{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:26:52Z","timestamp":1790072812510,"version":"4.0.1"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T00:00:00Z","timestamp":1590624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The field of multiple myeloma (MM) imaging has evolved. The International Myeloma Working Group recently recommended performing 18F-fluorodeoxyglucose glucose (18FDG) positron emission tomography\/computed tomography (PET\/CT) with the aim of staging MM patients at baseline and evaluating response to therapy. Novel oncological radiotracers such as 11C-Choline and 18F-Fluorocholine, have been studied in comparison with 18FDG, mostly in MM patients presenting with refractory disease or suspected relapse. Choline-based tracers may overcome some limitations of 18FDG, which include a lack of sensitivity in depicting skull lesions and the fact that 10% of MM patients are FDG-negative. The majority of MM lesions display a higher uptake of Choline than FDG. Also, in many situations, Choline may offer better lesion visualization, with a higher tumor to background ratio; however, various patterns of Choline and FDG uptake have been observed in MM and some limitations, notably as regards liver lesions, should be recognized. Overall, Choline may provide additional detection of up to 75% more lesions. This article aims to provide a comprehensive review of the potential role of Choline in multiple myeloma, as compared to FDG, encompassing Choline physiopathology as well as data from clinical studies.<\/jats:p>","DOI":"10.3390\/cancers12061394","type":"journal-article","created":{"date-parts":[[2020,5,29]],"date-time":"2020-05-29T00:44:02Z","timestamp":1590713042000},"page":"1394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Choline PET\/CT in Multiple Myeloma"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3889-755X","authenticated-orcid":false,"given":"Charles","family":"Mesguich","sequence":"first","affiliation":[{"name":"CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France"},{"name":"INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrille","family":"Hulin","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, Haematology, F-33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axelle","family":"Lascaux","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, Haematology, F-33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Bordenave","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Marit","sequence":"additional","affiliation":[{"name":"INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2101-5626","authenticated-orcid":false,"given":"Elif","family":"Hindi\u00e9","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e538","DOI":"10.1016\/S1470-2045(14)70442-5","article-title":"International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma","volume":"15","author":"Rajkumar","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e206","DOI":"10.1016\/S1470-2045(17)30189-4","article-title":"Role of (18)F-FDG PET\/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: A consensus statement by the International Myeloma Working Group","volume":"18","author":"Cavo","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e302","DOI":"10.1016\/S1470-2045(19)30309-2","article-title":"International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders","volume":"20","author":"Hillengass","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"(2019). Correction to Lancet Oncol 2019; 20: e302-12. Lancet Oncol., 20, e346.","DOI":"10.1016\/S1470-2045(19)30423-1"},{"key":"ref_5","first-page":"110","article-title":"Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: Initial findings in prostate cancer","volume":"61","author":"DeGrado","year":"2001","journal-title":"Cancer Res."},{"key":"ref_6","first-page":"1699","article-title":"Detection of hepatocellular carcinoma with PET\/CT: A prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease","volume":"51","author":"Talbot","year":"2010","journal-title":"J. Nucl. Med. Off. Publ. Soc. Nucl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1146\/annurev.nu.01.070181.000523","article-title":"Dietary choline: Biochemistry, physiology, and pharmacology","volume":"1","author":"Zeisel","year":"1981","journal-title":"Annu. Rev. Nutr."},{"key":"ref_8","first-page":"167","article-title":"Comparison of (11)C-choline and (18)F-FDG PET in primary diagnosis and staging of patients with thoracic cancer","volume":"43","author":"Pieterman","year":"2002","journal-title":"J. Nucl. Med. Off. Publ. Soc. Nucl. Med."},{"key":"ref_9","first-page":"1051","article-title":"Imaging of gynecologic tumors: Comparison of (11)C-choline PET with (18)F-FDG PET","volume":"44","author":"Torizuka","year":"2003","journal-title":"J. Nucl. Med. Off. Publ. Soc. Nucl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.nucmedbio.2017.04.004","article-title":"PET\/CT with (18)F-choline: Physiological whole bio-distribution in male and female subjects and diagnostic pitfalls on 1000 prostate cancer patients: (18)F-choline PET\/CT bio-distribution and pitfalls. A southern Italian experience","volume":"51","author":"Calabria","year":"2017","journal-title":"Nucl. Med. