Choline PET/CT for prostate cancer: Main clinical applications

Fuccio, Chiara; Rubello, Domenico; Castellucci, Paolo; Marzola, Maria Cristina; Fanti, Stefano

doi:10.1016/j.ejrad.2010.07.023

Cited by 55 publications

(28 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most commonly used oncologic PET tracer, 18 F-FDG, shows limited sensitivity for the detection of androgen-dependent PCa (4). In contrast, encouraging results have been published using both 11 C-and 18 F-labeled choline derivatives as PET tracers for PCa (5)(6)(7)(8)(9).…”

mentioning

confidence: 93%

Quantification of ¹⁸F-Fluorocholine Kinetics in Patients with Prostate Cancer

Geest

Metselaar²,

Storm³

2015

J Nucl Med

View full text Add to dashboard Cite

Choline kinase is upregulated in prostate cancer, resulting in increased 18 F-fluoromethylcholine uptake. This study used pharmacokinetic modeling to validate the use of simplified methods for quantification of 18 F-fluoromethylcholine uptake in a routine clinical setting. Methods: Forty-minute dynamic PET/CT scans were acquired after injection of 204 ± 9 MBq of 18 F-fluoromethylcholine, from 8 patients with histologically proven metastasized prostate cancer. Plasma input functions were obtained using continuous arterial blood-sampling as well as using image-derived methods. Manual arterial blood samples were used for calibration and correction for plasma-to-blood ratio and metabolites. Time-activity curves were derived from volumes of interest in all visually detectable lymph node metastases. 18 F-fluoromethylcholine kinetics were studied by nonlinear regression fitting of several single-and 2-tissue plasma input models to the time-activity curves. Model selection was based on the Akaike information criterion and measures of robustness. In addition, the performance of several simplified methods, such as standardized uptake value (SUV), was assessed. Results: Best fits were obtained using an irreversible compartment model with blood volume parameter. Parent fractions were 0.12 ± 0.4 after 20 min, necessitating individual metabolite corrections. Correspondence between venous and arterial parent fractions was low as determined by the intraclass correlation coefficient (0.61). Results for image-derived input functions that were obtained from volumes of interest in bloodpool structures distant from tissues of high 18 F-fluoromethylcholine uptake yielded good correlation to those for the blood-sampling input functions (R 2 5 0.83). SUV showed poor correlation to parameters derived from full quantitative kinetic analysis (R 2 , 0.34). In contrast, lesion activity concentration normalized to the integral of the blood activity concentration over time (SUV AUC ) showed good correlation (R 2 5 0.92 for metabolite-corrected plasma; 0.65 for whole-blood activity concentrations). Conclusion: SUV cannot be used to quantify 18 F-fluoromethylcholine uptake. A clinical compromise could be SUV AUC derived from 2 consecutive static PET scans, one centered on a large blood-pool structure during 0-30 min after injection to obtain the blood activity concentrations and the other a whole-body scan at 30 min after injection to obtain lymph node activity concentrations.

show abstract

mentioning

confidence: 93%

Quantification of ¹⁸F-Fluorocholine Kinetics in Patients with Prostate Cancer

Geest

Metselaar²,

Storm³

2015

J Nucl Med

View full text Add to dashboard Cite

show abstract

“…Encouraging results have been reported on the usefulness of radiolabeled-choline PET/CT in prostate cancer (18,19). Apart from its main recognized application in restaging disease in cases of biochemical relapse (20,21), 18 F-fluoromethylcholine might also qualify as a biomarker of response to therapy.…”

mentioning

confidence: 99%

Repeatability of Quantitative ¹⁸F-Fluoromethylcholine PET/CT Studies in Prostate Cancer

