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18F-Choline PET/CT Pitfalls in Image Interpretation

An Update on 300 Examined Patients With Prostate Cancer

Calabria, Ferdinando, MD*; Chiaravalloti, Agostino, MD; Schillaci, Orazio, MD*†

doi: 10.1097/RLU.0000000000000303
Original Articles

Objectives 18F-choline PET/CT is an important diagnostic tool in the management of patients with prostate cancer (PC). The aim of this study was to describe and discuss some abnormal sites of uptake that we observed, not due to PC recurrence.

Patients and Methods Three hundred patients were submitted to 18F-choline PET/CT for staging or restaging of PC. Whole-body PET/CT was acquired 40 minutes after the 18F-choline administration.

Results We found abnormal uptake of the tracer, not related to PC, in 48/300 patients (16%). Most of these findings were due to inflammatory processes. Furthermore, some malignant conditions, such as a case of colon cancer, a case of bladder carcinoma, and a multiple myeloma, were diagnosed. Mild uptake was also detected in some benign diseases, such as thymoma, adrenal adenoma, and sarcoidosis. Six patients showed focal brain uptake in correspondence to a meningioma.

Conclusions It is necessary for nuclear physicians, during clinical practice, to consider the possibility of 18F-choline uptake in some benign or malignant conditions for the intrinsic pharmacologic property of the tracer. An accurate medical investigation, correlative imaging with CT and/or MRI with contrast agents, laboratory data, and above all, histologic examination are often necessary for correct diagnosis.

From the *Department of Nuclear Medicine and Molecular Imaging, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico Mediterraneo Neuromed, Pozzilli; and †Department of Biomedicine and Prevention, University “Tor Vergata,” PTV Foundation–Policlinic “Tor Vergata,” Rome, Italy.

Received for publication April 09, 2013; revision accepted October 17, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Ferdinando Calabria, MD, Department of Nuclear Medicine and Molecular Imaging, IRCCS INM Neuromed, Via Atinense 18, 86077 Pozzilli (IS), Italy. E-mail:

© 2014 by Lippincott Williams & Wilkins