Choline PET/CT in Multiple Myeloma

Abstract

The field of multiple myeloma (MM) imaging has evolved. The International Myeloma Working Group recently recommended performing 18F-fluorodeoxyglucose glucose (18FDG) positron emission tomography/computed tomography (PET/CT) with the aim of staging MM patients at baseline and evaluating response to therapy. Novel oncological radiotracers such as 11C-Choline and 18F-Fluorocholine, have been studied in comparison with 18FDG, mostly in MM patients presenting with refractory disease or suspected relapse. Choline-based tracers may overcome some limitations of 18FDG, which include a lack of sensitivity in depicting skull lesions and the fact that 10% of MM patients are FDG-negative. The majority of MM lesions display a higher uptake of Choline than FDG. Also, in many situations, Choline may offer better lesion visualization, with a higher tumor to background ratio; however, various patterns of Choline and FDG uptake have been observed in MM and some limitations, notably as regards liver lesions, should be recognized. Overall, Choline may provide additional detection of up to 75% more lesions. This article aims to provide a comprehensive review of the potential role of Choline in multiple myeloma, as compared to FDG, encompassing Choline physiopathology as well as data from clinical studies.

Prospective Comparison of 18-FDG PET/CT and Whole-Body MRI with Diffusion-Weighted Imaging in the Evaluation of Treatment Response of Multiple Myeloma Patients Eligible for Autologous Stem Cell Transplant

“…Overall, the results of this study combined with ours seem to indicate that 18-FDG PET/CT should be the modality of choice in monitoring MM treatment response. The development and the use of novel PET/CT radiotracers should further improve the prognostication of MM patients in the next decade [ 19 , 20 , 21 ].…”

Emerging methods for prostate cancer imaging: evaluating cancer structure and metabolic alterations more clearly

“…Choline tracing has been largely used in PCa and is found to have a sensitivity and specificity of 85.6% and 92.6%, respectively, for all metastatic sites, and is thus advocated for use in the biochemical recurrence setting [ 94 ]. Furthermore, potential utility of choline PET has been investigated in multiple myeloma and hepatocellular carcinoma and has shown promise [ 95 , 96 ].…”

ChoK-Full of Potential: Choline Kinase in B Cell and T Cell Malignancies

“…More recently, PET/CT imaging studies with [ 11 C]-choline or [ 18 F]-fluorocholine have allowed the detection of DLBCL and Hodgkin lymphoma (HL) in patients with recurrent prostate cancer [ 28 , 44 , 45 ]. PET/CT imaging with [ 11 C]-choline or [ 18 F]-fluorocholine has actually become a useful tool for staging and assessment of therapeutic response in patients with NHL, MM and CNSL, and has demonstrated much higher sensitivity and specificity for MM and CNSL than the widely used [ 18 F]-FDG [ 27 , 29 , 30 , 31 ]. However, the specificity of choline tracers is not absolute, as [ 11 C]-choline or [ 18 F]-fluorocholine is also accumulated in tissues with sterile inflammation and bacterial/viral infections [ 2 , 5 , 46 ].…”

“…In vivo administration of RSM932A or MN58B substantially decreases the spleen size, partially reduces the percentage and drastically decreases the numbers of splenic B cells in B- Traf3 −/− mice but not in littermate control mice, suggesting that elevated Chkα-mediated P-Cho and PC biosynthesis contributes to the prolonged survival of Traf3 −/− B cells in vivo [ 59 ]. Furthermore, therapies that effectively control tumor progression such as radiotherapy and chemotherapy (rituximab, CHOP, R-CHOP or AZD3965) also dramatically reduce choline metabolism and decrease CHKα activity in patients, cell lines and animal models of B cell malignancies [ 21 , 27 , 30 , 40 , 41 , 42 , 43 , 77 ]. These findings obtained from B cell malignancies corroborate the evidence that inhibition of choline metabolism by CHKα inhibitors or genetic silencing of CHKα by siRNA has therapeutic effects in solid tumor models [ 1 , 2 , 3 , 4 , 5 , 6 , 15 ].…”

“…Radiolabeled choline tracers are particularly useful for diagnostic imaging of brain tumors, prostate cancer, lung cancer, esophageal cancer and hepatocellular carcinoma, in which the commonly used glucose tracer [ 18 F]-2-fluoro-2-deoxyglucose (FDG) lacks specificity or sensitivity [ 2 , 5 ]. Interestingly, both MRS imaging of tCho and PET/CT imaging with [ 11 C]-choline or [ 18 F]-fluorocholine tracers have also been clinically applied for the diagnosis of lymphoid malignancies, including non-Hodgkin lymphoma (NHL), multiple myeloma (MM) and central nervous system lymphoma (CNSL) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. However, in contrast to the well-documented oncogenic alterations and pathways that cause CHKα overexpression in solid tumors, information on how choline kinase is dysregulated in lymphoid malignancies is very limited and has just begun to be unraveled.…”