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01.12.2017 | Original research | Ausgabe 1/2017 Open Access

EJNMMI Research 1/2017

Quantitative 18F-fluorocholine positron emission tomography for prostate cancer: correlation between kinetic parameters and Gleason scoring

EJNMMI Research > Ausgabe 1/2017
Joshua D. Schaefferkoetter, Ziting Wang, Mary C. Stephenson, Sharmili Roy, Maurizio Conti, Lars Eriksson, David W. Townsend, Thomas Thamboo, Edmund Chiong
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s13550-017-0269-0) contains supplementary material, which is available to authorized users.
An erratum to this article is available at https://​doi.​org/​10.​1186/​s13550-017-0299-7.



The use of radiolabeled choline as a positron emission tomography (PET) agent for imaging primary tumors in the prostate has been evaluated extensively over the past two decades. There are, however, conflicting reports of its sensitivity and the relationship between choline PET imaging and disease staging is not fully understood. Moreover, relatively few studies have investigated the correlation between tracer uptake and histological tumor grade. This work quantified 18F-fluorocholine in tumor and healthy prostate tissue using pharmacokinetic modeling and stratified uptake parameters by histology grade. Additionally, the effect of scan time on the estimation of the kinetic exchange rate constants was evaluated, and the tracer influx parameters from full compartmental analysis were compared to uptake values quantified by Patlak and standardized uptake value (SUV) analyses.
18F-fluorocholine was administered as a 222 MBq bolus injection to ten patients with biopsy-confirmed prostate tumors, and dynamic PET data were acquired for 60 min. Image-derived arterial input functions were scaled by discrete blood samples, and a 2-tissue, 4-parameter model accounting for blood volume (2T4k+Vb) was used to perform fully quantitative compartmental modeling on tumor, healthy prostate, and muscle tissue. Subsequently, all patients underwent radical prostatectomy, and histological analyses were performed on the prostate specimens; kinetic parameters for tumors were stratified by Gleason score. Correlations were investigated between compartmental K 1 and K i parameters and SUV and Patlak slope; the effect of scan time on parameter bias was also evaluated.


Choline activity curves in seven tumors, eight healthy prostate regions, and nine muscle regions were analyzed. Net tracer influx was generally higher in tumor relative to healthy prostate, with the values in the highest grade tumors markedly higher than those in lower grade tumors. Influx terms from Patlak and full compartmental modeling showed good correlation within individual tissue groups. Kinetic parameters calculated from the entire 60-min scan data were accurately reproduced from the first 30 min of acquired data (R 2 ≈ 0.9).


Strong correlations were observed between K i and Patlak slope in tumor tissue, and K 1 and SUV were also correlated but to a lesser degree. Reliable estimates of all kinetic parameters can be achieved from the first 30 min of dynamic 18F-choline data. Although SUV, K 1, K i, and Patlak slope were found to be poor differentiators of low-grade tumor compared to healthy prostate tissue, they are strong indicators of aggressive disease.
Additional file 1: Figure S1. Venous blood sampling points for four patients. These data were consistent with the plasma partitioning model applied to all subjects in this work. Figure S2. Compartmental model rate parameters were independently estimated using five different metabolite correction models (a). Mean values are shown for all tissue regions in all patients (b); diamonds represent regions of healthy prostate and triangles represent tumors—with different colors corresponding to different Gleason scores. Error bars show the standard deviation of the results obtained with the four metabolite corrections. Calculations of the macroinflux parameters were more robust to changes in the input profile than were the individual compartmental parameters. Figure S3. Compartmental model rate parameters were independently estimated using two different plasma partitioning models for the first four patients with manual blood sampling; diamonds represent regions of healthy prostate and triangles represent tumors—with different colors corresponding to different Gleason scores. Error bars show the standard deviation of the results obtained with the two partitioning methods. Similar to the results shown in Additional file 1: Figure S2, estimations of choline influx rates were less sensitive than were the individual parameters. Figure S4. Akaike information criterion analysis for all tissue regions. Four different compartmental models were used to fit the data and the best model was determined by the lowest total AIC score. This plot shows mean AIC values in each of the three tissue regions; error bars show the interpatient standard deviation in each tissue category. The 2T4k+vB model (slightly) yielded the lowest overall AIC, but the reversible k 4 parameters were generally small compared to the other parameter values. Good correlation was still observed between choline influx terms, calculated from this model and Patlak analyses. Figure S5. Example patient maximum intensity projection image shown with 3D delineated tissue regions: red is tumor, green is healthy prostate, and blue is muscle. (DOCX 260 kb)
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