Effect of erythropoietin on bone marrow uptake of 18F-fluorocholine in prostate cancer: comparison with 18F-fluoride uptake.

The effect of erythropoietin stimulation on bone marrow uptake of FDG has been well documented. Similar metabolic activation of bone marrow with (18)F-fluorocholine (FCH) has not been previously reported. FCH PET/CT was performed in a patient with biochemical recurrent prostate cancer who was receiving erythropoietin for hemochromatosis. Diffuse skeletal uptake of FCH was seen. (18)F-Fluoride PET/CT performed the following day demonstrates multiple abnormal focal bone metastases. Generalized skeletal uptake of FCH results in poor contrast between the metastases compared to noninvolved bone. The metabolic activation of bone marrow by erythropoietin could result in false-negative FCH results for detecting bone metastases.