A water-soluble glucose conjugate of the hypoxia tracer 64 Cudiacetyl-bis(N 4 -methylthiosemicarbazone) ( 64 Cu-ATSM) was synthesized and radiolabeled ( 64 Cu-ATSE/A-G). Here we report our initial biological experiments with 64 Cu-ATSE/A-G and compare the results with those obtained for 64 Cu-ATSM and 18 F-FDG. Methods: The uptake of 64 Cu-ATSE/A-G and 64 Cu-ATSM into HeLa cells in vitro was investigated at a range of dissolved oxygen concentrations representing normoxia, hypoxia, and anoxia. Small-animal PET with 64 Cu-ATSE/A-G was performed in male BDIX rats implanted with P22 syngeneic carcinosarcomas. Images of 64 Cu-ATSM and 18 F-FDG were obtained in the same model for comparison. Results: 64 CuATSE/A-G showed oxygen concentration-dependent uptake in vitro and, under anoxic conditions, showed slightly lower levels of cellular uptake than 64 Cu-ATSM; uptake levels under hypoxic conditions were also lower. Whereas the normoxic uptake of 64 Cu-ATSM increased linearly over time, 64 Cu-ATSE/A-G uptake remained at low levels over the entire time course. In the PET study, 64 CuA-TSE/A-G showed good tumor uptake and a biodistribution pattern substantially different from that of each of the controls. In marked contrast to the findings for 64 Cu-ATSM, renal clearance and accumulation in the bladder were observed. 64 Cu-ATSE/A-G did not display the characteristic brain and heart uptake of 18 F-FDG. Conclusion: The in vitro cell uptake studies demonstrated that 64 Cu-ATSE/A-G retained hypoxia selectivity and had improved characteristics when compared with 64 Cu-ATSM. The in vivo PET results indicated a difference in the excretion pathways, with a shift from primarily hepatointestinal for 64 Cu-ATSM to partially renal with 64 Cu-ATSE/A-G. This finding is consistent with the hydrophilic nature of the glucose conjugate. A comparison with 18 F-FDG PET results revealed that 64 Cu-ATSE/A-G was not a surrogate for glucose metabolism. We have demonstrated that our method for the modification of Cu-bis(thiosemicarbazonato) complexes allows their biodistribution to be modified without negating their hypoxia selectivity or tumor uptake properties.