18F-Choline PET/CT Pitfalls in Image Interpretation

Abstract

It is necessary for nuclear physicians, during clinical practice, to consider the possibility of F-choline uptake in some benign or malignant conditions for the intrinsic pharmacologic property of the tracer. An accurate medical investigation, correlative imaging with CT and/or MRI with contrast agents, laboratory data, and above all, histologic examination are often necessary for correct diagnosis.

Detection of a second malignancy in prostate cancer patients by using [18F]Choline PET/CT: a case series

“…The suspicious of a second malignancy was supposed based on PET/CT findings (i.e. “unusual” site of [ 18 F]Cho uptake not consistent with clinical-instrumental history) according to previously reported by Calabria et al [11]. …”

New Acquisition Protocol of18F-Choline PET/CT in Prostate Cancer Patients: Review of the Literature about Methodology and Proposal of Standardization

“…There was a large variability on every aspect of the methodology adopted by each centre about the performance of FCH PET. Preparation before presenting for FCH PET ranged from a fasting condition of 12 hours [12], avoidance of foods containing high levels of choline for the week before the scan [26] to “fasting no necessary” [19] with also variable instructions on liquid assumption before scanning ranging from avoidance of liquids 1-hour before presenting to the PET department to reduce bladder filling before tracer injection [7], to hydration with 1.5 lt of water enriched with oral contrast 1-hour before injection [14]. Injected dose was also very variable ranging from fixed dose to dose calculated per body weight (ranging between 2.6 and 4.07 MBq/kg).…”

“…The higher variability though regards acquisition protocols. In 10/24 papers only one phase whole body acquisition is described at 2 min [13, 15], 12–15 min [21], 45 min [26], 60 min [6, 20, 23, 27, 30], and 60–90 min [24] with variable duration per minute of bed position (ranging from 2 to 7 min). The rest of the papers (14/25) describe at least two point acquisition protocols [5, 7, 8, 11, 12, 14, 16–19, 22, 25, 28, 29].…”

“…[5, 7, 14, 22, 29], while other 2 papers describe whole or “partial” body early acquisitions [11, 18]. Three papers describe three-point acquisition protocols, with late scans after the whole body acquisition performed routinely [8, 28] or if needed [25, 26] (see Table 1). …”

SPECT and PET Serve as Molecular Imaging Techniques and in Vivo Biomarkers for Brain Metastases

“…This makes 18 F-Cho easy to be produced far from the hospital and commercially available. Radiolabelled choline compounds are mainly used to diagnose prostate cancer [14,15]; furthermore they have been successfully employed to investigate primary brain tumours [16,17,18], but relatively scarce are the studies evaluating radiolabelled choline compounds in detecting brain metastases. The available studies will be presented as follows.…”