OtherClinical Investigations

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

Tatsuo Torizuka, Toshihiko Kanno, Masami Futatsubashi, Hiroyuki Okada, Etsuji Yoshikawa, Fumitoshi Nakamura, Munetaka Takekuma, Makoto Maeda and Yasuomi Ouchi
Journal of Nuclear Medicine July 2003, 44 (7) 1051-1056;

Article Figures & Data

Figures

  • FIGURE 1.
    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.

  • FIGURE 2.
    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.

  • FIGURE 3.
    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 × 6 mm, stage IB). BL = bladder activity; IS = physiologic uptake of 11C-choline in bilateral ischia.

  • FIGURE 4.
    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.

  • FIGURE 5.
    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.

Tables

  • TABLE 1

    Summary of Patients and Histology of Primary Tumors

    Patient no.Age (y)Histology of primary tumorTumorTumor SUV
    StageSize (cm)18F-FDG11C-CHO
    Untreated primary tumor (n = 18)
     Uterine corpus cancer
    149  Endometrial adenocarcinomaIIIA416.815.77
    266  Endometrial adenocarcinomaIB13.792.83
    372  Endometrial adenocarcinomaIB2.512.555.52
    442  Endometrial adenocarcinomaIB2.59.096.33
    562  Endometrial adenocarcinomaIB2.26.134.93
    640  Endometrial adenocarcinomaIA2.56.833.06
    763  Endometrial adenocarcinomaIA26.546.79
    877  CarcinosarcomaIIIA47.433.45
    972  CarcinosarcomaIC37.292.13
    1074  Clear cell carcinomaIB1.7FN4.81
    1168  Atypical hyperplasia0NAFNFN
     Uterine corpus cancer
    1268  Squamous cell carcinomaIIB412.537.07
    1336  Squamous cell carcinomaIIB39.494.43
    1447  Squamous cell carcinomaIIB7.514.575.27
    1553  Squamous cell carcinomaIIB3.710.955.53
    1654  Spindle cell carcinomaIB0.9FN3.86
    1775 Ovarian mucinous cystadenocarcinomaIA129.312.42
    1851 Pelvic inflammatory diseaseNA58.136.02
    (FP)(FP)
    Recurrent tumor (n = 3)
    1966    Ovarian serous adenocarcinomaNA1.53.753.63
    2069 Ovarian serous adenocarcinomaNA2FNFN
    2147 Ovarian serous adenocarcinomaNANAFNFN

    • FN = false-negative; NA = not applicable; FP = false-positive.

    • Tumor size is longest diameter.

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