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Review
. 2020 May 28;12(6):1394.
doi: 10.3390/cancers12061394.

Choline PET/CT in Multiple Myeloma

Charles Mesguich  1   2 , Cyrille Hulin  3 , Axelle Lascaux  3 , Laurence Bordenave  1 , Gerald Marit  2 , Elif Hindié  1
Affiliations
Review

Choline PET/CT in Multiple Myeloma

Charles Mesguich et al. Cancers (Basel). .

Abstract

The field of multiple myeloma (MM) imaging has evolved. The International Myeloma Working Group recently recommended performing 18F-fluorodeoxyglucose glucose (18FDG) positron emission tomography/computed tomography (PET/CT) with the aim of staging MM patients at baseline and evaluating response to therapy. Novel oncological radiotracers such as 11C-Choline and 18F-Fluorocholine, have been studied in comparison with 18FDG, mostly in MM patients presenting with refractory disease or suspected relapse. Choline-based tracers may overcome some limitations of 18FDG, which include a lack of sensitivity in depicting skull lesions and the fact that 10% of MM patients are FDG-negative. The majority of MM lesions display a higher uptake of Choline than FDG. Also, in many situations, Choline may offer better lesion visualization, with a higher tumor to background ratio; however, various patterns of Choline and FDG uptake have been observed in MM and some limitations, notably as regards liver lesions, should be recognized. Overall, Choline may provide additional detection of up to 75% more lesions. This article aims to provide a comprehensive review of the potential role of Choline in multiple myeloma, as compared to FDG, encompassing Choline physiopathology as well as data from clinical studies.

Keywords: 11C-Choline; 18F-Choline; 18FDG; PET/CT; multiple myeloma.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A 65-year-old male with a light chain multiple myeloma (MM). 18F-fluorodeoxyglucose glucose (18FDG) positron emission tomography/computed tomography (PET/CT) (left panel) and 18F-Choline PET/CT (right panel) were performed with a 4-day interval. 18F-Choline PET/CT axial image of the skull shows an intense uptake of a skull base lesion. Because of the intense surrounding cerebral uptake on 18FDG PET/CT, the lesion is more difficult to individualize. Clinical examination at baseline identified the presence of diplopia and left ptosis, which disappeared a few days after induction chemotherapy was started.
Figure 2
Figure 2
A 60-year-old female with IgG lambda smoldering multiple myeloma. An osteolytic lesion of the skull was found on a follow-up CT. 18F-Choline PET/CT was ordered to further characterize this lesion and search for additional bone lesions. 18F-Choline PET/CT axial image of the skull shows a moderate uptake of an occipital osteolytic lesion (A). Additional focal uptake of 18F-Choline was seen in the left femur, corresponding to a bone marrow lesion with no bone structural changes on CT (B).
Figure 3
Figure 3
A 72-year-old male with light chain multiple myeloma. 18FDG PET/CT (left panel) and 18F-Choline PET/CT (right panel) were performed with a 5-day-interval. Different uptake patterns are seen in this patient. Lesion exhibiting high choline uptake but low FDG uptake can be seen in the left femur (A). In contrast, however, a lesion with high FDG uptake but low Choline uptake can be seen in the posterior arch of the left 6th rib (B) corresponding to an osteolytic lesion on CT (central panel).
Figure 4
Figure 4
A 56-year-old female with IgG kappa MM. 18FDG PET/CT (left panel) and 18F-Choline PET/CT (right panel) were performed with a 3-day-interval. An axial PET/CT image of the pelvis shows a focal uptake of 18F-Choline within the right ischium without a corresponding uptake on 18FDG PET/CT. The corresponding axial CT image (central panel) shows no clear-cut structural changes (A). A focal lesion of the right femur exhibits a high uptake of 18F-Choline. This lesion exhibits only a faint uptake on 18FDG PET/CT (left panel) and is not visible on CT (central panel) (B).
Figure 4
Figure 4
A 56-year-old female with IgG kappa MM. 18FDG PET/CT (left panel) and 18F-Choline PET/CT (right panel) were performed with a 3-day-interval. An axial PET/CT image of the pelvis shows a focal uptake of 18F-Choline within the right ischium without a corresponding uptake on 18FDG PET/CT. The corresponding axial CT image (central panel) shows no clear-cut structural changes (A). A focal lesion of the right femur exhibits a high uptake of 18F-Choline. This lesion exhibits only a faint uptake on 18FDG PET/CT (left panel) and is not visible on CT (central panel) (B).
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