title: Role of 11C-choline PET/CT in the restaging of prostate cancer patients showing a single lesion on bone scintigraphy.
abstract: OBJECTIVE
  To assess the utility of (11)C-choline PET/CT in the restaging of prostate cancer (PC) patients who showed a single finding on bone scintigraphy (BS) that was classified as equivocal or suspected for metastatic lesion.
  
  
  METHODS
  A total of 25 PC patients with biochemical failure (mean PSA value 11.1 ng/mL; median value 6.3 ng/mL; range 0.2-37.7 ng/mL) after primary treatment were included in this retrospective study. All of them showed a single lesion on BS reported as suspected for metastatic lesion or as equivocal finding. Patients underwent (11)C-choline PET/CT within 1-4 months from BS. Validation was established by follow-up for at least 6 months.
  
  
  RESULTS
  On the basis of biopsy confirmation and/or 6-month follow-up, 22 of 25 patients were classified as positive for the presence of metastatic bone lesions: 13 with a single lesion and 9 with multiple lesions. (11)C-choline PET/CT was positive in 19/25 patients and, on a lesion basis, it showed 50 positive findings. BS results were confirmed in 8/25 (32%) patients. (11)C-choline PET/CT detected multiple sites of relapse in 11/25 (44%) patients: in 2/11, a single bone lesion associated with other extraosseous sites of relapse; in 6/11, multiple bone lesions; in 3/11, multiple bone lesions and other extraosseous localizations. Finally, 6/25 patients were negative on (11)C-choline PET/CT. In 3/6 patients, an osteoblastic lesion was seen on CT attenuation correction images (PET false negative; BS true positive), while in 3/6 patients only findings suggestive of the presence of degenerative disease were found (PET true negative; BS false positive). On a patient basis, (11)C-choline PET/CT showed a diagnostic sensitivity of 86% (19/22) and a specificity of 100% (19/19).
  
  
  CONCLUSIONS
  In our study, (11)C-choline PET/CT detected unknown lesions in 11/25 patients. Patients with a single equivocal finding on BS could have important additional information from (11)C-choline PET/CT study, especially in the detection of additional metastases, to choose an appropriate treatment.
authors.affiliation: Nuclear Medicine Unit, Hematology-Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fuccio
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellucci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Ivan
authors.initials: I
authors.lastname: Santi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Allegri
authors.forename: Vincenzina
authors.initials: V
authors.lastname: Pettinato
authors.forename: Stefano
authors.initials: S
authors.lastname: Boschi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.forename: Adil
authors.initials: A
authors.lastname: Al-Nahhas
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D002250:Carbon Radioisotopes; D002794:Choline; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D002794:Choline