Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 11/2010

01-11-2010 | Review Article

PET with 18F-labelled choline-based tracers for tumour imaging: a review of the literature

Authors: Koen Mertens, Dominique Slaets, Bieke Lambert, Marjan Acou, Filip De Vos, Ingeborg Goethals

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2010

Login to get access

Abstract

Purpose

To give an up-to-date overview of the potential clinical utility of 18F-labelled choline derivatives for tumour imaging with positron emission tomography.

Methods

A PubMed search for 18F-labelled choline analogues was performed. Review articles and reference lists were used to supplement the search findings.

Results

18F-labelled choline analogues have been investigated as oncological PET probes for many types of cancer on the basis of enhanced cell proliferation. To date, studies have focused on the evaluation of prostate cancer. Available studies have provided preliminary results for detecting local and metastatic disease. Experience with 18F-fluorocholine PET in other tumour types, including brain and liver tumours, is still limited. In the brain, excellent discrimination between tumour and normal tissue can be achieved due to the low physiological uptake of 18F-fluorocholine. In the liver, in which there is a moderate to high degree of physiological uptake in normal tissue, malignancy discrimination may be more challenging.

Conclusion

PET/CT with 18F-fluorocholine can be used to detect (recurrent) local prostate cancer, but seems to have limited value for T (tumour) and N (nodal) staging. In patients presenting with recurrent biochemical prostate cancer, it is a suitable single-step examination with the ability to exclude distant metastases when local salvage treatment is intended. In the brain, high-grade gliomas, metastases and benign lesions can be distinguished on the basis of 18F-fluorocholine uptake. Moreover, PET imaging is able to differentiate between radiation-induced injury and tumour recurrence. In the liver, 18F-fluorocholine PET/CT seems promising for the detection of hepatocellular carcinoma.
Literature
1.
Vallabhajosula S. (18)F-Labeled positron emission tomographic radiopharmaceuticals in oncology: an overview of radiochemistry and mechanisms of tumor localization. Semin Nucl Med 2007;37:400–19.CrossRefPubMed
2.
Swinnen JV, Brusselmans K, Verhoeven G. Increased lipogenesis in cancer cells: new players, novel targets. Curr Opin Clin Nutr Metab Care 2006;9:358–65.CrossRefPubMed
3.
4.
Ackerstaff E, Pflug BR, Nelson JB, Bhujwalla ZM. Detection of increased choline compounds with proton nuclear magnetic resonance spectroscopy subsequent to malignant transformation of human prostatic epithelial cells. Cancer Res 2001;61:3599–603.PubMed
5.
Swanson MG, Vigneron DB, Tabatabai ZL, Males RG, Schmitt L, Carroll PR, et al. Proton HR-MAS spectroscopy and quantitative pathologic analysis of MRI/3D-MRSI-targeted postsurgical prostate tissues. Magn Reson Med 2003;50:944–54.CrossRefPubMed
6.
Bhakoo KK, Williams SR, Florian CL, Land H, Noble MD. Immortalization and transformation are associated with specific alterations in choline metabolism. Cancer Res 1996;56:4630–5.PubMed
7.
Nakagami K, Uchida T, Ohwada S, Koibuchi Y, Suda Y, Sekine T, et al. Increased choline kinase activity and elevated phosphocholine levels in human colon cancer. Jpn J Cancer Res 1999;90:419–24.PubMed
8.
Ramirez de Molina A, Rodriguez-Gonzalez A, Gutierrez R, Martinez-Pineiro L, Sanchez J, Bonilla F, et al. Overexpression of choline kinase is a frequent feature in human tumor-derived cell lines and in lung, prostate, and colorectal human cancers. Biochem Biophys Res Commun 2002;296:580–3.CrossRefPubMed
