Abstract
PurposeTo investigate whether time-trends of enhanced [18F]Fluoromethylcholine ([18F]FCH) in lymph nodes (LN) of prostate cancer (PCa) patients can help to discriminate reactive from malignant ones, and whether single time point standardized uptake value (SUV) measurements also suffice.Procedures25 PCa patients with inguinal (presumed benign) and enlarged pelvic LN (presumed malignant) showing enhanced [18F]FCH uptake at dual-phase PET-CT were analyzed. Associations between LN status (benign versus malignant) and SUVmax and SUVmeanA50, determined at 2 min (early) and 30 min (late) post injection, were assessed. We considered two time-trends of [18F]FCH uptake: type A (SUV early > SUV late) and type B (SUV late ≥ SUV early). Histopathology and/or follow-up were used to confirm the assumption that LN with type A pattern are benign, and LN with type B pattern malignant.ResultsAnalysis of 54 nodes showed that LN status, time-trends, and ‘late’ (30 min p.i.) SUVmax and SUVmeanA50 parameters were strongly associated (P<0.0001). SUVmax relative difference was the best LN status predictor. All but one inguinal LN showed a decreasing [18F]FCH uptake over time (pattern A), while 95% of the pelvic nodes presented a stable or increasing uptake (pattern B) type.ConclusionsTime-trends of enhanced [18F]FCH uptake can help to characterize lymph nodes in prostate cancer patients. Single time-point SUV measurements, 30 min p.i., may be a reasonable alternative for predicting benign versus malignant status of lymph nodes, but this remains to be validated in non-enlarged pelvic lymph nodes.
Highlights
Choline-based PET has proven value in several neoplasms, and especially in prostate cancer [1,2]. [18F]FCH PET-CT seems to become a useful imaging tool to solve the clinical problem of rising serum prostate-specific antigen (PSA) after initially treated prostate cancer [3,4,5], with PET-CT sensitivity being proportionally related to the PSA level [6,7].Choline is the precursor of phosphatidylcholine (PC), an essential phospholipid of cell membranes
Analysis of 54 nodes showed that lymph nodes (LN) status, time-trends, and ‘late’ (30 min p.i.) SUVmax and SUVmeanA50 parameters were strongly associated (P,0.0001)
Single time-point Standard Uptake Value (SUV) measurements, 30 min p.i., may be a reasonable alternative for predicting benign versus malignant status of lymph nodes, but this remains to be validated in non-enlarged pelvic lymph nodes
Summary
Choline-based PET has proven value in several neoplasms, and especially in prostate cancer [1,2]. [18F]FCH PET-CT seems to become a useful imaging tool to solve the clinical problem of rising serum prostate-specific antigen (PSA) after initially treated prostate cancer [3,4,5], with PET-CT sensitivity being proportionally related to the PSA level [6,7].Choline is the precursor of phosphatidylcholine (PC), an essential phospholipid of cell membranes. [18F]FCH PET-CT seems to become a useful imaging tool to solve the clinical problem of rising serum prostate-specific antigen (PSA) after initially treated prostate cancer [3,4,5], with PET-CT sensitivity being proportionally related to the PSA level [6,7]. Since biopsy of presumed regional lymph node metastases is often not trivial due to their localization in prostate cancer, false positive readings may induce serious problems in the clinical context. Both [18F] and [11C]-labeled choline derivates have been developed and studied as possible metabolic imaging tools in the detection of primary PCa, regional LN and distant metastases [11,12]. Patterns of tracer uptake as a function of time have shown to be helpful in discriminating intraprostatic tracer uptake [8,15] as well as sites of suspected haematogeneous metastases [17]
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