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

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Abstract

Purpose

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).

Methods

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.

Results

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%).

Conclusion

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.

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Authors and Affiliations

  1. Nuclear Medicine Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Maria Picchio, Federico Fallanca & Luigi Gianolli

  2. Institute for Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Milan, Italy

    Maria Picchio & Cristina Messa

  3. Center for Molecular Bioimaging, University of Milano-Bicocca, Milan, Italy

    Elena Giulia Spinapolice, Cinzia Crivellaro, Giampiero Giovacchini & Cristina Messa

  4. Institute of Nuclear Medicine, University Hospital Basel, Basel, Switzerland

    Giampiero Giovacchini

  5. Department of Nuclear Medicine, San Gerardo Hospital, Monza, Italy

    Cristina Messa

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  1. Maria Picchio
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  2. Elena Giulia Spinapolice
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  3. Federico Fallanca
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Correspondence to Maria Picchio.

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Picchio, M., Spinapolice, E.G., Fallanca, F. et al. [11C]Choline PET/CT detection of bone metastases in patients with PSA progression after primary treatment for prostate cancer: comparison with bone scintigraphy. Eur J Nucl Med Mol Imaging 39, 13–26 (2012). https://doi.org/10.1007/s00259-011-1920-z

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  • DOI: https://doi.org/10.1007/s00259-011-1920-z

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