9.
Roivainen A, Forsback S, Gronroos T, Lehikoinen P, Kahkonen M, Sutinen E, et al. Blood metabolism of [methyl-11C]choline; implications for in vivo imaging with positron emission tomography. Eur J Nucl Med 2000;27:25–32.CrossRefPubMed
10.
DeGrado TR, Coleman RE, Wang S, Baldwin SW, Orr MD, Robertson CN, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res 2001;61:110–7.PubMed
11.
Hara T, Kosaka N, Kishi H. Development of (18)F-fluoroethylcholine for cancer imaging with PET: synthesis, biochemistry, and prostate cancer imaging. J Nucl Med 2002;43:187–99.PubMed
12.
Bansal A, Shuyan W, Hara T, Harris RA, Degrado TR. Biodisposition and metabolism of [(18)F]fluorocholine in 9L glioma cells and 9L glioma-bearing fisher rats. Eur J Nucl Med Mol Imaging 2008;35:1192–203.CrossRefPubMed
13.
Kwee SA, DeGrado TR, Talbot JN, Gutman F, Coel MN. Cancer imaging with fluorine-18-labeled choline derivatives. Semin Nucl Med 2007;37:420–8.CrossRefPubMed
14.
Hara T. 18F-fluorocholine: a new oncologic PET tracer. J Nucl Med 2001;42:1815–7.PubMed
15.
Iwata R, Pascali C, Bogni A, Furumoto S, Terasaki K, Yanai K. [18F]Fluoromethyl triflate, a novel and reactive [18F]fluoromethylating agent: preparation and application to the on-column preparation of [18F]fluorocholine. Appl Radiat Isot 2002;57:347–52.CrossRefPubMed
16.
Kryza D, Tadino V, Filannino MA, Villeret G, Lemoucheux L. Fully automated [18F]fluorocholine synthesis in the TracerLab MX FDG Coincidence synthesizer. Nucl Med Biol 2008;35:255–60.CrossRefPubMed
17.
Takahashi N, Inoue T, Lee J, Yamaguchi T, Shizukuishi K. The roles of PET and PET/CT in the diagnosis and management of prostate cancer. Oncology 2007;72:226–33.CrossRefPubMed
18.
Beerlage HP, de Reijke TM, de la Rosette JJ. Considerations regarding prostate biopsies. Eur Urol 1998;34:303–12.CrossRefPubMed
19.
Sedelaar JP, Vijverberg PL, De Reijke TM, de la Rosette JJ, Kil PJ, Braeckman JG, et al. Transrectal ultrasound in the diagnosis of prostate cancer: state of the art and perspectives. Eur Urol 2001;40:275–84.CrossRefPubMed
20.
Crook J, Malone S, Perry G, Bahadur Y, Robertson S, Abdolell M. Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients. Int J Radiat Oncol Biol Phys 2000;48:355–67.PubMed
21.
Pucar D, Sella T, Schoder H. The role of imaging in the detection of prostate cancer local recurrence after radiation therapy and surgery. Curr Opin Urol 2008;18:87–97.CrossRefPubMed
22.
Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT. Imaging prostate cancer: a multidisciplinary perspective. Radiology 2007;243:28–53.CrossRefPubMed
23.
Sala E, Eberhardt SC, Akin O, Moskowitz CS, Onyebuchi CN, Kuroiwa K, et al. Endorectal MR imaging before salvage prostatectomy: tumor localization and staging. Radiology 2006;238:176–83.CrossRefPubMed
24.
Hersh MR, Knapp EL, Choi J. Newer imaging modalities to assess tumor in the prostate. Cancer Control 2004;11:353–7.PubMed
25.
Wang L, Hricak H, Kattan MW, Chen HN, Scardino PT, Kuroiwa K. Prediction of organ-confined prostate cancer: incremental value of MR imaging and MR spectroscopic imaging to staging nomograms. Radiology 2006;238:597–603.CrossRefPubMed
26.
Scheidler J, Hricak H, Vigneron DB, Yu KK, Sokolov DL, Huang LR, et al. Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging – clinicopathologic study. Radiology 1999;213:473–80.PubMed
27.
Chen M, Dang HD, Wang JY, Zhou C, Li SY, Wang WC, et al. Prostate cancer detection: comparison of T2-weighted imaging, diffusion-weighted imaging, proton magnetic resonance spectroscopic imaging, and the three techniques combined. Acta Radiol 2008;49:602–10.CrossRefPubMed
