18F-FMISO PET imaging: insights over MRI in patients with glioma

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Hypoxic tumors have been demonstrated to be associated with amplified resistance to radiotherapy, chemo-resistance and less favorable outcome after surgery. Non-invasive identification and quantification of hypoxia in humans affected by glioma can be achieved using PET/CT and MRI techniques, although their use is still limited to the research setting. The objective of this review is to present an update of the literature about the potential clinical utility of FMISO PET imaging for the evaluation of hypoxia in patients with glioma, in comparison with advanced MRI techniques, when available.


A comprehensive search strategy was used based on SCOPUS and PubMed databases using the following terms: “FMISO”/“Fluoromisonidazole” AND “brain tumor”/“glioma” AND “PET”/“Positron Emission Tomography”. From all studies published in English, we selected—for this review—the most relevant articles of the last 20 years, evaluating the use of FMISO PET in glioma patients, and comparing PET findings with MRI imaging (when available).


The use of PET/CT with hypoxia radiotracers in glioma is still limited due to fragmentary data and scarce number of clinical trials in this setting. The most used PET radiotracer for the quantification of hypoxia brain tumor is 18F-FMISO and advanced MRI techniques may provide additional value, especially to couple perfusion information to hypoxia data obtained by PET. As example, relative cerebral blood volume maps could be integrated with PET imaging results for more precise and integrated evaluation of hypoxia, neo-angiogenesis and necrotic areas.


Hypoxia PET imaging has demonstrated potential benefits for grading, diagnostic and prognostic purposes, despite the lack of tangible results able to introduce such method in a wide clinical setting. MRI remains the gold standard in the morphologic evaluation of glioma, but the integration of results provided by 18F-FMISO PET imaging concerning hypoxia might provide new crucial information in patients with glioma.

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Fig. 1

(adapted with the permission of Hirata et al. [21])


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Author information

Laudicella R, Quartuccio N: literature search, literature review, manuscript writing, manuscript editing, content planning; Alongi P, Albano D, Gazzilli M, Durmo R: literature search, literature review, manuscript writing; Baldari S, Bertagna F: manuscript editing, content planning.

Correspondence to Albano Domenico.

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Laudicella Riccardo, Quartuccio Natale, Alongi Pierpaolo, Albano Domenico, Gazzilli Maria, Durmo Rexhep, Bertagna Francesco and Baldari Sergio declare no conflict of interest related to this work.

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Riccardo, L., Natale, Q., Pierpaolo, A. et al. 18F-FMISO PET imaging: insights over MRI in patients with glioma. Clin Transl Imaging (2020) doi:10.1007/s40336-019-00353-0

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  • PET
  • Glioma
  • Hypoxia
  • MRI