Increased [11C]Choline uptake in bronchioloalveolar cell carcinoma with negative [18F]FDG uptake. A PET/CT and pathology study

A case of a patient with bronchioloalveolar cell predominate lung adenocarcinoma (BAC) studied using integrated Positron Emission Tomography and Computed Tomography (PET/CT) with both 18F-fluorodeoxyglucose ([18F]FDG-PET) and [11C]Choline ([11C]Choline-PET) is described, with the aim of evaluating a new non invasive imaging method to detect and stage BAC, and providing information on tumour biology in vivo. The information derived from combining the two tracers could help in distinguishing lung adenocarcinoma with large BAC components ([18F]FDG negative and [11C]Choline positive) from inflammatory lesion ([18F]FDG and [11C]Choline positive). In addition, the simultaneous use of two PET tracers, evaluating two different metabolic pathways, together with histopathologic, immunohistochemical and gene expression analysis, could help to improve understanding of tumour in vivo behaviour.