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Cancers (Basel). 2019 Dec 7;11(12). pii: E1969. doi: 10.3390/cancers11121969.

Imaging and Tissue Biomarkers of Choline Metabolism in Diffuse Adult Glioma: 18F-Fluoromethylcholine PET/CT, Magnetic Resonance Spectroscopy, and Choline Kinase α.

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Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK.
Department of Imaging, Imperial College Healthcare NHS Trust, London SW7 2AZ, UK.
Department of Neurosurgery, Imperial College Healthcare NHS Trust, London SW7 2AZ, UK.
Department of Brain Sciences, Imperial College London, London SW7 2AZ, UK.
Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK.
Department of Cellular Pathology, Salford Royal Foundation Trust, Salford M6 8HD, UK.
Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester M13 9PL, UK.
Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh EH8 9YL, UK.


The cellular and molecular basis of choline uptake on PET imaging and MRS-visible choline-containing compounds is not well understood. Choline kinase alpha (ChoKα) is an enzyme that phosphorylates choline, an essential step in membrane synthesis. We investigate choline metabolism through 18F-fluoromethylcholine (18F-FMC) PET, MRS, and tissue ChoKα in human glioma. Fourteen patients with a suspected diffuse glioma underwent multimodal 3T MRI and dynamic 18F-FMC PET/CT prior to surgery. Co-registered PET and MRI data were used to target biopsies to regions of high and low choline signal, and immunohistochemistry for ChoKα expression was performed. The 18F-FMC/PET differentiated WHO (World Health Organization) grade IV from grade II and III tumours, whereas MRS differentiated grade III/IV from grade II tumours. Tumoural 18F-FMC/PET uptake was higher than in normal-appearing white matter across all grades and markedly elevated within regions of contrast enhancement. The 18F-FMC/PET correlated weakly with MRS Cho ratios. ChoKα expression on IHC was negative or weak in all but one glioblastoma sample, and did not correlate with tumour grade or imaging choline markers. MRS and 18F-FMC/PET provide complimentary information on glioma choline metabolism. Tracer uptake is, however, potentially confounded by blood-brain barrier permeability. ChoKα overexpression does not appear to be a common feature in diffuse glioma.


MRI; PET; brain; choline; glioma

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