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F18 choline avid incidentiloma

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History

75 year old gentleman with a history of prostate ca and rising PSA levels.


Findings

FCH (F18 choline) uptake is seen in the periphery of a partially calcified mass at the anterior aspect of the left frontal lobe with adjacent edema.


Diagnosis

F18 choline avid incidentiloma


DDx

Glioblastoma and meningioma.

Meningioma. FCH uptake is seen in the periphery of a partially calcified mass at the anterior aspect of the left frontal lobe with adjacent edema. This corresponds to the known meningioma at the site as described on the previous CT scan 6 months ago. 


Key points

F18 choline PET/CT is acquired for imaging prostate cancer and its role is evolving.

Scan sensitivity has been reported as 77% in patients with a PSA level of greater than 0.3 ng/mL.

The sensitivity of the (18)F-FCH PET was significantly higher (85%) in patients with ongoing androgen deprivation therapy (ADT) than in patients without ADT (59.5%). 

Patient management was reported as changed in 49.6 % of those with a positive FCH PET/CT scan and in 20 % of those with a negative FCH PET/CT scan.

FCH head and neck incidentilomas have been reported in 1.9% of cases. 

80% of incidentilomas have been reported as Benign: pituitary adenomas, meningiomas, hyperfunctioning parathyroid glands and  thyroid adenoma. 

Malignant: Prostate cancer metastasis, papillary thyroid cancer metastasis.


References

Radiol Oncol. 2014 Jul 10;48(3):228-34. Incidental uptake of (18)F-fluorocholine (FCH) in the head or in the neck of patients with prostate cancer. Hodolic M. et al. 

Clin Neurol Neurosurg. 2011 Feb;113(2):156-61. Promising role of [18F] fluorocholine PET/CT vs [18F] fluorodeoxyglucose PET/CT in primary brain tumors-early experience.Lam WW et al.

Eur J Nucl Med Mol Imaging. 2015 Nov;42(12):1784-93. Prognostic value of metabolic parameters and clinical impact of ¹⁸F-fluorocholine PET/CT in biochemical recurrent prostate cancer. Colombié M et al.

J Nucl Med. 2013 Jun;54(6):833-40. Impact of 18F-choline PET/CT in prostate cancer patients with biochemical recurrence: influence of androgen deprivation therapy and correlation with PSA kinetics. Beheshti M et al.



Author
Dr Saabry Osmany
Channel
ACNM Clinical cases channel
F18 choline avid incidentiloma Fused Transverse [WB_CTAC_MO] Body

Fused Transverse [WB_CTAC_MO] Body

F18 choline avid incidentiloma Fused Transverse [WB_CTAC_MO] Body

Fused Transverse [WB_CTAC_MO] Body

F18 choline avid incidentiloma Fused Transverse [WB_CTAC_MO] Body

Fused Transverse [WB_CTAC_MO] Body

F18 choline avid incidentiloma PET

PET

F18 choline avid incidentiloma CT

CT

F18 choline avid incidentiloma Fuse

Fuse

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