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Detection of bronchioloalveolar cancer by means of PET/CT and 18F-fluorocholine, and comparison with 18F-fluorodeoxyglucose

Balogova, Sonaa e; Huchet, Virginiea; Kerrou, Khaldouna; Nataf, Valerieb; Gutman, Fabricea; Antoine, Martinec; Ruppert, Anne-Maried; Prignon, Auréliea; Lavolée, Armelled; Montravers, Francoisea; Mayaud, Charlesd; Cadranel, Jacquesd; Talbot, Jean-Noëla

Nuclear Medicine Communications: May 2010 - Volume 31 - Issue 5 - p 389-397
doi: 10.1097/MNM.0b013e3283369654
Original Articles

Aim Bronchioloalveolar (BAC) cancer is a source of false-negative 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) results. A few studies reported better diagnostic performances with PET tracers of lipid metabolism, 11C-choline, or 11C-acetate, for the detection of well-differentiated adenocarcinoma or BAC. 18F-fluorocholine (FCH) is a lipid analogue for PET imaging, with advantages in terms of logistics and image resolution. We carried out this prospective pilot study to evaluate whether FCH PET/CT could detect lung cancer with a BAC component and could be more sensitive than FDG in this aim.

Methods Fifteen patients with a lung nodule or lesion suspected for BAC on CT and/or with a history of BAC had PET/CT 60–90 min after 5 MBq FDG/kg body mass and, on a separate day, 10–20 min after 4 MBq FCH/kg body mass. The standard of truth was histology and a 6-month follow-up.

Results Nine patients (12 lesions) presented BAC or adenocarcinoma with BAC features, two patients presented adenocarcinoma without BAC features (five lesions) and four patients presented benign lesions (15 non-malignant sites). For both FCH and FDG, patient-based sensitivity was 78% for detecting cancer with a BAC component and 82% for detecting malignancy. Site-based sensitivity for detecting malignancy was 76 and 75% for detecting cancer with BAC features, for both radiopharmaceuticals. Specificity was similar for FCH and FDG (site-based 93 vs. 81%, NS). In these early-stage cancers, only one adrenal metastasis was observed that took up FCH and FDG.

Conclusion In this population of patients with ground-glass opacities selected on CT suggestive of BAC or with a history of BAC and a recent lung anomaly on CT, FCH detected all malignant lesions with at least a 2.0 cm short axis. However, FDG had similar performance.

Departments of aNuclear Medicine


cPathological Anatomy

dPulmonology, Hôpital Tenon AP-HP, Paris, France

eDepartment of Nuclear Medicine, University Hospital of Bratislava, Slovakia

Correspondence to Dr Sona Balogova, PhD, Department of Nuclear Medicine, l'Hôpital Tenon AP-HP, 59, Rue de la Chine, Paris 75020, France

Tel: +42 190 396 9869; fax: +33 156 016 171;


Received 24 July 2009 Revised 9 December 2009 Accepted 10 December 2009

© 2010 Lippincott Williams & Wilkins, Inc.