A Comparative pO(2) Probe and [(18)F]-Fluoro-Azomycinarabino-Furanoside ([(18)F]FAZA) PET Study Reveals Anesthesia-Induced Impairment of Oxygenation and Perfusion in Tumor and Muscle

Tumor hypoxia can be identified by [(18)F]FAZA positron emission tomography, or invasively using oxygen probes. The impact of anesthetics on tumor hypoxia remains controversial. The aim of this comprehensive study was to investigate the impact of isoflurane and ketamine/xylazine anesthesia on [(18)F]FAZA uptake and partial oxygen pressure (pO(2)) in carcinoma and muscle tissue of air- and oxygen-breathing mice. METHODS: CT26 colon carcinoma-bearing mice were anesthetized with isoflurane (IF) or ketamine/xylazine (KX) while breathing air or oxygen (O(2)). We performed 10 min static PET scans 1 h, 2 h and 3 h after [(18)F]FAZA injection and calculated the [(18)F]FAZA-uptake and tumor-to-muscle ratios (T/M). In another experimental group, we placed a pO(2) probe in the tumor as well as in the gastrocnemius muscle to measure the pO(2) and perfusion. RESULTS: Ketamine/xylazine-anesthetized mice yielded up to 3.5-fold higher T/M-ratios compared to their isoflurane-anesthetized littermates 1 h, 2 h and 3 h after [(18)F]FAZA injection regardless of whether the mice breathed air or oxygen (3 h, KX-air: 7.1 vs. IF-air: 1.8, p = 0.0001, KX-O(2): 4.4 vs. IF-O(2): 1.4, p < 0.0001). The enhanced T/M-ratios in ketamine/xylazine-anesthetized mice were mainly caused by an increased [(18)F]FAZA uptake in the carcinomas. Invasive pO(2) probe measurements yielded enhanced intra-tumoral pO(2) values in air- and oxygen-breathing ketamine/xylazine-anesthetized mice compared to isoflurane-anesthetized mice (KX-air: 1.01 mmHg, IF-air: 0.45 mmHg; KX-O(2) 9.73 mmHg, IF-O(2): 6.25 mmHg). Muscle oxygenation was significantly higher in air-breathing isoflurane-anesthetized (56.9 mmHg) than in ketamine/xylazine-anesthetized mice (33.8 mmHg, p = 0.0003). CONCLUSION: [(18)F]FAZA tumor uptake was highest in ketamine/xylazine-anesthetized mice regardless of whether the mice breathed air or oxygen. The generally lower [(18)F]FAZA whole-body uptake in isoflurane-anesthetized mice could be due to the higher muscle pO(2)-values in these mice compared to ketamine/xylazine-anesthetized mice. When performing preclinical in vivo hypoxia PET studies, oxygen should be avoided, and ketamine/xylazine-anesthesia might alleviate the identification of tumor hypoxia areals.