PET/CT with F-choline: Physiological whole bio-distribution in male and female subjects and diagnostic pitfalls on 1000 prostate cancer patients: F-choline PET/CT bio-distribution and pitfalls. A southern Italian experience.

INTRODUCTION

The C/F-choline is a PET/CT radiopharmaceutical useful in detecting tumors with high lipogenesis. C/F-choline uptake can occur in physiological conditions or tumors. The knowledge of its bio-distribution is essential to recognize physiologic variants or diagnostic pitfalls. Moreover, few information are available on the bio-distribution of this tracer in female patients. Our aim was to discuss some documented F-choline PET/CT pitfalls in prostate cancer patients. Our secondary aim was to describe the F-choline bio-distribution in the female body.

METHODS

We collected diagnostic pitfalls in three PET centers examining 1000 prostate cancer by F-choline PET/CT. All pitfalls were ensured by follow-up, imaging and/or histology. We also performed whole body F-choline PET/CT in 5 female patients.

RESULTS

169/1000 (16.9%) patients showed pitfalls not owing to prostate cancer. These findings were due to inflammation, benign tumors while, in 1% of examined patients, a concomitant neoplasm was found. In the female body, the breast showed low physiological uptake.

CONCLUSIONS

The accurate knowledge of F-choline PET/CT bio-distribution and diagnostic pitfalls is essential. Correlative imaging and histological exam are often necessary to depict pitfalls. In women, the uptake in the breast is due to the physiological gradient of F-choline uptake in the exocrine glands.

ADVANCES IN KNOWLEDGE

Our results confirm the possibility of F-choline uptake in several diseases other than prostate cancer. However, our experience was acquired on a large population and shows that a conspicuous amount of F-choline diagnostic pitfalls are easily recognizable and attributable to inflammation. A new advance in knowledge is the minimal difference in terms of physiological tracer bio-distribution between male and female patients.

IMPLICATIONS FOR PATIENT CARE

The knowledge of the physiological bio-distribution and of the potential pitfalls linked of a tracer could help physicians to choose the best diagnostic and therapeutic approaches for a better patient quality of life.