[11C]Choline PET/CT detection of bone metastases in patients with PSA progression after primary treatment for prostate cancer: comparison with bone scintigraphy

  • Maria Picchio
  • Elena Giulia Spinapolice
  • Federico Fallanca
  • Cinzia Crivellaro
  • Giampiero Giovacchini
  • Luigi Gianolli
  • Cristina Messa
Original Article



The aim of this study was to evaluate the clinical usefulness of [11C]choline positron emission tomography (PET)/CT in comparison with bone scintigraphy (BS) in detecting bone metastases (BM) of patients with biochemical progression after radical treatment for prostate cancer (PCa).


Seventy-eight consecutive patients with biochemical progression of PCa (mean prostate-specific antigen 21.1 ng/ml, range 0.2–500.0 ng/ml) referred for both [11C]choline PET/CT and BS for restaging purposes were retrospectively analysed. The diagnostic accuracy of [11C]choline PET/CT and BS was assessed by using morphological imaging and/or follow-up as standards of reference. As equivocal findings were found, the accuracy analysis was performed twice, once including them as positive and once as negative. A separate analysis was also performed in hormone-resistant patients and data compared with those of patients who did not receive anti-androgenic treatment.


Equivocal findings occurred in 1 of 78 (1%) cases in [11C]choline PET/CT and in 21 of 78 (27%) cases in BS. Depending on their attribution as either positive or negative, the ranges of sensitivity, specificity, positive predictive value, negative predictive value and accuracy for [11C]choline PET/CT were 89–89%, 98–100%, 96–100%, 94–96% and 95–96%, respectively. For BS they were 100–70%, 75–100%, 68-–100%, 100–86% and 83–90%, respectively. Concordant findings between [11C]choline PET/CT and BS occurred in 55 of 78 (71%) cases. The accuracy of [11C]choline PET/CT did not significantly (p = 0.30) differ between hormone-resistant patients (97%) and those who did not receive anti-androgenic treatment (95%).


In clinical practice, [11C]choline PET/CT may not replace BS because of its lower sensitivity. However, for its high specificity, [11C]choline PET/CT positive findings may accurately predict the presence of BM. Equivocal findings are more frequent in BS than [11C]choline PET/CT.


[11C]Choline Positron emission tomography PET/CT Bone scintigraphy Prostate cancer recurrence Bone metastases 


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Maria Picchio
    • 1
    • 2
  • Elena Giulia Spinapolice
    • 3
  • Federico Fallanca
    • 1
  • Cinzia Crivellaro
    • 3
  • Giampiero Giovacchini
    • 3
    • 4
  • Luigi Gianolli
    • 1
  • Cristina Messa
    • 2
    • 3
    • 5
  1. 1.Nuclear Medicine DepartmentSan Raffaele Scientific InstituteMilanItaly
  2. 2.Institute for Bioimaging and Molecular PhysiologyNational Research Council (IBFM-CNR)MilanItaly
  3. 3.Center for Molecular BioimagingUniversity of Milano-BicoccaMilanItaly
  4. 4.Institute of Nuclear MedicineUniversity Hospital BaselBaselSwitzerland
  5. 5.Department of Nuclear MedicineSan Gerardo HospitalMonzaItaly

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