title: Evaluation of 11C-choline PET/CT for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract: a pilot study.
abstract: OBJECTIVE
  We conducted a pilot study to prospectively evaluate the efficacy of PET/CT with (11)C-choline (choline PET/CT) for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract (UUT-UC).
  
  
  METHODS
  Enrolled in this study were 16 patients (9 men, 7 women; age range 51 - 83 years, mean ± SD 69 ± 10.8 years) with suspected UUT-UC. The patients were examined by choline PET/CT, and 13 underwent laparoscopic nephroureterectomy and partial cystectomy. Lymphadenectomy and chemotherapy were also performed as necessary in some of the patients. Of the 16 patients, 12 were confirmed to have UUT-UC (7 renal pelvis carcinoma and 5 ureteral carcinoma), 1 had malignant lymphoma (ureter), 1 had IgG4-related disease (ureter), and 2 had other benign diseases (ureter).
  
  
  RESULTS
  Of the 16 study patients, 13 showed definite choline uptake in urothelial lesions, and of these, 11 had UUT-UC, 1 had malignant lymphoma, and 1 had IgG4-related disease. Three patients without choline uptake comprised one with UUT-UC and two with benign diseases. Of the 12 patients with UUT-UC, 3 had distant metastases, 2 had metastases only in the regional lymph nodes, and 7 had no metastases. Distant metastases and metastases in the regional lymph nodes showed definite choline uptake. The outcome in patients with UUT-UC, which was evaluated 592 - 1,530 days after surgery, corresponded to the patient classification based on the presence or absence of metastases and locoregional or distant metastases. Choline uptake determined as SUVmax 10 min after administration was significantly higher than at 20 min in metastatic tumours of UUT-UC (p < 0.05), whereas there was no statistically significant difference between the SUVmax values at 10 and those at 20 min in primary tumours of UUT-UC.
  
  
  CONCLUSIONS
  This study suggests that choline PET/CT is a promising tool for the primary diagnosis and staging of UUT-UC.
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Sassa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kato
authors.forename: Shinji
authors.initials: S
authors.lastname: Abe
authors.forename: Shingo
authors.initials: S
authors.lastname: Iwano
authors.forename: Shinji
authors.initials: S
authors.lastname: Ito
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ikeda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shimamoto
authors.forename: Seiichi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Tokunori
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002250:Carbon Radioisotopes; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D002794:Choline; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline
references.citation: Radiology. 2007 Sep;244(3):797-806
references.pmid: 17652190
references.citation: Eur J Radiol. 2011 Nov;80(2):e50-6
references.pmid: 20800404
references.citation: J Urol. 2010 Sep;184(3):938-43
references.pmid: 20643445
references.citation: Eur Urol. 2010 Apr;57(4):641-7
references.pmid: 19477579
references.citation: Semin Nucl Med. 2004 Oct;34(4):274-92
references.pmid: 15493005
references.citation: Anticancer Res. 1996 May-Jun;16(3B):1375-80
references.pmid: 8694504
references.citation: Mol Cell Biol. 1989 Jan;9(1):325-8
references.pmid: 2538723
references.citation: Arch Biochem Biophys. 1995 Nov 10;323(2):313-22
references.pmid: 7487093
references.citation: Eur Urol. 2011 Nov;60(5):935-43
references.pmid: 21840116
references.citation: Semin Nucl Med. 2006 Jan;36(1):51-72
references.pmid: 16356796
references.citation: Curr Opin Rheumatol. 2011 Jan;23(1):57-66
references.pmid: 21124086
references.citation: Eur J Nucl Med Mol Imaging. 2002 Oct;29(10):1283-8
references.pmid: 12271408
references.citation: Urol Int. 2010;84(4):418-23
references.pmid: 20299773
references.citation: J Clin Oncol. 2009 Sep 10;27(26):4314-20
references.pmid: 19652070
references.citation: J Urol. 2006 Sep;176(3):954-60; discussion 960
references.pmid: 16890665
references.citation: J Nucl Med. 2005 Oct;46(10):1642-9
references.pmid: 16204714
references.citation: CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49
references.pmid: 19474385
references.citation: Eur Urol. 2007 Aug;52(2):423-9
references.pmid: 17397992
references.citation: Mod Rheumatol. 2012 Feb;22(1):1-14
references.pmid: 21881964
references.citation: BJU Int. 2011 Apr;107(7):1059-64
references.pmid: 20825397
references.citation: Eur Urol. 2011 Jul;60(1):125-30
references.pmid: 21292388
references.citation: Clin Cancer Res. 2011 Dec 15;17(24):7673-83
references.pmid: 22038995
references.citation: Adv Urol. 2012;2012:601572
references.pmid: 21822429
references.citation: Cancer. 2012 Jan 1;118(1):72-81
references.pmid: 21720989
references.citation: J Nucl Med. 2006 Aug;47(8):1249-54
references.pmid: 16883001
references.citation: Cancer Res. 2001 May 1;61(9):3599-603
references.pmid: 11325827
references.citation: Eur Urol. 2012 Jun;61(6):1229-38
references.pmid: 22189383
references.citation: BJU Int. 2010 Sep;106(5):658-63
references.pmid: 20151968
references.citation: BJU Int. 2008 Aug;102(4):446-51
references.pmid: 18410442