García J R, Soler M, Blanch M A, Ramírez I, Riera E, Lozano P, Pérez X, Delgado E, Carrio I, Lomeña F
CETIR Unitat PET, Esplugues de Llobregat, Barcelona, España.
Rev Esp Med Nucl. 2009 May-Jun;28(3):95-100.
To compare the diagnostic accuracy of PET/CT with (18)F-FDG and (11)C-choline for early detection and localization of recurrent prostate cancer.
Thirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n = 20/radiation therapy n = 18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with (11)C-choline and (18)F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n = 10); PSA monitoring (n = 21) and/ or other methods (n = 7).
Focal uptake of (11)C-choline was detected in 26 patients (68%), and focal uptake of (18)F-FDG was detected in 13 patients (34%). The (11)C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with (18)F-FDG. Pelvic lymph nodes were detected with (11)C-choline PET/CT in 8 patients and only in 4 patients (50%) with (18)F-FDG. Mediastinal involvement was detected in 5 patients with (11)C-choline and 3 patients (60%) with (18)F-FDG. Focal bone involvement was detected in 3 patients with (11)C-choline and (18)F-FDG. (11)C-choline was able to detect 40% of recurrences in patients with PSA < 1 ng/ml, 50% of recurrences in patients with PSA 1-4 ng/ml and 87% of recurrences with PSA > 4 ng/ml. Sensitivity of (11)C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy.
(11)C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to (18)F-FDG. (11)C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with (11)C-choline showed direct impact for the selection of the most appropriate therapeutic approach.
比较PET/CT使用（18）F-FDG和（11）C-胆碱对复发性前列腺癌进行早期检测和定位的诊断准确性。
纳入38例前列腺癌根治性治疗（手术20例/放疗18例）后PSA水平升高（0.8 - 9.5 ng/ml）的患者。10例患者接受激素治疗。所有患者在同一天分别接受了（11）C-胆碱和（18）F-FDG的PET/CT检查。将PET成像结果与组织病理学（10例）、PSA监测（21例）和/或其他方法（7例）进行比较。
26例患者（68%）检测到（11）C-胆碱局灶性摄取，13例患者（34%）检测到（18）F-FDG局灶性摄取。14例患者的（11）C-胆碱摄取提示局部复发，而（18）F-FDG摄取患者中只有4例（48%）提示局部复发。8例患者通过（11）C-胆碱PET/CT检测到盆腔淋巴结，而（18）F-FDG检测到盆腔淋巴结的患者仅4例（50%）。5例患者通过（11）C-胆碱检测到纵隔受累，3例患者（60%）通过（18）F-FDG检测到纵隔受累。3例患者通过（11）C-胆碱和（18）F-FDG检测到局灶性骨受累。（11）C-胆碱能够检测出PSA<1 ng/ml患者中40%的复发、PSA 1 - 4 ng/ml患者中50%的复发以及PSA>4 ng/ml患者中87%的复发。（11）C-胆碱对手术治疗患者的敏感性更高，接受和未接受激素治疗的患者之间未发现显著差异。
（11）C-胆碱PET/CT对前列腺癌生化复发的检测有用，与（18）F-FDG相比检出率更高。（11）C-胆碱的敏感性与PSA水平明显相关，对手术患者更高，且似乎不受激素治疗的影响。使用（11）C-胆碱进行疾病分期对选择最合适的治疗方法有直接影响。
