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Case Reports in Radiology
Volume 2015, Article ID 731361, 4 pages
Case Report

Assessing Biological Response to Bevacizumab Using 18F-Fluoromisonidazole PET/MR Imaging in a Patient with Recurrent Anaplastic Astrocytoma

1Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
2Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Room 779 M, San Francisco, CA 94143-0112, USA
3Department of Radiation Oncology, UCSF Long Hospital, 505 Parnassus Avenue, San Francisco, CA 94143-0226, USA

Received 22 December 2014; Revised 19 January 2015; Accepted 2 February 2015

Academic Editor: Marco Leonardi

Copyright © 2015 Ramon F. Barajas Jr. et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We present our initial experience in using single modality fluoromisonidazole (FMISO) PET/MR imaging to noninvasively evaluate the biological effects induced by bevacizumab therapy in a patient treated for recurrent high grade glioma. In this index patient, bevacizumab therapy resulted in the development of nonenhancing tumor characterized by reduced diffusion and markedly decreased FMISO uptake in the setting of maintained CBF and CBV. These observations suggest that the dynamic biological interplay between tissue hypoxia and vascular normalization occurring within treated recurrent high grade glioma can be captured utilizing FMISO PET/MR imaging.