Abstract
Purpose
The aim of this prospective study was to compare the potential value of 18F fluorocholine (FCH) and 18F fluoride positron emission tomography (PET)–CT scanning for the detection of bony metastases from prostate cancer.
Methods
Thirty-eight men (mean age, 69 ± 8 years) with biopsy-proven prostate cancer underwent both imaging modalities within a maximum interval of 2 weeks. Seventeen patients were evaluated preoperatively, and 21 patients were referred for post-operative evaluation of suspected recurrence or progression based on clinical algorithms. The number, sites and morphological patterns of bone lesions on 18F FCH and 18F fluoride PET–CT were correlated: Concordant lesions between the two modalities with corresponding changes on CT were considered to be positive for malignancy; discordant lesions were verified by follow-up examinations. The mean follow-up interval was 9.1 months.
Results
Overall, 321 lesions were evaluated in this study. In a lesion-based analysis, a relatively close agreement was found between these two imaging modalities for detection of malignant bone lesions (kappa = 0.57), as well as in a patient-based analysis (kappa = 0.76). Sixteen malignant sclerotic lesions with a high density were negative in both 18F FCH and 18F fluoride PET–CT [mean Hounsfield unit (HU), 1,148 ± 364]. There was also a significant correlation between tracer intensity by SUV and density of sclerotic lesions by HU both in 18F FCH PET–CT (r = −0.28, p < 0.006) and 18F fluoride PET–CT (r = −0.20, p < 0.05).
The sensitivity, specificity and accuracy of PET–CT in the detection of bone metastases in prostate cancer was 81%, 93% and 86% for 18F fluoride, and 74% (p = 0.12), 99% (p = 0.01) and 85% for FCH, respectively.
18F FCH PET–CT led to a change in the management in two out of 38 patients due to the early detection of bone marrow metastases. 18F fluoride PET–CT identified more lesions in some patients when compared with 18F FCH PET–CT but did not change patient management.
Conclusion
FCH PET–CT may be superior for the early detection (i.e. bone marrow involvement) of metastatic bone disease. In patients with FCH-negative suspicious sclerotic lesions, a second bone-seeking agent (e.g. 18F fluoride) is recommended. 18F fluoride PET–CT demonstrated a higher sensitivity than 18F FCH PET–CT, but the difference was not statistically significant. Furthermore, 18F fluoride PET could be also negative in highly dense sclerotic lesions, which presumably reflects the effect of treatment. It will be important to clarify in future studies whether these lesions are clinically relevant when compared with metabolically active bone metastases.
Similar content being viewed by others
References
Blum D. Prostate cancer: can we reduce mortality while preserving the quality of life? Washington, DC: US Department of Health and Human Services; 1995. p. 1.
Davidson P, Gabbay J. Should mass screening for prostate cancer be introduced at the national level? WHO Regional Office for Europe’s Health Evidence Network Report (HEN), May 2004.
Abuzallouf S, Dayes I, Lukka H. Baseline staging of newly diagnosed prostate cancer: a summary of the literature. J Urol 2004;171(6 Pt 1):2122–7.
Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med 2006;47(2):287–97.
Jacobson AF, Fogelman I. Bone scanning in clinical oncology: does it have a future? Eur J Nucl Med 1998;25(9):1219–23.
Schirrmeister H, Guhlmann A, Elsner K, et al. Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18F PET. J Nucl Med 1999;40(10):1623–29.
Schirrmeister H, Glatting G, Hetzel J, et al. Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2001;42(12):1800–4.
Cook GJ, Fogelman I. The role of positron emission tomography in skeletal disease. Semin Nucl Med 2001;31(1):50–1.
Cook GJ, Fogelman I. The role of positron emission tomography in the management of bone metastases. Cancer 2000;88(12 Suppl):2927–33.
Even-Sapir E, Mishani E, Flusser G, Metser U. 18F-Fluoride positron emission tomography and positron emission tomography/computed tomography. Semin Nucl Med 2007;37(6):462–69.
Cimitan M, Bortolus R, Morassut S, et al. [(18)F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients. Eur J Nucl Med Mol Imaging 2006;33(12):1387–98.
Kwee SA, Wei H, Sesterhenn I, Yun D, Coel MN. Localization of primary prostate cancer with dual-phase 18F-fluorocholine PET. J Nucl Med 2006;47(2):262–9.
