Intraindividual comparison of [¹¹C]acetate and [¹¹C]choline PET for detection of metastases of prostate cancer^[*]

Abstract

In a pilot trial we investigated whether significant differences in prostate cancer (PCA) imaging would be observed using [¹¹C]acetate and [¹¹C]choline positron emission tomography (PET). Methods: Twelve patients were studied with both radiotracers. Whole body PET without attenuation correction was performed after injection of 0.95 ± 0.15 GBq [¹¹C]acetate and 0.84 ± 0.13 GBq [¹¹C]choline, respectively, from 5 to 60 min p. i. Focally increased uptake in bone, below the urinary bladder or in a lymph node region was considered as tumour. Primary tumour, lymph node involvement, bone metastases, local recurrence; and no evidence of disease were known in 2, 4, 2, 2; and 2 patients, respectively. Results: [¹¹C]Acetate uptake was highest in spleen and pancreas while [¹¹C]choline uptake was predominant in liver and kidney parenchyma. However, interindividual variation was high. The potential of both radiotracers to detect known bone lesions, lymph node metastases, and imaging of the primary tumour was identical. However, both failed to detect a small local recurrence in two patients as well as to demonstrate lymph node involvement in one patient, which was confirmed by surgery. Conclusions: In this preliminary study, uptake of both radiotracers in prostate cancer or its metastases was nearly identical and none of them should be favoured. At present, both radiotracers influence patient management by detection of local recurrence, lymph node, or bone metastases of PCA.

Zusammenfassung

Ziel: In einer Pilotstudie untersuchten wir, ob sich zwischen [¹¹C]Azetat- und [¹¹C]Cholin-Positronenemissionstomographie (PET) wesentliche Unterschiede in der Darstellung des Prostatakarzinoms (PCA) ergeben. Methode: Zwölf Patienten wurden mit beiden Radiotracern untersucht. Die Ganzkörper-PET ohne Schwächungskorrektur wurde nach Injektion von 0,95 ± 0,15 GBq [¹¹C]Azetat bzw. 0,84 ± 0,13 GBq [¹¹C]Cholin von 5 bis 60 min p. i. durchgeführt. Fokal erhöhte Traceraufnahme im Knochen, kaudal der Harnblase oder in Lymphknotenregionen wurden als Tumorbefall betrachtet. Bei den Patienten waren Primärtumor (n = 2), Lymphknotenbefall (n = 4), Knochenmetastasen (n = 2), Lokalrezidiv (n = 2) und kein Anhalt für Tumorgewebe (n = 2) bekannt. Ergebnisse: [¹¹C]Azetat wurde am stärksten in Milz und Pankreas aufgenommen, während der [¹¹C]Cholin-Uptake in Leber und Nierenparenchym am höchsten war. Jedoch variierte der Uptake interindividuell stark. Beide Radiotracer waren identisch im Nachweis von Skelettläsionen, Lymphknotenmetastasen und Primärtumor. Sie versagten beide beim Nachweis eines kleinen Lokalrezidivs bei zwei Patienten sowie bei der Detektion eines histologisch verifizierten Lymphknotenbefalls bei einem weiteren Patienten. Schlussfolgerung: In dieser Pilotstudie war der Uptake der Radiotracer [¹¹C]Azetat und [¹¹C]Cholin beim Prostatakarzinom und seinen Metastasen so weit identisch, dass keine der beiden Substanz favorisiert werden kann. Derzeit können beide Radiotracer die Therapieplanung durch den Nachweis von Lokalrezidiv, Lymphknoten- oder Skelettmetastasen beeinflussen.

Keywords

Acetate - choline - positron emission tomography - prostate cancer

Schlüsselwörter

Azetat - Cholin - Positronenemissionstomographie - Prostatakarzinom

^* Diese Arbeit ist Prof. Dr. med. Dr. h.c. Heinz Hundeshagen zum 75. Geburtstag gewidmet.

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