C-11 choline PET/CT imaging for differentiating malignant from benign prostate lesions

Purpose: To investigate the potential of C-11 choline PET/CT imaging for differentiating prostate cancer (PCa) from benign prostate hyperplasia (BPH). Materials and Methods: Forty-nine patients with prostate lesions underwent C-11 choline PET/CT imaging that was performed 5 minutes after injection of 7.4 MBq/kg (0.2 mCi/kg C-11 choline in the supine position over 2 bed positions (3 minutes per position), covering the pelvis, and the whole body (6 bed) when necessary. After attenuation correction, PET data were analyzed visually and semiquantitatively by measuring maximum standardized uptake value (SUVmax) of the prostate lesions (target) and the muscles (nontarget) and calculating their ratios (P/M). Results: Twenty-one PCa and 28 BPH lesions were proven histologically. The mean values of the SUVmax of PCa and BPH were 7.87 +/- 5.74 and 4.95 +/- 5.14, respectively without a significant difference between these 2 groups (t = 2.02; P > 0.05). The mean P/M of PCa and BPH were 4.21 +/- 1.61 and 1.87 +/- 0.98. The statistical difference of P/M between them was significant (t = 2.04; P < 0.01). Using 2.3 (P/M) as the criterion, C-11 choline PET/CT imaging showed a sensitivity of 90.48%, a specificity of 85.71%, and a negative predictive value of 92.31%. PET/CT precise localization of the hot spot in different parts of the prostate could contribute to the diagnosis. Conclusions: C-11 choline PET/CT is a valuable noninvasive imaging technology in the diagnosis of PCa. The parameter P/M could differentiate PCa from benign lesions better than SUV.