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Comparison of ¹¹C-Choline and ¹⁸F-FDG PET in Primary Diagnosis and Staging of Patients with Thoracic Cancer

¹ PET Center, Groningen University Hospital, Groningen, The Netherlands
² Department of Pulmonary Diseases, Groningen University Hospital, Groningen, The Netherlands

PET with ¹⁸F-FDG is used for detection and staging of thoracic cancer; however, more specific PET radiopharmaceuticals would be welcome. ¹¹C-labeled choline (CHOL) is a new radiopharmaceutical potentially useful for tumor imaging, since it is incorporated into cell membranes as phosphatidylcholine. The aim of this study was to investigate whether ¹¹C-CHOL PET has advantages over ¹⁸F-FDG PET in patients with thoracic cancer. Methods: We evaluated 17 patients with thoracic cancer both with ¹¹C-CHOL PET and ¹⁸F-FDG PET. After transmission scanning, ¹¹C-CHOL was injected intravenously, and whole-body scanning was started after 5 min. Immediately thereafter, ¹⁸F-FDG was injected intravenously, followed after 90 min by interleaved attenuation-corrected whole-body scanning. Scans were performed from crown to femur. Visual and quantitative (standardized uptake value) analyses of ¹¹C-CHOL PET and ¹⁸F-FDG PET were performed and compared with results of traditional staging and follow-up. Results: The most prominent features of normal ¹¹C-CHOL distribution were high uptake in liver, renal cortex, and salivary glands. Except for some uptake in choroid plexus and pituitary gland, brain uptake was negligible. All primary thoracic tumors were detected with ¹¹C-CHOL PET and ¹⁸F-FDG PET. Both ¹¹C-CHOL PET and ¹⁸F-FDG PET correctly identified all 16 patients with lymph node involvement. However, in a lesion-to-lesion analysis, ¹¹C-CHOL PET detected only 29 of 43 metastatic lymph nodes, whereas ¹⁸F-FDG PET detected 41 of 43. ¹¹C-CHOL PET detected fewer intrapulmonary and pleural metastases than ¹⁸F-FDG PET (27/47 vs. 46/47). More brain metastases were detected with ¹¹C-CHOL PET (23/23) than with ¹⁸F-FDG PET (3/23). For primary tumors, the median (range) standard uptake values of ¹¹C-CHOL and ¹⁸F-FDG were 1.68 (0.98–3.22) and 4.22 (1.40–8.26), respectively (P = 0.001). Conclusion: ¹¹C-CHOL PET can be used to visualize thoracic cancers. Although detection of lymph node metastases with ¹¹C-CHOL PET was inferior compared with ¹⁸F-FDG PET, the detection of brain metastases was superior.

Key Words: ¹¹C-choline • ¹⁸F-FDG • PET • thoracic cancer • metastasis

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