Use of 18F-choline and 11C-choline as contrast agents in positron emission tomography imaging—guided stereotactic biopsy sampling of gliomas

Abstract

Object. Neuroimaging-guided stereotactic biopsy procedures are commonly used for diagnosis of gliomas. A number of the imaging modalities currently in use are not reliable enough in depicting these tumors. The authors developed 18F-choline and 11C-choline as tumor imaging agents for positron emission tomography (PET) scanning, and used them to visualize gliomas prior to stereotactic biopsy procedures. Methods. The PET studies were performed in 12 patients who were thought to be affected by gliomas observed on computerized tomography and magnetic resonance images. The 18F- and 11C-choline were injected separately, and the PET scanning was started 5 and 20 minutes postinjection. The PET scans gave quantitative information about the distribution of 18F- and 11C-choline in the brain. The tumor uptake was constant between 5 and 20 minutes with both agents. Stereotactic biopsy sampling was performed to obtain tissues from the most radioactive areas on the PET scan; histological diagnoses were made using these tissues. The results were as follows: oligodendroglioma was found in two patients, astrocytoma in one, anaplastic astrocytoma in two, and glioblastoma in seven. Conclusions. The uptake of contrast agents was always low in low-grade gliomas, and the uptake in high-grade glioma was always high. The tumor/normal (T/N) ratio of 18F-choline was 10.5:12 in anaplastic astrocytoma and 13.2:21 in glioblastoma. The 18F-choline yielded slightly superior results compared with 11C-choline with regard to the T/N ratio. In one case of oligodendroglioma the tumor showed no uptake of 18F- and 11C-choline. With this exception, the PET scans of gliomas in which 18F- and 11C-choline contrast agents were added would guide the approach to the most malignant areas for stereotactic biopsy sampling.