pp 1–6 | Cite as

F18-choline/C11-choline PET/CT thyroid incidentalomas

  • Francesco Bertagna
  • Domenico Albano
  • Luca Giovanella
  • Raffaele Giubbini
  • Giorgio Treglia



Thyroid incidentaloma is defined as a thyroid lesion incidentally and newly detected by imaging techniques performed for an unrelated purpose and especially for a non-thyroid disease. Aim of this review is to evaluate the prevalence and clinical significance of focal incidental radiolabelled choline uptake in the thyroid gland (CTI) revealed by PET or PET/CT.


A comprehensive computer literature search of the PubMed/MEDLINE, Scopus, and Embase databases was conducted to find relevant published articles about the prevalence and clinical significance of CTIs detected by PET or PET/CT in patients studied for other oncologic purposes.


Fifteen articles (14 case reports, one retrospective study on a larger population sample) were included in the systematic review. Considering the case reports, 7/14 CTIs were benign and 7/14 malignant. In the retrospective study on a larger population sample, 14/15 CTIs which underwent further investigations were benign.


Despite very rare but probably underestimated, CTIs frequently signal in the presence of unexpected lesions in the thyroid that differ from the indicated reason for which the patient was initially scanned, and the risk of malignancy is not negligible.


Thyroid Incidental Thyroid incidentaloma Choline PET/CT Positron emission tomography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    R.L. Siegel, K.D. Miller, A. Jemal, Cancer statistics, 2016. CA Cancer J. Clin. 66, 7–30 (2016)CrossRefGoogle Scholar
  2. 2.
    F. Podo, Tumour phospholipid metabolism. NMR Biomed. 12, 413–439 (1999)CrossRefGoogle Scholar
  3. 3.
    M. Picchio, C. Messa, C. Landoni, L. Gianolli, S. Sironi, M. Brioschi, M. Matarrese, D.V. Matei, F. De Cobelli, A. Del Maschio, F. Rocco, P. Rigatti, F. Fazio, Value of [11C]choline-positron emission tomography for re-staging prostate cancer: a comparison with [18F]fluorodeoxyglucose-positron emission tomography. J. Urol. 169, 1337–1340 (2003)CrossRefGoogle Scholar
  4. 4.
    T.R. DeGrado, R.E. Reiman, D.T. Price, S. Wang, R.E. Coleman, Pharmacokinetics and radiation dosimetry of 18F-fluorocholine. J. Nucl. Med. 43, 92–96 (2002)Google Scholar
  5. 5.
    A. Chiti, M. Picchio, The rising PET: the increasing use of choline PET/CT in prostate cancer. Eur. J. Nucl. Med. Mol. Imaging 38, 53–54 (2011)CrossRefGoogle Scholar
  6. 6.
    K. Mertens, D. Slaets, B. Lambert, M. Acou, F. De Vos, I. Goethals, PET with (18)F-labelled choline-based tracers for tumour imaging: a review of the literature. Eur. J. Nucl. Med. Mol. Imaging 37, 2188–2193 (2010)CrossRefGoogle Scholar
  7. 7.
    M. Picchio, E. Giovannini, C. Messa, The role of PET/computed tomography scan in the management of prostate cancer. Curr. Opin. Urol. 21, 230–236 (2011)CrossRefGoogle Scholar
  8. 8.
    G. Bauman, T. Belhocine, M. Kovacs, A. Ward, M. Beheshti, I. Rachinsky, 18)F-fluorocholine for prostate cancer imaging: a systematic review of the literature. Prostate Cancer Prostatic Dis. 15, 45–55 (2012)CrossRefGoogle Scholar
  9. 9.