et al. 2015

View full text Add to dashboard Cite

Repeatable quantification is essential when using 18 F-fluoromethylcholine PET/CT to monitor treatment response in prostate cancer. It has been shown that SUV normalized to the area under the blood activity concentration curve (SUV AUC ) provides a better correlation with full kinetic analysis than does standard SUV. However, the precision of SUV AUC is not known yet. The purpose of this study was to assess the repeatability of various semiquantitative 18 F-fluoromethylcholine parameters in prostate cancer. Methods: Twelve patients (mean age ± SD, 64 ± 8 y) with metastasized prostate cancer underwent two sets of 18 F-fluoromethylcholine PET/CT scans, on consecutive days. Each set consisted of a 30-min dynamic PET/CT scan of the chest after intravenous administration of 200 MBq of 18 F-fluoromethylcholine, followed by a whole-body PET/CT scan at 40 min. The dynamic scan was used to derive the area under the blood activity concentration curve. Lesion uptake was derived from the whole-body scan using various types of volumes of interest: maximum, peak, and mean. Each of these parameters was normalized to injected activity per body weight, area under the blood activity concentration curve, and blood concentration itself at 40 min, resulting in several types of SUVs: SUV, SUV AUC , and SUV TBR . The test-retest repeatability of these metrics, as well as metabolic tumor volume (MTV) and total uptake of choline in the lesion, were studied. The level of agreement between testretest data and reliability was assessed using Bland-Altman plots, repeatability coefficients, and intraclass correlation coefficients (ICCs). Results: A total of 67 choline-avid metastases were identified: 44 bone lesions and 23 lymph node lesions. In the case of SUV max , the repeatability coefficients for SUV, SUV AUC , and SUV TBR were 26% (ICC, 0.95), 31% (ICC, 0.95), and 46% (ICC, 0.89), respectively. Similar values were obtained for SUV peak and SUV mean . The repeatability of SUV AUC was comparable to that of SUV max , SUV peak , and SUV mean. Tissue type and tumor localization did not affect repeatability. An MTV of less than 4.2 cm 3 had larger variability than larger volumes (repeatability coefficient, 45% vs. 29%; P 5 0.048). The repeatability coefficient did not significantly differ between lesions with SUV peak above or below the median value of 8.3 (19% vs. 28%; P 5 0.264). Conclusion: The repeatability of SUV AUC was comparable to that of standard SUV. The repeatability coefficients of various semiquantitative 18 F-fluoromethylcholine parameters (SUV, MTV, and total uptake in the lesion) were approximately 35%. Larger differences are likely to represent treatment effects. Prost ate cancer is the second most common cancer in men worldwide and was the third most diagnosed malignancy in Europe in 2012, with 92,000 deaths (1,2). This androgen-dependent neoplasm is characterized by a good initial response to antihormonal therapy and an unpredictable latent castration-resistant status (3). At the beginning of this decennium, molecular prof...

show abstract

“…In some reports it is not specifi ed how many of the patients were receiving endocrine therapy at the time of evaluation. It is therefore not yet possible to identify for which patients a PET/CT should be considered as a routine staging procedure or which tracer should be used [ 15 ] . Patients with poorly differentiated prostate cancer or high PSA values may have multiple metastases despite negative fi ndings on standard non-invasive staging procedures, such as planar bone scan and CT [ 16,17 ] .…”

mentioning

confidence: 99%

Combined ¹⁸F‐fluorocholine and ¹⁸F‐fluoride positron emission tomography/computed tomography imaging for staging of high‐risk prostate cancer