Reske SN, Blumstein NM, Neumaier B, et al. Imaging prostate cancer with 11C-choline PET/CT. J Nucl Med 2006;47(8):1249–54.
Seltzer MA, Jahan SA, Sparks R, et al. Radiation dose estimates in humans for (11)C-acetate whole-body PET. J Nucl Med 2004;45(7):1233–6.
Zheng QH, Gardner TA, Raikwar S, et al. [11C]Choline as a PET biomarker for assessment of prostate cancer tumor models. Bioorg Med Chem 2004;12(11):2887–93.
Schoder H, Larson SM. Positron emission tomography for prostate, bladder, and renal cancer. Semin Nucl Med 2004;34(4):274–92.
Fogelman I, Cook G, Israel O, Van der Wall H. Positron emission tomography and bone metastases. Semin Nucl Med 2005;35(2):135–42.
Schirrmeister H, Guhlmann A, Kotzerke J, et al. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography. J Clin Oncol 1999;17(8):2381–9.
Even-Sapir E, Metser U, Flusser G, et al. Assessment of malignant skeletal disease: initial experience with 18F-fluoride PET/CT and comparison between 18F-fluoride PET and 18F-fluoride PET/CT. J Nucl Med 2004;45(2):272–78.
Beheshti M, Vali R, Fitz F, et al. Influence of hormone therapy in assessment of bone metastases in prostate cancer by means of F-18 choline PET/CT. Eur J Nuclear Med Mol Imaging 2007;34(Suppl 2):S122.
Vassiliev D, Krasikova R, Kutznetsova O, Federova O, Nader M. Simple HPLC method for the detection of N,N-dimethylaminoethanol in the preparation of [N-methyl-11C] choline. Eur J Nucl Med Mol Imaging 2003;30(Suppl):342P.
Nader MW, Schubert M, Becker DW. Design and validation of a semi-automated sodium[18F]fluoride formulation system. J Nucl Med 2007;48(Suppl 2):136P.
Even-Sapir E. Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities. J Nucl Med 2005;46(8):1356–67.
Petren-Mallmin M, Andreasson I, Ljunggren O, et al. Skeletal metastases from breast cancer: uptake of 18F-fluoride measured with positron emission tomography in correlation with CT. Skelet Radiol 1998;27(2):72–6.
Heinisch M, Dirisamer A, Loidl W, et al. Positron emission tomography/computed tomography with F-18-fluorocholine for restaging of prostate cancer patients: meaningful at PSA <5 ng/ml. Mol Imaging Biol 2006;8(1):43–8.
Beheshti M, Haim S, Nader M, et al. Assessment of bone metastases in patients with prostate cancer by dual-phase F-18 fluor choline PET/CT. Eur J Nucl Med Mol Imaging 2006;33(Suppl 2):208.
Langsteger W, Beheshti M, Nader M, et al. Evaluation of lymph node and bone metastases with fluor choline (FCH) PET–CT in the follow-up of prostate cancer patients. Eur J Nucl Med Mol Imaging 2006;33(Suppl 2):209.
Bang S, Baud CA. Topographical distribution of fluoride in iliac bone of a fluoride-treated osteoporotic patient. J Bone Miner Res 1990;5(Suppl 1):S87–9.
Cook GJ, Houston S, Rubens R, Maisey MN, Fogelman I. Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol 1998;16(10):3375–9.
Galasko CS. Skeletal metastases. Clin Orthop Relat Res 1986;210:18–30.
Clavo AC, Brown RS, Wahl RL. Fluorodeoxyglucose uptake in human cancer cell lines is increased by hypoxia. J Nucl Med 1995;36(9):1625–32.
Hawkins RA, Choi Y, Huang SC, et al. Evaluation of the skeletal kinetics of fluorine-18-fluoride ion with PET. J Nucl Med 1992;33(5):633–42.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Beheshti, M., Vali, R., Waldenberger, P. et al. Detection of bone metastases in patients with prostate cancer by 18F fluorocholine and 18F fluoride PET–CT: a comparative study. Eur J Nucl Med Mol Imaging 35, 1766–1774 (2008). https://doi.org/10.1007/s00259-008-0788-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-008-0788-z