title: Carbon-11 choline positron emission tomography in musculoskeletal tumors: comparison with fluorine-18 fluorodeoxyglucose positron emission tomography.
abstract: OBJECTIVE
  Recently, a new positron emission tomography (PET) tracer, carbon-11 choline, has been introduced in oncology investigations, but the role of choline PET in musculoskeletal tumor evaluation has not been previously examined. This is the first trial to investigate the utility of choline PET in evaluating musculoskeletal tumors in comparison with fluorine-18 fluoro-2-deoxy-D-glucose (FDG) PET.
  
  
  METHODS
  Thirty-three patients were examined with both choline PET and FDG PET, of which standardized uptake values (SUVs) were used for evaluation of the lesions. To decide the appropriate cutoff value and compare the two PET studies, receiver operating characteristic curve analysis was used. The binomial test was used for comparison of sensitivities between choline PET and FDG PET.
  
  
  RESULTS
  A significant correlation (r = 0.537, P = 0.0013) between choline and FDG SUVs was noted for all lesions (n = 33). Mean SUVs for malignant tumors were significantly higher than those for benign lesions in both choline PET and FDG PET. Using a cutoff value of 2.7 for choline SUVs, the sensitivity for correctly diagnosing malignancy was 92.3% (12/13) with a specificity of 90.0% (18/20), resulting in an accuracy rate of 90.9%. With use of a cutoff value of 3.3 for SUVs in FDG PET, the sensitivity was 84.6% (11/13) with a specificity of 80.0% (16/20), resulting in an accuracy rate of 81.8%. The receiver operating characteristic curves of two analyses showed that the mean area under the curve value of choline PET (0.9577 +/- 0.041) was significantly greater (P = 0.0488) than that of FDG PET (0.8192 +/- 0.0806). There was no significant difference in sensitivity and specificity between choline PET and FDG PET analysis using either the binomial test (P = 0.4531) or McNemar test (P = 0.371).
  
  
  CONCLUSIONS
  Choline PET analysis may not be inferior to FDG PET analysis for differentiating malignant from benign musculoskeletal tumors. The advantages of choline PET were shorter examination time and little retention in the bladder; therefore, this modality may be useful for preoperative planning for musculoskeletal tumors, especially for lesions around the hip joints.
authors.affiliation: Department of Orthopedic Surgery, Gunma University Faculty of Medicine, Maebashi, Gunma, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yanagawa
authors.forename: Hideomi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Tomio
authors.initials: T
authors.lastname: Inoue
authors.forename: Adel Refaat
authors.initials: AR
authors.lastname: Ahmed
authors.forename: Katsumi
authors.initials: K
authors.lastname: Tomiyoshi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shinozaki
authors.forename: Noboru
authors.initials: N
authors.lastname: Oriuchi
authors.forename: Keigo
authors.initials: K
authors.lastname: Endo
authors.forename: Kenji
authors.initials: K
authors.lastname: Takagishi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002250:Carbon Radioisotopes; D002648:Child; D002794:Choline; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000175:diagnosis* / Q000473:pathology; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008080:Liposarcoma / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000175:diagnosis* / Q000473:pathology; D019275:Radiopharmaceuticals; D012507:Sarcoidosis / Q000175:diagnosis / Q000473:pathology; D013584:Sarcoma, Synovial / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002794:Choline