Total choline in tumors is associated with increased aggressiveness. Since the distribution of total choline in tumors is usually heterogenous, here we have examined the relationship between high and low total choline, obtained with 1H MRSI, with hypoxia and necrosis in a human breast cancer xenograft model engineered to express red fluorescence protein under hypoxic conditions. We found that the highest total choline regions were associated with hypoxia. We also observed that overall total choline in tumors inversely correlated with the necrotic fraction, suggesting that reduced total choline may reflect increased cell death in tumors.
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