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The aim of this study was to investigate the efficacy of 11C-choline PET/CTimaging for lung cancer and the correlation between choline uptake of lung cancertissue and the expression of choline kinase (ChoK), phosphorylcholine-cytidyltransferase and Ki-67 index. Between March 2008 and June 2010, 53 patients diagnosedor suspected of having lung cancer underwent integrated 11C-choline PET/CT andcontrast-enhanced CT scans before surgery. After surgery, specimens from 42 patientsdiagnosed with lung cancer were used to detect the expression of ChoK, phosphorylcholine-cytidyltransferase and the Ki-67 index. The PET/CT results were analyzed using visualmethods and the standardized uptake value (SUV) of lesions was measured usingsemi-quantitative methods. Finally, the analyzed results were compared to thehistopathological results. The accuracy of the 11C-choline PET/CT for diagnosinglung cancer was 81.13% (43/53), compared with 71.70% (38/53) for CT scanning.The difference was not statistically significant (P=0.61). The accuracy of 11C-cholinePET/CT for diagnosing lymph nodes was 83.76% (227/271), compared with 66.79% (181/271)for CT scanning. This difference was statistically significant (P=0.04); the SUVmeanvalue of lesions correlated positively with the Ki-67 index (r=0.51, p=0.002).Of the 35 patients with positive 11C-choline PET results, 29 (82.86%) overexpressedChoK, 26 (74.29%) overexpressed phosphorylcholine-cytidyl transferase. The sevenpatients with negative 11C-choline PET results did not exhibit overexpressionof ChoK or phosphorylcholine-cytidyl transferase; the SUVmean value correlatedpositively with the expression of both ChoK and phosphorylcholine-cytidyl transferase(r=0.52, p=0.001; r=0.37, p=0.029). In conclusion, compared with contrast-enhancedCT, 11C-choline PET offers nodal staging with higher accuracy. The SUV value ofPET is correlated with the proliferation of tumor cells and the mechanism of PETimaging is associated with the overexpression of ChoK and phosphorylcholine-cytidyltransferase.

Value of 11C-choline PET/CT for lung cancer diagnosis and the relation between choline metabolism and proliferation of cancer cells