Distribution Patterns of 18F-Labelled Fluoromethylcholine in Normal Structures and Tumors of the Head A PET/MRI Evaluation

Purpose: To evaluate the distribution of F-18-labelled fluoromethylcholine (FCho) in normal structures and tumors of the head region using positron emission tomography (PET) and magnetic resonance imaging. Materials and Methods: We retrospectively reviewed the positron emission tomography, magnetic resonance imaging, and the coregistered images obtained in 17 patients with suspected high-grade gliomas. The accumulation of F-18-FCho in the normal structures and in brain lesions was visually and semiquantitatively assessed. A 4-point grading system was used for the visual analysis. A standardized uptake value (SUV) was used to quantify uptake. Results: In the normal brain parenchyma, F-18-FCho uptake was faint (SUVmean, 0.15 +/- 0.03 (SD)). Uptake was generally moderate in the choroid plexus (SUVmean, 0.82 +/- 0.16), cavernous sinus (SUVmean, 0.87 +/- 0.19), extraocular eye muscles (SUVmean, 1.10 +/- 0.27), masticatory muscles (SUVmean, 0.99 +/- 0.22), and bone marrow (SUVmean, 1.06 +/- 0.26), whereas uptake was usually moderately intense in the pituitary gland (SUVmean, 1.90 +/- 0.21). Uptake was variable in the lacrimal glands and the mucosa of the nasal cavity (for SUVmean of subgroups see text). Intense uptake was observed in the parotid glands (SUVmean, 3.27 +/- 0.73). (Moderately) intense F-18-FCho uptake was observed in glioblastomas (range SUVmax, 2.26-6.37) and typical meningiomas (range SUVmax, 3.75-5.81). Uptake was globally faint in grade II and III gliomas (range SUVmax, 0.33-0.78). F-18-FCho uptake was also demonstrated in benign lesions, such as a tumefactive demyelinating brain lesion. Conclusions: F-18-FCho uptake was faint in the normal brain parenchyma and usually moderate in the choroid plexus, cavernous sinus, extraocular eye muscles, masticatory muscles, and bone marrow. Uptake in the pituitary gland was generally moderately intense, whereas uptake in the lacrimal glands and the mucosa of the nasal cavity was variable. Parotid glands had intense uptake. Also, uptake in glioblastomas and meningiomas was usually (moderately) intense, whereas uptake in grade II and III gliomas was globally faint. However, F-18-FCho uptake was not tumor specific.