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Localization of Primary Prostate Cancer with Dual-Phase 18F-Fluorocholine PET

Sandi A. Kwee, MD1,2, Hai Wei, PhD3, Isabell Sesterhenn, MD4, David Yun, PhD5 and Marc N. Coel, MD1

1 Hamamatsu/Queen's PET Imaging Center LLC, Honolulu, Hawaii; 2 Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii; 3 i.Solutions, Inc., Honolulu, Hawaii; 4 Armed Forces Institute of Pathology, Washington, DC; and 5 Laboratory of Intelligent and Parallel Systems, College of Engineering, University of Hawaii at Manoa, Honolulu, Hawaii


Figure 1
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  		FIGURE 1.  Subject 3, with histologically proven malignancy in left prostate lobe. (A) Coronal whole-body 18F-fluorocholine PET image 7 min after injection shows focal uptake in left lobe of prostate (large arrow) corresponding to malignant lesion on biopsy. Increasing bladder activity is evident in second FOV of this image (small arrow). (B) Coronal image of pelvis 1 h after injection shows increasing activity in prostate lesion. Images are shown at same intensity. (C) Graph depicts distribution of SUVmax increase in transverse slice of prostate at midsection (inset: delayed transverse image). SUVmax in lesion increased by 22% (+4.4), whereas SUVmax in contralateral benign area decreased by 6% (–0.4).

 

Figure 2
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  		FIGURE 2.  Histopathologic correlation of 18F-fluorocholine PET of prostate. (A) One-hour delayed PET scan of pelvis of subject 14 shows increased 18F-fluorocholine uptake in prostate (enclosed by white box). (B) Computer-rendered surface model based on PET images depicts 3-dimensional configuration of highest activity within prostate. (C) Low-power micrograph of prostate specimen shows left-sided tumor with contralateral tumor extension (outlined in black), morphologically resembling corresponding PET and computer-rendered images.

 

Figure 3
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  		FIGURE 3.  Plots of SUVmax in probable benign regions (A) and dominant malignant regions (B) on initial (time point 1) and delayed (time point 2) 18F-fluorocholine PET images of prostate.

 

Figure 4
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  		FIGURE 4.  Relative accuracy of different SUVmax measurements. Receiver operating characteristic curve for distinguishing dominant malignant region from probable benign region is based on SUVmax measurements on initial and delayed PET scans and their percentage difference (i.e., retention index).

 




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