Clinical applications of PET using C-11/F-18-choline in brain tumours: a systematic review

Purpose The purpose of this study is to conduct a systematic review of the published data about the current indications in clinical practice for the use of positron emission tomography (PET) or PET/computed tomography (PET/CT) using either Carbon-11 ( 11 C) or Fluorine-18 ( 18 F) choline tracer in brain tumours. Methods A comprehensive literature search of PubMed until April 30, 2016 with the Mesh terms: ‘‘positron emission tomography’’, ‘‘choline’’, and ‘‘brain neoplasm’’ was first performed. On a second step, the references of the retrieved articles were also screened, adding any relevant publications about the subject. Results A total of 15 articles corresponding to 453 patients with brain lesions (mostly gliomas) were included for the analysis, successfully imaging brain tumours for the following indications: diagnosis and tumour characterisation; biopsy guide; treatment planning; differential diagnosis of recurrence or radiation necrosis; and therapy response assessment and prognosis. In addition, other brain lesions have been imaged by PET choline, such as meningiomas and metastasis. PET or PET/CT with radiolabelled choline must be considered as an emerging procedure for the evaluation of brain tumours. Since choline has a low physiological uptake, it provides precise images with a very good tumour-to-background ratio, especially in lesions with disruption of the blood–brain barrier. Conclusions Even though the small population and heterogeneity of analyzed studies precluded performing a meta-analysis, the exposed results in this review support the use of choline in the aforementioned indications based on its availability, but larger studies are needed to better validate its use.