The purpose of this article is to provide a focused overview of the current use of positron emission tomography (PET) molecular imaging in the burgeoning era of
personalized medicine in the treatment of patients with
glioma. Specifically, we demonstrate the utility of PET imaging as a tool for personalized diagnosis and
therapy by highlighting a case series of four patients with recurrent high grade
glioma who underwent
18F-fluoromisonidazole (
FMISO) PET/MR (magnetic resonance) imaging through the course of antiangiogenic
therapy. Three distinct features were observed from this small cohort of patients. First, the presence of pseudoprogression was retrospectively associated with the absence of
hypoxia. Second, a subgroup of patients with recurrent high grade
glioma undergoing
bevacizumab therapy demonstrated
disease progression characterized by an enlarging nonenhancing mass with newly developed reduced diffusion, lack of
hypoxia, and preserved cerebral blood volume. Finally, a reduction in hypoxic volume was observed concurrent with
therapy in all patients with recurrent
tumor, and markedly so in two patients that developed a nonenhancing reduced diffusion mass. This case series demonstrates how medical imaging has the potential to influence
personalized medicine in several key aspects, especially involving molecular PET imaging for personalized diagnosis, patient specific disease prognosis, and therapeutic monitoring.