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Updated: Apr 5, 2026
Implantation and Monitoring by PET/CT of an Orthotopic Model of Human Pleural Mesothelioma in Athymic Mice
Published on: December 21, 2019
Characterization of hypoxia in malignant pleural mesothelioma with FMISO PET-CT
Roslyn J Francis1, Tatiana Segard2, Laurence Morandeau3
1School of Medicine and Pharmacology, University of Western Australia, Crawley 6009 & Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
Objectives:
Malignant pleural mesothelioma (MPM) is a chemotherapy resistant tumor with a poor prognosis. Hypoxia is increasingly recognized as an important factor in tumor aggressiveness and cellular resistance to chemotherapy and radiation treatment. This prospective pilot study was performed with [F-18] fluoromisonidazole (FMISO) PET-CT to characterize hypoxia in patients with MPM.
Materials And Methods:
Twenty prospectively recruited patients with histologically or cytologically confirmed MPM not currently receiving systemic or local treatment underwent both FMISO and fluorodeoxyglucose (FDG) PET-CT scans within 2 weeks. FMISO and FDG PET-CT scans were independently analyzed visually and semi-quantitatively using SUVmax and tumor to background ratio (TBR) in order to assess tumor hypoxia and metabolic activity. Lesion by lesion analysis was performed in sites of measurable pleural masses.
Results:
Visual analysis demonstrated tumor FMISO activity in 17 of 20 patients, and tumor FDG activity in 19 of 20 patients. Focal areas of bulky tumor were most likely to demonstrate hypoxia. In 19 patients suitable for semi-quantitative analysis the median FDG SUVmax was 6.4 (range 1.9-19.1), median FMISO SUVmax was 2.5 (range 1.4-3.7) and median FMISO TBR was 1.8 (1.1-2.5). There was a positive correlation between intensity of metabolic activity and hypoxia (r=0.72, p=0.001). Lesion by lesion analysis demonstrated a positive correlation between tumor thickness and FMISO activity (r=0.77, p<0.001).
Conclusion:
This pilot study confirms that MPM is a tumor with significant areas of hypoxia, particularly in dominant tumor masses. The relationship of tumor hypoxia to effectiveness of chemotherapy and/or radiation therapy warrants prospective assessment.
Insights
Malignant pleural mesothelioma (MPM) is a hypoxic tumor, especially in bulky masses. This [F-18] fluoromisonidazole (FMISO) PET-CT study highlights hypoxia
Area of Science:
- Oncology
- Nuclear Medicine
- Radiology
Background:
- Malignant pleural mesothelioma (MPM) is a difficult-to-treat cancer with poor outcomes.
- Tumor hypoxia is linked to cancer aggressiveness and resistance to therapies.
- Characterizing hypoxia in MPM is crucial for understanding treatment resistance.
Purpose of the Study:
- To investigate and characterize tumor hypoxia in patients with malignant pleural mesothelioma (MPM).
- To utilize [F-18] fluoromisonidazole (FMISO) Positron Emission Tomography-Computed Tomography (PET-CT) for hypoxia assessment.
- To correlate hypoxia with metabolic activity and tumor characteristics in MPM.
Main Methods:
- Prospective pilot study involving 20 patients with confirmed MPM.
- Patients underwent both [F-18] fluoromisonidazole (FMISO) and [F-18] fluorodeoxyglucose (FDG) PET-CT scans.
- Visual and semi-quantitative analyses (SUVmax, TBR) were performed on measurable pleural masses.
Main Results:
- Tumor hypoxia (FMISO uptake) was detected in 17 of 20 patients.
- Metabolic activity (FDG uptake) was present in 19 of 20 patients.
- Significant positive correlations were found between metabolic activity and hypoxia (r=0.72), and between tumor thickness and hypoxia (r=0.77).
Conclusions:
- Malignant pleural mesothelioma (MPM) exhibits significant tumor hypoxia, particularly in dominant masses.
- The findings suggest a link between hypoxia and tumor aggressiveness.
- Further prospective studies are needed to assess the impact of hypoxia on treatment efficacy.
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