Quantification of [¹¹C]choline uptake using PET

Background

[Methyl-¹¹C]Choline ([¹¹C]choline) is a marker for cellular proliferation, because choline is a precursor for the biosynthesis of phospholipids which are the essential components of all cell membranes (Krohn, 2001).

Blood

Parent tracer represents 62% ± 19% of the total radioactivity in arterial plasma at 5 min after injection and 27% ± 12% at 15 min; the major metabolite in plasma is [¹¹C]betaine (Roivainen et al., 2000).

Tumors

Usefulness of [¹¹C]choline in the tumor diagnosis has been demonstrated (Hara 2002), and quantification by using Gjedde-Patlak plot (MTGA for irreversibly binding tracers), and SUV in clinical setting has been validated (Utriainen et al., 2003; Sutinen et al., 2004). However, cell proliferation may not explain the uptake of [¹¹C]choline in certain cancers (Breeuwsma et al., 2005).

Rheumatoid arthritis

[¹¹C]Choline has been shown to accumulate in clinically active synovitis, and the uptake (measured as SUV and net influx rate, K_i) correlated with the volume of synovium (Roivainen et al., 2003). Initial uptake of [¹¹C]choline is very fast, and the concentration of C-11 label reaches a plateau 10 min after bolus injection (Roivainen et al., 2003; Roivainen & Yli-Kerttula, 2006), suggesting irreversible kinetics during the PET study length. Gjedde-Patlak plot (MTGA for irreversibly binding tracers) was linear (Roivainen et al., 2003), confirming the irreversible uptake. Furthermore, Gjedde-Patlak plot intercept with y axis was close to zero (Roivainen et al., 2003), suggesting that calculation of Gjedde-Patlak (requiring dynamic PET scanning) plot could quantitatively be replaced by FUR, which only requires one late PET scan and enables whole-body imaging.

References:

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Hara T. ¹¹C-Choline and 2-deoxy-2-[¹⁸F]fluoro-D-glucode in tumor imaging with positron emission tomography. Mol Imaging Biol. 2002; 4(4): 267-273.

Krohn KA. Evaluation of alternative approaches for imaging cellular growth. Q J Nucl Med. 2001; 45: 174-178.

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Roivainen A, Yli-Kerttula T. Whole-body distribution of ¹¹C-choline and uptake in knee synovitis. Eur J Nucl Med Mol Imaging 2006; 33(11): 1372-1373.

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