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Published online before print June 20, 2007, 10.1148/radiol.2442060898
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(Radiology 2007;244:557-565.)
© RSNA, 2007

Nuclear Medicine

Solitary Brain Lesions Enhancing at MR Imaging: Evaluation with Fluorine 18–Fluorocholine PET1

Sandi A. Kwee, MD, Jehoon P. Ko, MD, Caroline S. Jiang, MS, Michael R. Watters, MD, and Marc N. Coel, MD

1 From the Hamamatsu/Queen's PET Imaging Center (S.A.K., J.P.K., M.N.C.), Honolulu, Hawaii; and The Queen's Medical Center (C.S.J.) and Department of Medicine (S.A.K., M.R.W.), University of Hawaii John A. Burns School of Medicine, 1301 Punchbowl St, Honolulu, HI 96813. Received May 23, 2006; revision requested July 24; revision received August 14; accepted September 18; final version accepted November 20. Supported by the Queen Emma Research Foundation. Address correspondence to S.A.K. (e-mail: skwee{at}queens.org).

Purpose: To prospectively determine whether differences between benign and malignant brain lesions can be depicted with fluorine 18 (18F) fluorocholine positron emission tomography (PET).

Materials and Methods: Thirty consecutive patients (14 women, 16 men; age range, 26–79 years) with solitary brain lesions that were enhanced at magnetic resonance (MR) imaging underwent whole-brain 18F-fluorocholine PET after giving informed consent in this institutional review board–approved, HIPAA-compliant study. Histopathologic diagnoses were made in 24 cases (13 high-grade gliomas, eight metastases to the brain, and three benign lesions). In six cases, benign lesions were diagnosed on the basis of longitudinal follow-up MR findings. The maximum standardized uptake value (SUVmax) for lesion and peritumoral regions was measured on PET images, and a lesion-to–normal tissue uptake ratio (LNR) was calculated. Differences were assessed with one-way analysis of variance, Fisher exact, and Student t tests.

Results: Differences in SUVmax between high-grade gliomas (1.89 ± 0.78 [mean ± standard deviation]), metastases (4.11 ± 1.68), and benign lesions (0.59 ± 0.31) were significant (P < .0001). LNRs also differed significantly (5.15 ± 2.51, 10.91 ± 2.14, and 1.28 ± 0.32, respectively; P < .0001). These differences were also significant at pairwise analysis. The peritumoral LNR exceeded 2.0 in seven high-grade gliomas and no metastases (P = .02). In 14 radiation-treated patients, the lesions classified as benign demonstrated significantly less uptake compared with the recurrent tumors (SUVmax: 0.72 ± 0.38 vs 2.27 ± 1.24, P < .01; LNR: 1.36 ± 0.43 vs 5.88 ± 3.66, P < .01).

Conclusion: High-grade gliomas, metastases, and benign lesions can be distinguished on the basis of measured fluorocholine uptake. Increased peritumoral fluorocholine uptake is a distinguishing characteristic of high-grade gliomas.

© RSNA, 2007