et al. 2012

View full text Add to dashboard Cite

5 0 1What ' s known on the subject? and What does the study add? Positron emission tomography/computed tomography (PET/CT) with choline and fl uoride for the detection of metastases in patients with prostate cancer have each been evaluated, with mixed results. Choline PET/CT has been evaluated against pelvic lymphadenectomy, generally with a low sensitivity but a high specifi city; however, the study populations have been heterogenous. Fluoride PET/CT has been evaluated against other imaging methods, such as bone scan, single photon emission CT and MRI, and has been shown to have high specifi city as well as sensitivity for bone metastases, but there are no studies with biopsy verifi cation. This is the fi rst study that evaluates the clinical use of both choline and fl uoride PET/CT on the same patients in a well-defi ned population of patients with high-risk prostate cancer. OBJECTIVE• To investigate how often positron emission tomography/computed tomography (PET/CT) scans, with both 18 F-fl uorocholine and 18 F-fl uoride as markers, add clinically relevant information for patients with prostate cancer who have high-risk tumours and a normal or inconclusive planar bone scan. PATIENTS AND METHODS• Patients with prostate cancer with prostate specifi c antigen (PSA) levels between 20 and 99 ng/mL and/or Gleason score 8 -10 tumours, planned for treatment with curative intent based on routine staging with a negative or inconclusive bone scan, were further investigated with a 18 F-fl uorocholine and a 18 F-fl uoride PET/CT.• None of the patients received hormonal therapy before the staging procedures were completed. RESULTS• For 50 of the 90 included patients (56%) one or both PET/CT scans indicated metastases.• 18 F-fl uorocholine PET/CT indicated lymph node metastases and/or bone metastases in 35 patients (39%).• 18 F-fl uoride PET/CT was suggestive for bone metastases in 37 patients (41%).• In 18 patients (20%) the PET/CT scans indicated widespread metastases, leading to a change in therapy intent from curative to non-curative.• Of the patients with positive scans, 74% had Gleason score 8 -10 tumours. Of the patients with Gleason score 8 -10 tumours, 64% had positive scans. CONCLUSIONS• PET/CT scans with 18 F-fl uorocholine and 18 F-fl uoride commonly detect metastases in patients with high-risk prostate cancer and a negative or inconclusive bone scan.• For 20% of the patients the results of the PET/CT scans changed the treatment plan. KEYWORDS INTRODUCTIONThe most common sites for metastases from prostate cancer are the pelvic and retroperitoneal lymph nodes and the axial skeleton. Radical local therapy is usually not considered for patients with skeletal metastases, widespread or large lymph node metastases. The standard of reference for detection of lymph node metastases is an extended pelvic lymph node dissection (ePLND) [ 1,2 ] . However, this procedure is invasive and associated with complications and morbidity [ 3 ] . Positron emission tomography (PET) with 11 C-or 18 F-labelledAccepted for publication 20...

show abstract

Choline PET/CT for prostate cancer: Main clinical applications

Cited by 55 publications

References 55 publications

Quantification of ¹⁸F-Fluorocholine Kinetics in Patients with Prostate Cancer

Quantification of ¹⁸F-Fluorocholine Kinetics in Patients with Prostate Cancer

Repeatability of Quantitative ¹⁸F-Fluoromethylcholine PET/CT Studies in Prostate Cancer

Combined ¹⁸F‐fluorocholine and ¹⁸F‐fluoride positron emission tomography/computed tomography imaging for staging of high‐risk prostate cancer

Contact Info

Product

Resources

About

Choline PET/CT for prostate cancer: Main clinical applications

Cited by 55 publications

References 55 publications

Quantification of 18F-Fluorocholine Kinetics in Patients with Prostate Cancer

Quantification of 18F-Fluorocholine Kinetics in Patients with Prostate Cancer

Repeatability of Quantitative 18F-Fluoromethylcholine PET/CT Studies in Prostate Cancer

Combined 18F‐fluorocholine and 18F‐fluoride positron emission tomography/computed tomography imaging for staging of high‐risk prostate cancer

Contact Info

Product

Resources

About

Quantification of ¹⁸F-Fluorocholine Kinetics in Patients with Prostate Cancer

Quantification of ¹⁸F-Fluorocholine Kinetics in Patients with Prostate Cancer

Repeatability of Quantitative ¹⁸F-Fluoromethylcholine PET/CT Studies in Prostate Cancer

Combined ¹⁸F‐fluorocholine and ¹⁸F‐fluoride positron emission tomography/computed tomography imaging for staging of high‐risk prostate cancer