fluorocholine and Neoplasms

Choline PET has a role in the diagnosis of malignancies. Knowledge of normal biodistribution plays a vital role in disease characterization and in differentiating normal variants from disease processes. CT and MR scans provide complementary information, and choline-positive sites should be correlated clinically to exclude inflammatory disorders.

Topics: Abdomen; Central Nervous System; Choline; Contraindications; Fluorine Radioisotopes; Humans; Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Thorax; Tissue Distribution; Tomography, X-Ray Computed; Urogenital System

To give an up-to-date overview of the potential clinical utility of (18)F-labelled choline derivatives for tumour imaging with positron emission tomography.. A PubMed search for (18)F-labelled choline analogues was performed. Review articles and reference lists were used to supplement the search findings.. (18)F-labelled choline analogues have been investigated as oncological PET probes for many types of cancer on the basis of enhanced cell proliferation. To date, studies have focused on the evaluation of prostate cancer. Available studies have provided preliminary results for detecting local and metastatic disease. Experience with (18)F-fluorocholine PET in other tumour types, including brain and liver tumours, is still limited. In the brain, excellent discrimination between tumour and normal tissue can be achieved due to the low physiological uptake of (18)F-fluorocholine. In the liver, in which there is a moderate to high degree of physiological uptake in normal tissue, malignancy discrimination may be more challenging.. PET/CT with (18)F-fluorocholine can be used to detect (recurrent) local prostate cancer, but seems to have limited value for T (tumour) and N (nodal) staging. In patients presenting with recurrent biochemical prostate cancer, it is a suitable single-step examination with the ability to exclude distant metastases when local salvage treatment is intended. In the brain, high-grade gliomas, metastases and benign lesions can be distinguished on the basis of (18)F-fluorocholine uptake. Moreover, PET imaging is able to differentiate between radiation-induced injury and tumour recurrence. In the liver, (18)F-fluorocholine PET/CT seems promising for the detection of hepatocellular carcinoma.

Topics: Brain Neoplasms; Choline; Humans; Liver Neoplasms; Male; Neoplasms; Positron-Emission Tomography; Prostatic Neoplasms

Molecular imaging is the visualization, characterization, and measurement of biological processes at the molecular and cellular levels in a living system. At present, positron emission tomography/computed tomography (PET/CT) is one the most rapidly growing areas of medical imaging, with many applications in the clinical management of patients with cancer. Although [(18)F]fluorodeoxyglucose (FDG)-PET/CT imaging provides high specificity and sensitivity in several kinds of cancer and has many applications, it is important to recognize that FDG is not a "specific" radiotracer for imaging malignant disease. Highly "tumor-specific" and "tumor cell signal-specific" PET radiopharmaceuticals are essential to meet the growing demand of radioisotope-based molecular imaging technology. In the last 15 years, many alternative PET tracers have been proposed and evaluated in preclinical and clinical studies to characterize the tumor biology more appropriately. The potential clinical utility of several (18)F-labeled radiotracers (eg, fluoride, FDOPA, FLT, FMISO, FES, and FCH) is being reviewed by several investigators in this issue. An overview of design and development of (18)F-labeled PET radiopharmaceuticals, radiochemistry, and mechanism(s) of tumor cell uptake and localization of radiotracers are presented here. The approval of clinical indications for FDG-PET in the year 2000 by the Food and Drug Administration, based on a review of literature, was a major breakthrough to the rapid incorporation of PET into nuclear medicine practice, particularly in oncology. Approval of a radiopharmaceutical typically involves submission of a "New Drug Application" by a manufacturer or a company clearly documenting 2 major aspects of the drug: (1) manufacturing of PET drug using current good manufacturing practices and (2) the safety and effectiveness of a drug with specific indications. The potential routine clinical utility of (18)F-labeled PET radiopharmaceuticals depends also on regulatory compliance in addition to documentation of potential safety and efficacy by various investigators.

Topics: Amino Acids; Animals; Bone and Bones; Cell Hypoxia; Choline; Dideoxynucleosides; Dihydroxyphenylalanine; Estradiol; Fluorine Radioisotopes; Fluoroacetates; Fluorodeoxyglucose F18; Glucose; Humans; Membrane Lipids; Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed

The choline transporter and choline kinase enzyme frequently are overexpressed in malignancy. Therefore, positron-emitter-labeled compounds derived from choline have the potential to serve as oncologic probes for positron emission tomography. The fluorine-18 ((18)F)-labeled choline derivative fluorocholine (FCH) in particular has demonstrated potential utility for imaging of a variety of neoplasms, including those of the breast, prostate, liver, and brain. The pharmacokinetics of FCH and other choline tracers allow for whole-body imaging within minutes of injection while still achieving high tumor-to-background contrast in most organs, including the brain. These features, along with the possibility of imaging malignancies that have proved elusive with the use of (18)F-fluorodeoxyglucose positron emission tomography support further clinical investigations of (18)F-labeled choline tracers.

Topics: Brain Neoplasms; Carcinoma, Hepatocellular; Choline; Esophageal Neoplasms; Female; Fluorine Radioisotopes; Humans; Liver Neoplasms; Male; Nasopharyngeal Neoplasms; Neoplasms; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals

[¹⁸F]Fluorodeoxyglucose-positron emission tomography/computerized tomography (FDG-PET) is commonly used to assess response to patients treated with radiation (RT) or combination of chemotherapy and RT (CRT). The intent of this pilot study is to explore whether [¹⁸F]fluorocholine PET (FCH-PET) can serve as an early predictive biomarker for early detection of RT/CRT response.. Fourteen patients have been accrued and analyzed. The lesions were base of tongue, tonsil, nodes, hypopharynx, maxilla, palate, lung, pancreas, brain, uterine, and rectal. There were 16 lesions that were considered target lesion and were followed for correlation between change in FCH-PET SUVmax readings and clinical outcome. Median tumor size was 4.4 cm. Median RT dose was 66 Gy. The change in SUVmax (Δ SUVmax) of FCH-PET scans performed before and during RT was correlated with clinical outcome at the last follow-up.. The median FCH-PET SUVmax for the 1st and 2nd scans was 6.15 and 4.65, respectively. Fourteen (87.5%) lesions showed a reduction in SUVmax in either a complete response (CR) or a partial response (PR), and 2 lesions showed an increase in SUVmax both of which were determined to be non-response (NR). The median percentage change between the 1st and 2nd scan was -19.5%. Forty-four percent of lesions (7/16) had CR, 44% (7/16) had PR, and 12% (2/16) had NR (no response). Median follow-up was 12 months. The results showed a difference between NR and PR, between NR and CR, and a trend towards significance (p=0.06).. FCH-PET scan demonstrated changes in SUVmax during RT that were predictive of final outcome.

Topics: Aged; Aged, 80 and over; Choline; Female; Humans; Male; Middle Aged; Neoplasms; Pilot Projects; Positron-Emission Tomography; Radiotherapy; Treatment Outcome

Topics: Animals; Antineoplastic Agents; Choline; Humans; Neoplasms