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Imaging Prostate Cancer with 11C-Choline PET/CT

Sven N. Reske1, Norbert M. Blumstein1, Bernd Neumaier1, Hans-Werner Gottfried2, Frank Finsterbusch1, Darius Kocot1, Peter Möller3, Gerhard Glatting1 and Sven Perner3

1 Department of Nuclear Medicine, University of Ulm, Ulm, Germany; 2 Department of Urology, University of Ulm, Ulm, Germany; and 3 Department of Pathology, University of Ulm, Ulm, Germany


Figure 1
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  		FIGURE 1.  (A–D) Image analysis of 11C-choline PET/CT and histopathology. (A) Assessed cutting planes of prostate are indicated as dashed lines. (B) 11C-Choline PET/CT slice from middle third of prostate: corresponding transversal whole-gland section (hematoxylin and eosin). (C) Segmental allocation. (D) Scatter plot of 11C-choline maximal standardized uptake value (SUVmax) of all 36 segments of this patient. Tumor stage was pT2a; 11C-choline PET/CT localized PCa correctly to left lower peripheral segment (arrow in B). Scatter plot in D shows higher 11C-choline SUVmax in segments with PCa than in those with benign histopathologic lesions.

 

Figure 2
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  		FIGURE 2.  Focal (A) and multifocal (B) distribution of PCa within prostate gland (arrows). Scatter plots of segmental 11C-choline SUVmax show higher 11C-choline SUVmax in most segments with PCa compared with segments with benign histopathologic lesions.

 

Figure 3
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  		FIGURE 3.  11C-Choline SUVmax in segments with normal prostate tissue, benign hyperplasia (BPH), focal prostatitis (FP), BPH mixed with focal prostatitis (BPH + FP), and segments with PCa. Data are expressed as mean ± SD, with significant differences (all with P < 0.001) indicated above histograms.

 

Figure 4
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  		FIGURE 4.  Percentage of segments in each patient with SUVmax PCa > SUVmax of benign histopathology (class width, 20%) vs. number of patients in respective class (2 patients are not listed because they had PCa in all segments).

 

Figure 5
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  		FIGURE 5.  (A) ROC curve for correctly assigning PCa by segmental 11C-choline uptake to segmental histopathologic examination. Maximal 11C-choline uptake (SUVmax) is plotted against tumor stage (B), Gleason score (C), and serum PSA concentration (D). 11C-Choline SUVmax showed weak, but significant, correlation with pT stage (Spearman r = 0.49; P = 0.01).

 




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