    C. Nanni, D. Rubello, S. Fanti, Could choline PET play a role in malignancies other than prostate cancer? Eur. J. Nucl. Med. Mol. Imaging 35, 216–218 (2008)CrossRefGoogle Scholar
  10. 10.
    G. Treglia, E. Giovannini, D. Di Franco, M.L. Calcagni, V. Rufini, M. Picchio, A. Giordano, The role of positron emission tomography using carbon-11 and fluorine-18 choline in tumors other than prostate cancer: a systematic review. Ann. Nucl. Med. 26, 451–461 (2012)CrossRefGoogle Scholar
  11. 11.
    M. Hodolic, V. Huchet, S. Balogova, L. Michaud, K. Kerrou, V. Nataf, M. Cimitan, J. Fettich, J.N. Talbot, Incidental uptake of (18)F-fluorocholine (FCH) in the head or in the neck of patients with prostate cancer. Radiol. Oncol. 48, 228–234 (2014)CrossRefGoogle Scholar
  12. 12.
    G. Paone, G. Treglia, M. Bongiovanni, T. Ruberto, L. Ceriani, L. Giovanella, Incidental detection of Hürthle cell adenoma by 18F-choline PET/CT scan in a patient with prostate cancer. Rev. Esp. Med. Nucl. Imagen Mol. 32, 340–341 (2013)Google Scholar
  13. 13.
    R. Ciappuccini, C. Jeanne, S. Bardet. Incidental focal thyroid uptake on 18F-Choline PET-CT: need to rule out thyroid cancer. Endocrine.(2018).
  14. 14.
    A.L. Aziz, F. Courbon, L.O. Dierickx, O. Pascal, S. Zerdoud, Oncocytic adenoma of thyroid incidentally detected by 18F-fluorocholine PET/CT. J. Nucl. Med. Technol. 43, 133–134 (2015)CrossRefGoogle Scholar
  15. 15.
    A. Eccles, A. Challapalli, S. Khan, T. Barwick, S. Mangar, Thyroid lymphoma incidentally detected by 18F-fluorocholine (FCH) PET/CT. Clin. Nucl. Med. 38, 755–757 (2013)CrossRefGoogle Scholar
  16. 16.
    G. Treglia, E. Giovannini, P. Mirk, D. Di Franco, L. Oragano, F. Bertagna, A thyroid incidentaloma detected by 18F-choline PET/CT. Clin. Nucl. Med. 39, e267–e269 (2014)CrossRefGoogle Scholar
  17. 17.
    P. Lalire, M. Zalzali, C. Garbar, C. Bruna-Muraille, D. Morland, Incidental detection of oxyphilic papillary thyroid carcinoma by 18F-fluorocholine PET/CT. Clin. Nucl. Med. 41, 512–513 (2016)CrossRefGoogle Scholar
  18. 18.
    A. Ouattara, T.R. de Oliveira, S. Holz, H. Van den Bossche, D. Strybol, C. Assenmacher, W. Everaerts, G. De Meerleer, S. Joniau, Incidental detection of occult thyroid carcinoma with 11C-choline PET/CT for high risk prostate cancer. Curr. Urol. 10, 217–220 (2017)CrossRefGoogle Scholar
  19. 19.
    A. Haroon, L. Zanoni, M. Celli, R. Zakavi, M. Beheshti, W. Langsteger, S. Fanti, M. Emberton, J. Bomanji, Multicenter study evaluating extraprostatic uptake of 11C-choline, 18F-methylcholine, and 18F-ethylcholine in male patients: physiological distribution, statistical differences, imaging pearls, and normal variants. Nucl. Med. Commun. 36, 1065–1075 (2015)CrossRefGoogle Scholar
  20. 20.
    C.L. Welle, E.L. Cullen, P.J. Peller, V.J. Lowe, R.C. Murphy, G.B. Johnson, L.A. Binkovitz, ¹¹C-Choline PET/CT in recurrent prostate cancer and nonprostatic neoplastic processes. Radiographics 36, 279–292 (2016)CrossRefGoogle Scholar
  21. 21.
    O. Schillaci, F. Calabria, M. Tavolozza, C. Cicciò, M. Carlani, C.R. Caracciolo, R. Danieli, A. Orlacchio, G. Simonetti, 18F-choline PET/CT physiological distribution and pitfalls in image interpretation: experience in 80 patients with prostate cancer. Nucl. Med. Commun. 31, 39–45 (2010)CrossRefGoogle Scholar
