[ 11 C]Choline as a Novel PET/CT Biomarker of Liver Cirrhosis: A Prospective Pilot Study

Aim: Choline plays a role in hepatic mitochondrial impairment, oxidative stress and DNA methylation levels of genes involved in lipid metabolism. The aim of this study was to compare findings between patients with liver cirrhosis and subjects with a normal liver on a [11C]choline PET/CT. Methods: This prospective pilot study was conducted between the years 2012-2016. The cohort included 14 patients with prostate cancer (reference group) and 11 patients with cirrhosis attending a tertiary medical center. Demographic, clinical and laboratory data were obtained from the medical files. All participants underwent a dynamic [11C]choline PET/CT (Discovery ST, GE Medical Systems, Milwaukee WI). We compared the maximal standard uptake values (SUVmax) and the area under the curve (AUC) at 1110 seconds in both groups. Results: The mean age of the cirrhosis group (63.4% men) was 68.4 ± 10.7 and the control group, 69.7 ± 7.3 years. The mean SUVmax was significantly higher in the cirrhosis group than in the controls (right lobe, 10.06 ± 12 vs. 6.3 ± 1.6, P=0.011; left lobe, 8.6 ± 11.6 vs. 5.4 ± 0.9, P=0.024; spleen 17.99 ± 27.8 vs. 13.4 ± 2.6, P=0.027; kidney, 35.9 ± 59.5 vs. 19.3 ± 4.8, P=0.025). The corresponding AUC values at 1110 seconds was significantly distinguished between the groups (right lobe, 13538 ± 20020 vs. 8427.3 ± 1557.9, P=0.026; left lobe 12304 ± 18871 vs. 6878.9 ± 1294.3, P=0.024; spleen, 12875 ± 17930 vs. 8263.9 ± 1279.2, P=0.023; kidney, 24623 ± 36025 vs. 13667 ± 3873.9, P=0.032). No correlations were found between the clinical characteristics and the imaging-derived parameters in the patients with cirrhosis. Conclusions: Our findings suggest a role for [11C]choline PET/CT as a noninvasive biomarker of cirrhosis. Further larger-scale studies are needed to confirm these observations.