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Imaging of Gynecologic Tumors: Comparison of ¹¹C-Choline PET with ¹⁸F-FDG PET

¹ Positron Medical Center, Hamamatsu Medical Center, Hamakita, Japan
² Central Research Laboratory, Hamamatsu Photonics K.K., Hamakita, Japan
³ Department of Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan

View larger version (12K): [in a new window]   FIGURE 1. Time–activity curve of 11C-choline PET in patient with uterine cervical cancer (patient 12) shows rapid initial uptake in tumor tissue with almost constant level afterward.

View larger version (28K): [in a new window]   FIGURE 2. Coronal T2-weighted MR image (A) shows enlarged isointense area of endometrium (arrow), indicating presence of tumor. Arrowhead points to intestine. This patient was diabetic. Blood sugar levels were 177 mg/dL (9.8 mmol/L) and 188 mg/dL (10.4 mmol/L) at time of 18F-FDG PET and 11C-choline PET, respectively. In 18F-FDG PET image (B), tumor uptake is negative in presence of hyperglycemia. 11C-Choline PET image (C) demonstrates increased tracer uptake (arrow), corresponding to endometrial tumor. 11C-Choline accumulation in bladder was only minimal, but small hot spot was seen in intestine (arrowhead). Surgical histologic examination revealed clear cell carcinoma (stage IB). BL = bladder activity.

View larger version (21K): [in a new window]   FIGURE 3. Transaxial T2-weighted MR image (A) shows small hyperintense lesion in uterine cervix (arrow). In 18F-FDG PET image (B), tumor visualization is obscured by high bladder activity. 11C-Choline PET image (C) clearly shows intense tumor uptake (arrow), corresponding to cervical cancer. No bladder activity is seen in 11C-choline PET image. Surgical histologic examination revealed spindle cell carcinoma (9 x 6 mm, stage IB). BL = bladder activity; IS = physiologic uptake of 11C-choline in bilateral ischia.

View larger version (36K): [in a new window]   FIGURE 4. Coronal T1-weighted MR image (A) demonstrates right parailiac lymphadenopathy (arrow) in patient with uterine cervical cancer. 18F-FDG PET image (B) clearly shows intense uptake in right parailiac region (arrow), indicating lymph node metastasis. Although 11C-choline PET image (C) detects abnormal activity (arrow), physiologic bowel uptake (arrowheads) mimics parailiac lymph node metastases. Lymphadenopathy was not seen on follow-up MR images after transarterial infusion of chemotherapy. BL = bladder activity.

View larger version (93K): [in a new window]   FIGURE 5. Whole-body 18F-FDG PET (A) and 11C-choline PET (B) images show hot spot in para-aortic lymph node metastasis (arrows) in patient with recurrent ovarian cancer. High physiologic uptake of 11C-choline in liver, pancreas, and intestine hampers interpretation of abdomen and pelvis.