Prognostic radiology: Quantitative assessment of tumor oxygen dynamics by MRI

It is generally recognized that tumor hypoxia has a strong influence over therapeutic outcome in the clinic. The authors have developed an oximetry approach using ¹⁹F echo planar magnetic resonance imaging-FREDOM (Fluorocarbon Relaxometry using Echoplanar imaging for Dynamic Oxygen Mapping), which reveals dynamic changes based on sequential maps of regional tumor P_O2. Preclinical investigations focused on diverse sublines of the Dunning prostate R3327 tumor. As expected, intratumoral heterogeneity was considerable. However, large tumors (>3.5 cm³) were significantly less well oxygenated than smaller tumors (<2 cm³). Faster growing, less differentiated tumors were less well oxygenated than size-matched tumors of slower growing sublines. The greatest potential of this technique is the ability to follow the fate of individual tumor regions with respect to interventions. For each subline, there was a significant response to respiratory challenge with oxygen for initially well-oxygenated regions (baseline P_O2 > 10 mm Hg). More interestingly, subline dependent behavior was found for initially hypoxic regions that correlated with rate of growth. The authors believe the FREDOM approach is essentially ripe for translation to the clinic. This approach could help to identify patients with hypoxic tumors and indicate the feasibility of manipulating tumor characteristics through adjuvant interventions to improve therapeutic response.