Comparison of Cell Proliferation, Protein, and Glucose Metabolism in Musculoskeletal Tumors in a PET Study

Abstract

11C-choline and18F-FAMT are known to correlate with tumor cell proliferation and amino acid metabolism. We investigated the ability of11C-Choline and18F-FAMT PET in diagnosis of musculoskeletal tumors in thirty-six patients in comparison of18F-FDG PET.11C-Choline and18F-FDG PET were positive in all the malignant tumors (n=13), whereas18F-FAMT was positive in 11 tumors. The mean SUVs for malignant tumors were significantly higher than those for benign lesions in all three tracers imaging. A moderate correlation was found between11C-Choline and18F-FDG (r=0.540,P<.05), or18F-FAMT and FDG (r=0.596,P<.05). The diagnostic sensitivity and specificity for malignancy were 91.7% and 71.4%, respectively, using11C-choline with a SUV cut-off of 2.69. The sensitivity and specificity of18F-FAMT for malignancy were 66.7% and 85.7%, respectively, using a SUV cut-off of 1.26. For18F-FDG, using a SUV cut-off of 2.77, the sensitivity and specificity were 83.3% and 71.4%, respectively. According to ROC analysis, the ROC curves for11C-Choline,18F-FAMT, and18F-FDG were 0.855, 0.734, and 0.847, respectively.11C-Choline PET is superior in the visualization of musculoskeletal tumors with high contrast imaging, whereas the combination of18F-FAMT and18F-FDG PET provides valuable information for the preoperative planning in patients with musculoskeletal tumors.