Role of [18F]FMISO PET Imaging for the Evaluation of Gliomas: A Comprehensive Literature Review

[18F]fluoromisonidazole ([18F]FMISO) positron emission tomography (PET) imaging has been explored for its potential use as an added modality for the assessment of gliomas. The aim of this review was to synthesize the existing literature investigating this topic. A comprehensive search of the PubMed/MEDLINE, Scopus, and Embase databases was performed to identify eligible original research investigating the role of [18F]FMISO PET imaging for the evaluation of gliomas. Thirty-tree studies were included in the present review. Overall, the findings reported suggest that [18F]FMISO PET may have relevant clinical implications in glioma assessment and management, including improved tumor characterization, differential diagnosis between different grades and other neoplasms, prognostic stratification, and potential guidance for personalized therapeutic strategies. The available evidence supports the idea that [18F]FMISO PET can act as a robust and biologically meaningful imaging modality in gliomas. Its strengths lie in tumor grading, prognostication, and treatment monitoring, particularly in glioblastoma. Future research should focus on standardized imaging protocols, integration with molecular classification frameworks, and validation of hypoxia-guided therapeutic strategies.