  22. 22.
    N.T.K. Thanseer, S.K. Bhadada, A. Sood, A.S. Parihar, D. Dahiya, P. Singh, R.K. Basher, A. Das, B.R. Mittal, Dual pathologies of parathyroid adenoma and papillary thyroid cancer on fluorocholine and fluorodeoxyglucose PET/CT. Nucl. Med. Mol. Imaging 52, 154–158 (2018)CrossRefGoogle Scholar
  23. 23.
    R. Ruiz-Esponda, V.J. Lowe, D.S. Dean. Clinical significance of incidental thyroid uptake on 11Ccholine PET/CT. Endo. Rev. 35 SUPPL (2014).Google Scholar
  24. 24.
    A.M. García Vicente, A. Núñez García, A.M. Soriano Castrejón, G.A. Jiménez Londoño, J.M. Cordero García, A. Palomar Muñoz, Pitfalls with 18F-choline PET/CT in patients with prostate cancer. Rev. Esp. Med. Nucl. Imagen Mol. 32, 37–39 (2013)Google Scholar
  25. 25.
    A. Parvinian, E.L. Martin-Macintosh, A.H. Goenka, J.M. Durski, B.P. Mullan, B.J. Kemp, G.B. Johnson, 11)C-choline PET/CT for detection and localization of parathyroid adenomas. Am. J. Roentgenol. 210, 418–422 (2018)CrossRefGoogle Scholar
  26. 26.
    G. Treglia, F. Bertagna, R. Sadeghi, F.A. Verburg, L. Ceriani, L. Giovanella, Focal thyroid incidental uptake detected by 18F-fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk. Nuklearmedizin 52, 130–136 (2013)CrossRefGoogle Scholar
  27. 27.
    G. Treglia, L. Giovanella, F. Bertagna, D. Di Franco, M. Salvatori, Prevalence and risk of malignancy of thyroid incidentalomas detected by (18)f-fluorodeoxyglucose positron-emission tomography. Thyroid 23, 124–126 (2013)CrossRefGoogle Scholar
  28. 28.
    F. Bertagna, G. Treglia, A. Piccardo, E. Giovannini, G. Bosio, G. Biasiotto, K. Bahij el, R. Maroldi, R. Giubbini, F18-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value. Endocrine 43, 678–685 (2013)CrossRefGoogle Scholar
  29. 29.
    F. Bertagna, G. Treglia, A. Piccardo, R. Giubbini, Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J. Clin. Endocrinol. Metab. 97, 3866–3875 (2012)CrossRefGoogle Scholar
  30. 30.
    H.B. Wu, Q.S. Wang, M.F. Wang, H.S. Li, Utility of ¹¹C-choline imaging as a supplement to F-18 FDG PET imaging for detection of thyroid carcinoma. Clin. Nucl. Med. 36, 91–95 (2011)CrossRefGoogle Scholar
  31. 31.
    S. Grimaldi, J. Young, P. Kamenicky, D. Hartl, M. Terroir, S. Leboulleux, A. Berdelou, J. Hadoux, S. Hescot, H. Remy, E. Baudin, M. Schlumberger, D. Deandreis, Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-Fluorocholine PET/CT. Eur. J. Nucl. Med. Mol. Imaging 45, 1772–1780 (2018)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Francesco Bertagna
    • 1
  • Domenico Albano
    • 1
  • Luca Giovanella
    • 2
  • Raffaele Giubbini
    • 1
  • Giorgio Treglia
    • 2
    • 3
    • 4
  1. 1.Nuclear MedicineUniversity of Brescia and Spedali Civili di BresciaBresciaItaly
  2. 2.Department of Nuclear Medicine and PET/CT CenterOncology Institute of Southern SwitzerlandBellinzonaSwitzerland
  3. 3.Department of Nuclear Medicine and Molecular ImagingLausanne University HospitalLausanneSwitzerland
  4. 4.Health Technology Assessment UnitGeneral Directorate, Ente Ospedaliero CantonaleBellinzonaSwitzerland

Personalised recommendations