Prostate cancer: a comparative study of 11C-choline PET and MR imaging combined with proton MR spectroscopy

Eur J Nucl Med Mol Imaging. 2005 Jul;32(7):742-8. doi: 10.1007/s00259-004-1755-y. Epub 2005 Mar 15.


Purpose: Prostate cancer is difficult to visualise in its early stages using current imaging technology. The present study aimed to clarify the utility of 11C-choline PET for localising and evaluating cancer lesions in patients with prostate cancer by conducting a prospective comparison with magnetic resonance (MR) imaging combined with proton MR spectroscopy.

Methods: PET and MR imaging combined with proton MR spectroscopy were performed in 20 patients with prostate cancer. Correlations among the metabolite ratio of choline + creatine to citrate (Cho+Cr/Ci) on MR spectroscopy, serum PSA and maximum standardised uptake value (SUVmax) of (11)C-choline were assessed. The location of the primary lesion was assessed by the site of SUVmax and the laterality of the highest Cho+Cr/Ci ratio and confirmed by examination of surgical pathology specimens (n=16).

Results: PET exhibited a diagnostic sensitivity of 100% (20/20) for primary lesions, while the sensitivities of MR imaging and MR spectroscopy were 60% (12/20) and 65% (13/20), respectively. Weak linear correlations were observed between SUVmax and serum PSA (r=0.52, p<0.05), and between SUVmax and Cho+Cr/Ci ratio (r=0.49, p<0.05). Regarding the localisation of main primary lesions, PET results agreed with pathological findings in 13 patients (81%) (kappa=0.59), while MR spectroscopy results were in accordance with pathological findings in eight patients (50%) (kappa=0.11).

Conclusion: This preliminary study suggests that 11C-choline PET may provide more accurate information regarding the localisation of main primary prostate cancer lesions than MR imaging/MR spectroscopy. A further clinical study of 11C-choline PET in a large number of patients suspected of prostate cancer will be necessary to determine the clinical utility of 11C-choline PET in patients who clinically require biopsy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biopsy
  • Carbon Radioisotopes*
  • Choline*
  • Citrates / metabolism
  • Creatine / metabolism
  • Humans
  • Magnetic Resonance Spectroscopy / methods*
  • Male
  • Middle Aged
  • Nootropic Agents
  • Positron-Emission Tomography / methods*
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / diagnostic imaging*


  • Carbon Radioisotopes
  • Citrates
  • Nootropic Agents
  • Prostate-Specific Antigen
  • Creatine
  • Choline