中均检测到缺氧。头颈部癌中FMISO和FDG摄取之间的平均相关系数为0.62，乳腺癌为0.47，多形性胶质母细胞瘤为0.38，软组织肉瘤为0.32。FDG的总体肿瘤最大标准化摄取值与缺氧体积之间的相关性较小（Spearman秩相关系数r = 0.24），不同肿瘤类型之间存在高度显著差异（P < 0.005）。
缺氧是影响葡萄糖代谢的一个普遍因素；然而，一些缺氧肿瘤的葡萄糖代谢可能适度，而一些高代谢肿瘤并非缺氧，这表明示踪剂摄取存在不一致性，且可能具有肿瘤类型特异性。
