title: Contribution of 11C-choline positron emission tomography/computerized tomography to preoperative staging of advanced transitional cell carcinoma.
abstract: OBJECTIVE
  Current imaging modalities for preoperative staging of advanced transitional cell carcinoma of the bladder or upper urinary tract are not sensitive for detection of metastases. This study examines the contribution of 11C-choline positron emission tomography/computerized tomography to preoperative staging of transitional cell carcinoma.
  
  
  METHODS
  We prospectively evaluated 18 patients with 19 advanced transitional cell carcinomas (17 bladder tumors and 2 upper tract transitional cell carcinomas). All patients had computerized tomography of the chest, abdomen and pelvis negative for metastases. 11C-choline positron emission tomography/computerized tomography was performed on a Discovery ST(R) positron emission tomography/computerized tomography system. Finally 16 patients underwent radical surgery and positron emission tomography/computerized tomography images were compared to histopathological findings. Two patients were not operated on due to the findings on 11C-choline positron emission tomography/computerized tomography.
  
  
  RESULTS
  11C-choline uptake was found in all primary transitional cell carcinomas, with a maximum standardized uptake value of 7.3 +/- 3.2 (mean +/- SD). The series included 3 patients with refractory bladder carcinoma in situ, which was visualized in all 3, with a standardized uptake value of 6.9 +/- 5.6. In 6 patients uptake of 11C-choline in lymph nodes as small as 5 mm was visualized (standardized uptake value 3.8 +/- 1.4). Of these patients 4 underwent surgery and histopathology confirmed malignancy in 3 of 4. No additional patients with positive lymph nodes were found on histopathology. Metastases were visualized in bones with normal architecture on computerized tomography in 4 patients (standardized uptake value 5.2 +/- 1.1) and were confirmed by followup computerized tomography.
  
  
  CONCLUSIONS
  In this small series 11C-choline positron emission tomography/computerized tomography was highly sensitive for primary and metastatic transitional cell carcinoma. Carcinoma in situ, lymph node metastases and early bony metastases were visualized. 11C-choline positron emission tomography/computerized tomography is a promising tool for preoperative staging of advanced transitional cell carcinoma.
authors.affiliation: Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel. ong1000@netvision.net.il
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Eyal
authors.initials: E
authors.lastname: Mishani
authors.forename: Marina
authors.initials: M
authors.lastname: Orevi
authors.forename: Martine
authors.initials: M
authors.lastname: Klein
authors.forename: Nanette
authors.initials: N
authors.lastname: Freedman
authors.forename: Dov
authors.initials: D
authors.lastname: Pode
authors.forename: Amos
authors.initials: A
authors.lastname: Shapiro
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.forename: Eugene
authors.initials: E
authors.lastname: Libson
authors.forename: Roland
authors.initials: R
authors.lastname: Chisin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002250:Carbon Radioisotopes; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D002794:Choline; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D002250:Carbon Radioisotopes; D002794:Choline