28.
Schmid DT, John H, Zweifel R, Cservenyak T, Westera G, Goerres GW, et al. Fluorocholine PET/CT in patients with prostate cancer: initial experience. Radiology 2005;235:623–8.CrossRefPubMed
29.
Kwee SA, Coel MN, Lim J, Ko JP. Prostate cancer localization with 18fluorine fluorocholine positron emission tomography. J Urol 2005;173:252–5.CrossRefPubMed
30.
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;47:262–9.PubMed
31.
Igerc I, Kohlfurst S, Gallowitsch HJ, Matschnig S, Kresnik E, Gomez-Segovia I, et al. The value of 18F-choline PET/CT in patients with elevated PSA-level and negative prostate needle biopsy for localisation of prostate cancer. Eur J Nucl Med Mol Imaging 2008;35:976–83.CrossRefPubMed
32.
Kwee SA, Thibault GP, Stack RS, Coel MN, Furusato B, Sesterhenn IA. Use of step-section histopathology to evaluate 18F-fluorocholine PET sextant localization of prostate cancer. Mol Imaging 2008;7:12–20.PubMed
33.
Tiguert R, Gheiler EL, Tefilli MV, Oskanian P, Banerjee M, Grignon DJ, et al. Lymph node size does not correlate with the presence of prostate cancer metastasis. Urology 1999;53:367–71.CrossRefPubMed
34.
Häcker A, Jeschke S, Leeb K, Prammer K, Ziegerhofer J, Sega W, et al. Detection of pelvic lymph node metastases in patients with clinically localized prostate cancer: comparison of [18F]fluorocholine positron emission tomography-computerized tomography and laparoscopic radioisotope guided sentinel lymph node dissection. J Urol 2006;176:2014–8.CrossRefPubMed
35.
Husarik DB, Miralbell R, Dubs M, John H, Giger OT, Gelet A, et al. Evaluation of [(18)F]-choline PET/CT for staging and restaging of prostate cancer. Eur J Nucl Med Mol Imaging 2008;35:253–63.CrossRefPubMed
36.
Langsteger W, Heinisch M, Fogelman I. The role of fluorodeoxyglucose, 18F-dihydroxyphenylalanine, 18F-choline, and 18F-fluoride in bone imaging with emphasis on prostate and breast. Semin Nucl Med 2006;36:73–92.CrossRefPubMed
37.
Heinisch M, Dirisamer A, Loidl W, Stoiber F, Gruy B, Haim S, 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;8:43–8.CrossRefPubMed
38.
Cimitan M, Bortolus R, Morassut S, Canzonieri V, Garbeglio A, Baresic T, et al. [18F]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;33:1387–98.CrossRefPubMed
39.
Mohler J, Babaian RJ, Bahnson RR, Boston B, D’Amico A, Eastham JA, et al. Prostate cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2007;5:650–83.PubMed
40.
Pelosi E, Arena V, Skanjeti A, Pirro V, Douroukas A, Pupi A, et al. Role of whole-body 18F-choline PET/CT in disease detection in patients with biochemical relapse after radical treatment for prostate cancer. Radiol Med 2008;113:895–904.CrossRefPubMed
41.
Vees H, Buchegger F, Albrecht S, Khan H, Husarik D, Zaidi H, et al. 18F-Choline and/or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low prostate-specific antigen values (<1 ng/mL) after radical prostatectomy. BJU Int 2007;99:1415–20.CrossRefPubMed
42.
Hara T. 11C-Choline and 2-deoxy-2-[18F]fluoro-D-glucose in tumor imaging with positron emission tomography. Mol Imaging Biol 2002;4:267–73.CrossRefPubMed
43.
Kwee SA, Coel MN, Lim J, Ko JP. Combined use of F-18 fluorocholine positron emission tomography and magnetic resonance spectroscopy for brain tumor evaluation. J Neuroimaging 2004;14:285–9.PubMed
44.
Kwee SA, Ko JP, Jiang CS, Watters MR, Coel MN. Solitary brain lesions enhancing at MR imaging: evaluation with fluorine 18 fluorocholine PET. Radiology 2007;244:557–65.CrossRefPubMed
45.
Spaeth N, Wyss MT, Weber B, Scheidegger S, Lutz A, Verwey J, et al. Uptake of 18F-fluorocholine, 18F-fluoroethyl-L-tyrosine, and 18F-FDG in acute cerebral radiation injury in the rat: implications for separation of radiation necrosis from tumor recurrence. J Nucl Med 2004;45:1931–8.PubMed
