title: Comparison of 11C-choline with 18F-FDG in positron emission tomography/computerized tomography for staging urothelial carcinoma: a prospective study.
abstract: OBJECTIVE
  11C-choline was postulated to provide better diagnostic capabilities than other tracers used in positron emission tomography/computerized tomography for staging urothelial carcinoma. We compared the value of using 11C-choline with the well investigated 18F-FDG tracer in this setting.
  
  
  METHODS
  The study group included 20 consecutive patients with bladder cancer who underwent evaluation for local and metastatic disease using 11C-choline and 18F-FDG positron emission tomography/computerized tomography. Patients were treated with radical cystectomy with lymph node dissection, radiation therapy or chemotherapy independent of positron emission tomography/computerized tomography results. The histopathological findings (when available), followup positron emission tomography and radiological imaging served as the reference standard. Using the paired t test we compared the maximum standardized uptake and lesion-to-background ratio of the tracers. The positive predictive values were determined.
  
  
  RESULTS
  A total of 51 lesions showed abnormal tracer activity. The positive predictive value for all detected lesions was 84.7% for 11C-choline positron emission tomography/computerized tomography and 90.7% for 18F-FDG positron emission tomography/computerized tomography. The corresponding positive predictive values for extravesical lesions were 79.4% and 88.2%, respectively. Discrepant findings between the tracers were noted at 11 sites. 18F-FDG positron emission tomography/computerized tomography correctly identified 4 extravesical metastases missed by choline positron emission tomography/computerized tomography in the absence of a contrary observation. Mean maximum standardized uptake and lesion-to-background ratio at extravesical sites were significantly higher for FDG.
  
  
  CONCLUSIONS
  Within the limitations of a relatively small number of patients and partial histopathological analysis, 11C-choline positron emission tomography/computerized tomography appears to have no advantage compared to 18F-FDG positron emission tomography/computerized tomography in the detection of metastatic bladder cancer. 18F-FDG positron emission tomography/computerized tomography has a tendency toward greater accuracy.
authors.affiliation: Institute of Urology, Department of Nuclear Medicine, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shaygo1@yahoo.com
authors.forename: Shay
authors.initials: S
authors.lastname: Golan
authors.forename: Vladimir
authors.initials: V
authors.lastname: Sopov
authors.forename: Jack
authors.initials: J
authors.lastname: Baniel
authors.forename: David
authors.initials: D
authors.lastname: Groshar
mesh_terms: D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D002250:Carbon Radioisotopes; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D002794:Choline; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002794:Choline