Comparison of 11C-choline PET/CT and enhanced CT in the evaluation of patients with pulmonary abnormalities and locoregional lymph node involvement in lung cancer

Qi Liu, Zhongmin Peng, Qingwei Liu, Meng Li, Mingyong Han, Shuzhan Yao

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: This study compares the diagnostic abilities of integrated 11C-choline PET/CT imaging and contrast-enhanced helical CT imaging in pulmonary lesions and locoregional lymph node metastases in patients with lung cancer. Patients and Methods: One hundred eight patients with proven or suspected lung cancer underwent integrated 11C-choline PET/CT and contrast-enhanced CT, followed by surgical resection and nodal staging. Results: The 11C-choline PET/CT and CT diagnoses of pulmonary lesions and locoregional lymph node metastases were compared with pathologic findings, which revealed benign lesions in 26 patients (tuberculoma [8 patients], inflammatory pseudotumor [7 patients], hamartoma [6 patients], sclerosing hemangioma [4 patients], and pulmonary sequestration [1 patient]) and lung cancers in 82 patients (adenocarcinoma [39 patients], squamous cell carcinoma [23 patients], carcinoid [7 patients], small-cell lung cancer [5 patients], adenosquamous carcinoma [5 patients], and large-cell lung cancer [3 patients]). The accuracy, sensitivity, and specificity of 11C-choline PET/CT for diagnosing lung cancer were 82.4%, 85.4%, and 73.1%, respectively, compared with 73.1%, 76.8%, and 61.5%, respectively, for CT. Differences between 11C- choline PET/CT and CT in diagnosing lung cancer were not statistically significant (p =.503,.118, and.375, respectively). We used receiver operating characteristic (ROC) curve for analysis, finding the ROC of standard uptake value (SUV max) for diagnosing lung cancer. The cutoff value of SUV max was 3.54. Preoperative nodal staging was compared with postoperative histopathologic staging. 11C-choline PET/CT correctly staged 80.5% of patients, 12.2% were overstaged, and 7.3% were understaged; for CT these values were 58.5%, 24.4%, and 17.1%, respectively. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 11C-choline PET/CT for lymph nodes were 83.8%, 82.4%, 84.1%, 50.3%, and 96.1%, respectively, compared with 69.3%, 63.7%, 71.2%, 30.2%, 91.0%, respectively, for CT. Conclusion: Differences in the accuracy, sensitivity, specificity, PPV, and NPV between 11C-choline PET/CT and CT are thus statistically significant for nodal staging (p =.003,.007,.000,.000, and.004, respectively). Although 11C-choline PET/CT is not significantly better at diagnosing pulmonary lesions than is enhanced CT, 11C-choline PET/CT has improved sensitivity, specificity, accuracy, PPV, and NPV relative to enhanced CT in the evaluation of locoregional lymph nodes.

Original languageEnglish
Pages (from-to)312-320
Number of pages9
JournalClinical Lung Cancer
Issue number4
StatePublished - Jul 2012
Externally publishedYes


  • C-choline PET
  • CT
  • Lung cancer
  • Lymph node metastasis


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