The role of positron emission tomography using carbon-11 and fluorine-18 choline in tumors other than prostate cancer: a systematic review

Abstract

To systematically review published data on the role of positron emission tomography (PET) or PET/computed tomography (PET/CT) using either Carbon-11 ((11)C) or Fluorine-18 ((18)F) choline tracer in tumors other than prostatic cancer. A comprehensive literature search of studies published in PubMed/MEDLINE and Embase databases through January 2012 and regarding (11)C-choline or (18)F-choline PET or PET/CT in patients with tumors other than prostatic cancer was carried out. Fifty-two studies comprising 1800 patients were included and discussed. Brain tumors were evaluated in 15 articles, head and neck tumors in 6, thoracic tumors (including lung and mediastinal neoplasms) in 14, liver tumors (including hepatocellular carcinoma) in 5, gynecologic malignancies (including breast tumors) in 5, bladder and upper urinary tract tumors in 5, and musculoskeletal tumors in 7. Radiolabeled choline PET or PET/CT is useful to differentiate high-grade from low-grade gliomas and malignant from benign brain lesions, to early detect brain tumor recurrences and to guide the stereotactic biopsy sampling. The diagnostic accuracy of radiolabeled choline PET is superior compared to Fluorine-18 fluorodeoxyglucose ((18)F-FDG) PET in this setting. Radiolabeled choline PET or PET/CT seems to be accurate in differential diagnosis between malignant and benign thoracic lesions and in staging lung tumors; nevertheless, a superiority of radiolabeled choline compared to (18)F-FDG has not been demonstrated in this setting, except for the detection of brain metastases. Few but significant studies on radiolabeled choline PET and PET/CT in patients with hepatocellular carcinoma (HCC) and musculoskeletal tumors are reported in the literature. The combination of radiolabeled choline and (18)F-FDG PET increases the detection rate of HCC. The diagnostic accuracy of radiolabeled choline PET or PET/CT seems to be superior compared to (18)F-FDG PET or PET/CT and conventional imaging methods in patients with bone and soft tissue tumors. Limited experience exists about the role of radiolabeled choline PET and PET/CT in patients with head and neck tumors, bladder cancer and gynecologic malignancies including breast cancer.

Biodistribution and Radiation Dosimetry of Deuterium-Substituted 18F-Fluoromethyl-[1, 2-2H4]Choline in Healthy Volunteers

“…The inherently poor sensitivity of MRS in vivo precludes resolution of individual choline metabolite resonances. PET-labeled choline tracers provide improved sensitivity when compared with MRS and enable dynamic measurements of the early steps of choline metabolism to be assessed by virtue of cellular radiotracer trapping but without the chemical resolution of ex vivo MRS. To date, 11 C-choline and 18 F-FCH have been extensively used for the clinical imaging of prostate, brain, breast, and esophageal carcinomas (7,8). Because of the metabolic instability of choline radiotracers and the desire to use late imaging protocols (;60 min, to permit elimination of nonspecific metabolites), we developed a more stable choline radiotracer, 18 F-D4-FCH (12).…”

“…Overexpression of ChKa and increased enzyme activity have been reported in prostate, breast, lung, ovarian, and colon cancers (5,6) and are largely responsible for the increased phosphocholine levels with malignant transformation and progression (1). 11 C-choline has been widely used to study tumor metabolic activity in vivo (7,8).…”

Imaging of Pulmonary Tuberculosis with 18F-Fluoro-Deoxy-Glucose and 18F-Ethylcholine

“…However, several authors have also evaluated its use in other malignancies [6][7][8]. Superiority of FEC PET over FDG PET has been demonstrated in differentiating low-grade glioblastomas from high-grade lesions, in detection of tumor recurrence and in guiding brain biopsies.…”

Automated synthesis of [18F]fluorocholine using a modified GE TracerLab module

“…For this reason, other PET radiotracers have been developed to target alternative biological processes of cancer biology [19]. One particular radiotracer of interest is choline radiolabelled with fluorine-18 or carbon-11 for the use of PET imaging [20]. control the helium flow before each synthesis run.…”