Abstract
Over the last decade, 18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) has gained in popularity for the staging and restaging of patients with prostate cancer (PCa). However, despite abundant literature on the topic, there is a lack of publications on how to actually interpret FCH-PET/CT in a clinical setting. Here we propose a practical, TNM-oriented approach to read FCH-PET/CT, with notes on procedure technique, image display, review sequence and report structure. The purpose of this article is to provide guidance to radiologists, nuclear medicine physicians and residents who are new to FCH-PET/CT, as well as to propose an alternate approach to more experienced physicians.
Highlights
Positron emission tomography/computed tomography (PET/CT) with radiolabeled choline, a marker of cell membrane synthesis, has proven to be a useful imaging technique in the management of prostate cancer (PCa). 18F-fluorocholine (FCH) is more convenient than 11C-choline, the tracer of reference, as it can be delivered to centers devoid of an on-site cyclotron, owing to the longer half-life of 18F. 11C-choline is FDA-approved for restaging of PCa in the setting of biochemical relapse after radical prostatectomy [1], and this indication is the most established one for FCH-PET/CT to date [2,3,4]
It has been demonstrated that a high Gleason score, a high PSA and a short PSA doubling time are associated with higher sensitivity of FCH-PET/CT [4]
An equivocal finding based on FCH-PET/CT images alone, such as a solitary pelvic lymph with a rather mild FCH uptake, could be interpreted as more likely to represent metastasis in a patient with any of these characteristics, or less likely to in a patient with none
Summary
Positron emission tomography/computed tomography (PET/CT) with radiolabeled choline, a marker of cell membrane synthesis, has proven to be a useful imaging technique in the management of prostate cancer (PCa). 18F-fluorocholine (FCH) is more convenient than 11C-choline, the tracer of reference, as it can be delivered to centers devoid of an on-site cyclotron, owing to the longer half-life of 18F. 11C-choline is FDA-approved for restaging of PCa in the setting of biochemical relapse after radical prostatectomy [1], and this indication is the most established one for FCH-PET/CT to date [2,3,4]. 11C-choline is FDA-approved for restaging of PCa in the setting of biochemical relapse after radical prostatectomy [1], and this indication is the most established one for FCH-PET/CT to date [2,3,4]. FCH usually refers to 18F-fluoromethylcholine, but 18F-fluoroethylcholine has been employed. Both tracers appear to have a comparable biosdistribution [5], 18F-fluoromethylcholine has been used and studied more extensively [6]. Androgen deprivation therapy (ADT) does not need to be stopped before FCH-PET/ CT performed in the setting of biochemical recurrence under ADT, as castration-resistant PCa lesions are proliferating despite ADT [7]
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