46.
Yamamoto Y, Nishiyama Y, Kameyama R, Okano K, Kashiwagi H, Deguchi A, et al. Detection of hepatocellular carcinoma using 11C-choline PET: comparison with 18F-FDG PET. J Nucl Med 2008;49:1245–8.CrossRefPubMed
47.
Salem N, Kuang Y, Wang F, Maclennan GT, Lee Z. PET imaging of hepatocellular carcinoma with 2-deoxy-2[18F]fluoro-D-glucose, 6-deoxy-6[18F] fluoro-D-glucose, [1-11C]-acetate and [N-methyl-11C]-choline. Q J Nucl Med Mol Imaging 2009;53:144–56.PubMed
48.
Talbot JN, Gutman F, Fartoux L, Grange JD, Ganne N, Kerrou K, et al. PET/CT in patients with hepatocellular carcinoma using [(18)F]fluorocholine: preliminary comparison with [(18)F]FDG PET/CT. Eur J Nucl Med Mol Imaging 2006;33:1285–9.CrossRefPubMed
49.
Tian M, Zhang H, Oriuchi N, Higuchi T, Endo K. Comparison of 11C-choline PET and FDG PET for the differential diagnosis of malignant tumors. Eur J Nucl Med Mol Imaging 2004;31:1064–72.PubMed
50.
Hara T, Inagaki K, Kosaka N, Morita T. Sensitive detection of mediastinal lymph node metastasis of lung cancer with 11C-choline PET. J Nucl Med 2000;41:1507–13.PubMed
51.
Pieterman RM, Que TH, Elsinga PH, Pruim J, van Putten JW, Willemsen AT, et al. Comparison of (11)C-choline and (18)F-FDG PET in primary diagnosis and staging of patients with thoracic cancer. J Nucl Med 2002;43:167–72.PubMed
52.
Khan N, Oriuchi N, Zhang H, Higuchi T, Tian M, Inoue T, et al. A comparative study of 11C-choline PET and [18F]fluorodeoxyglucose PET in the evaluation of lung cancer. Nucl Med Commun 2003;24:359–66.CrossRefPubMed
53.
Jager PL, Que TH, Vaalburg W, Pruim J, Elsinga P, Plukker JT. Carbon-11 choline or FDG-PET for staging of oesophageal cancer? Eur J Nucl Med 2001;28:1845–9.CrossRefPubMed
54.
Khan N, Oriuchi N, Ninomiya H, Higuchi T, Kamada H, Endo K. Positron emission tomographic imaging with 11C-choline in differential diagnosis of head and neck tumors: comparison with 18F-FDG PET. Ann Nucl Med 2004;18:409–17.CrossRefPubMed
55.
Ninomiya H, Oriuchi N, Kahn N, Higuchi T, Endo K, Takahashi K, et al. Diagnosis of tumor in the nasal cavity and paranasal sinuses with [11C]choline PET: comparative study with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) PET. Ann Nucl Med 2004;18:29–34.CrossRefPubMed
56.
Torizuka T, Kanno T, Futatsubashi M, Okada H, Yoshikawa E, Nakamura F, et al. Imaging of gynecologic tumors: comparison of (11)C-choline PET with (18)F-FDG PET. J Nucl Med 2003;44:1051–6.PubMed
Metadata
Title
PET with 18F-labelled choline-based tracers for tumour imaging: a review of the literature
Authors
Koen Mertens
Dominique Slaets
Bieke Lambert
Marjan Acou
Filip De Vos
Ingeborg Goethals
Publication date
01-11-2010
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2010
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-010-1496-z

Other articles of this Issue 11/2010

European Journal of Nuclear Medicine and Molecular Imaging 11/2010 Go to the issue

Guidelines

EANM procedure guidelines for therapy of benign thyroid disease

Original Article

Biodistribution and dosimetry of 18F-EF5 in cancer patients with preliminary comparison of 18F-EF5 uptake versus EF5 binding in human glioblastoma

Image of the month

Breast lymphatic drainage via the pulmonary lymphatic system

Original Article

Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology

Letter to the Editor

Is a SUV cut-off necessary in the evaluation of the response of axillary lymph node metastases to neoadjuvant therapy?

Editorial Commentary

Comparison of diagnostic performances of three different software packages in detecting coronary artery disease