Imaging features of Paget's disease on 11C choline PET/CT

• Published in: American journal of nuclear medicine and molecular imaging 2017-01, Vol.7 (3), p.105-110
• Main Authors: Leitch, Cameron E, Goenka, Ajit H, Howe, Benjamin M, Broski, Stephen M
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2160-8407; 2160-8407

The purpose of this study was to investigate the appearance of Paget’s disease (PD) on 11 C choline PET/CT and correlate these findings to serum alkaline phosphatase (ALP) level and skeletal scintigraphy. With IRB approval, our institutional 11 C choline PET/CT database (9/2005-6/2015) was searched for patients with PD. Site of osseous involvement, CT appearance, and multiple semi-quantitative measures were measured and correlated with ALP and degree of uptake on bone scan. Our search identified 10 males (mean age 79.6 ± 7.8 years). Four had polyostotic disease and seven had more than one 11 C choline PET/CT. In total, 58 affected bones were evaluated on 25 PET/CTs. Mean lesion SUV max was 2.6 ± 0.89 (range 1.0-4.4), SUV max /Liver SUV mean 0.33 ± 0.13 (0.12-0.61), SUV max /Liver SUV max 0.29 ± 0.11 (0.10-0.52), SUV max /BP SUV mean 2.47 ± 0.86 (0.91-4.22), and SUV max /BP SUV max 1.92 ± 0.71 (0.68-3.45). There was no correlation between ALP and any semiquantitative measure. Bone scan uptake was marked in 41 bones, moderate in nine, and mild in six. There was no correlation between lesion SUV max and bone scan uptake (P = 0.26). Paget’s disease on 11 C choline PET/CT demonstrates mild to moderate activity, which does not correlate with bone scan uptake or ALP level. It is important to recognize Paget’s disease as a potential pitfall on 11 C choline PET/CT. However, the characteristic appearance on the CT portion of PET/CT examinations should allow confident diagnosis and differentiation from prostate cancer osseous metastases.