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Original Research

Solitary Brain Lesions Enhancing at MR Imaging: Evaluation with Fluorine 18–Fluorocholine PET

Published Online:Aug 1 2007https://doi.org/10.1148/radiol.2442060898

Abstract

Purpose: To prospectively determine whether differences between benign and malignant brain lesions can be depicted with fluorine 18 (18F) fluorocholine positron emission tomography (PET).

Materials and Methods: Thirty consecutive patients (14 women, 16 men; age range, 26–79 years) with solitary brain lesions that were enhanced at magnetic resonance (MR) imaging underwent whole-brain 18F-fluorocholine PET after giving informed consent in this institutional review board–approved, HIPAA-compliant study. Histopathologic diagnoses were made in 24 cases (13 high-grade gliomas, eight metastases to the brain, and three benign lesions). In six cases, benign lesions were diagnosed on the basis of longitudinal follow-up MR findings. The maximum standardized uptake value (SUVmax) for lesion and peritumoral regions was measured on PET images, and a lesion-to–normal tissue uptake ratio (LNR) was calculated. Differences were assessed with one-way analysis of variance, Fisher exact, and Student t tests.

Results: Differences in SUVmax between high-grade gliomas (1.89 ± 0.78 [mean ± standard deviation]), metastases (4.11 ± 1.68), and benign lesions (0.59 ± 0.31) were significant (P < .0001). LNRs also differed significantly (5.15 ± 2.51, 10.91 ± 2.14, and 1.28 ± 0.32, respectively; P < .0001). These differences were also significant at pairwise analysis. The peritumoral LNR exceeded 2.0 in seven high-grade gliomas and no metastases (P = .02). In 14 radiation-treated patients, the lesions classified as benign demonstrated significantly less uptake compared with the recurrent tumors (SUVmax: 0.72 ± 0.38 vs 2.27 ± 1.24, P < .01; LNR: 1.36 ± 0.43 vs 5.88 ± 3.66, P < .01).

Conclusion: High-grade gliomas, metastases, and benign lesions can be distinguished on the basis of measured fluorocholine uptake. Increased peritumoral fluorocholine uptake is a distinguishing characteristic of high-grade gliomas.

© RSNA, 2007

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Article History

Published in print: 2007