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1177\/0284185118762245","article-title":"Physiological uptake of 18F-FDG in the vertebral bone marrow in healthy adults on PET\/CT imaging","volume":"59","author":"Shen","year":"2018","journal-title":"Acta Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/PL00006658","article-title":"Blood metabolism of [methyl-11C]choline; implications for in vivo imaging with positron emission tomography","volume":"27","author":"Roivainen","year":"2000","journal-title":"Eur. J. Nucl. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1007\/s00259-004-1741-4","article-title":"In vivo uptake of [11C]choline does not correlate with cell proliferation in human prostate cancer","volume":"32","author":"Breeuwsma","year":"2005","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1023\/A:1023342516925","article-title":"Evaluation of brain tumor metabolism with [11C]choline PET and 1H-MRS","volume":"62","author":"Utriainen","year":"2003","journal-title":"J. Neurooncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s11745-999-332-5","article-title":"Abnormal serum lysophospholipids in multiple myeloma patients","volume":"34","author":"Sasagawa","year":"1999","journal-title":"Lipids"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Rizzieri, D., Paul, B., and Kang, Y. (2019). Metabolic alterations and the potential for targeting metabolic pathways in the treatment of multiple myeloma. J. Cancer Metastasis Treat., 5.","DOI":"10.20517\/2394-4722.2019.05"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mohamed, A., Collins, J., Jiang, H., Molendijk, J., Stoll, T., Torta, F., Wenk, M.R., Bird, R.J., Marlton, P., and Mollee, P. (2020). Concurrent lipidomics and proteomics on malignant plasma cells from multiple myeloma patients: Probing the lipid metabolome. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227455"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jare.2018.03.005","article-title":"Synopsis of arachidonic acid metabolism: A review","volume":"11","author":"Hanna","year":"2018","journal-title":"J. Adv. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1182\/blood-2017-03-774422","article-title":"Low expression of hexokinase-2 is associated with false-negative FDG-positron emission tomography in multiple myeloma","volume":"130","author":"Rasche","year":"2017","journal-title":"Blood"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"50","DOI":"10.3324\/haematol.10554","article-title":"A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma","volume":"92","author":"Zamagni","year":"2007","journal-title":"Haematologica"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1182\/blood-2009-03-213280","article-title":"F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma","volume":"114","author":"Bartel","year":"2009","journal-title":"Blood"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5989","DOI":"10.1182\/blood-2011-06-361386","article-title":"Prognostic relevance of 18-F FDG PET\/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation","volume":"118","author":"Zamagni","year":"2011","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1182\/blood-2012-08-451690","article-title":"Prognostic implications of serial 18-fluoro-deoxyglucose emission tomography in multiple myeloma treated with total therapy 3","volume":"121","author":"Usmani","year":"2013","journal-title":"Blood"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2911","DOI":"10.1200\/JCO.2017.72.2975","article-title":"Prospective Evaluation of Magnetic Resonance Imaging and [(18)F]Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography at Diagnosis and Before Maintenance Therapy in Symptomatic Patients With Multiple Myeloma Included in the IFM\/DFCI 2009 Trial: Results of the IMAJEM Study","volume":"35","author":"Moreau","year":"2017","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/1477-7819-5-68","article-title":"11C-choline vs. 18F-FDG PET\/CT in assessing bone involvement in patients with multiple myeloma","volume":"5","author":"Nanni","year":"2007","journal-title":"World J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s00259-016-3392-7","article-title":"18F-fluorocholine versus 18F-fluorodeoxyglucose for PET\/CT imaging in patients with suspected relapsing or progressive multiple myeloma: A pilot study","volume":"43","author":"Balogova","year":"2016","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1097\/RLU.0000000000002638","article-title":"Comparison of 11C-Choline and 11C-Methionine PET\/CT in Multiple Myeloma","volume":"44","author":"Lapa","year":"2019","journal-title":"Clin. Nucl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.clml.2018.06.002","article-title":"Bone Health and Survival in Women With Multiple Myeloma","volume":"18","author":"Rosko","year":"2018","journal-title":"Clin. Lymphoma Myeloma Leuk"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1007\/s00259-015-3241-0","article-title":"Diagnostic value of combining (1)(1)C-choline and (1)(8)F-FDG PET\/CT in hepatocellular carcinoma","volume":"43","author":"Franco","year":"2016","journal-title":"E Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s00259-019-04312-9","article-title":"Low hexokinase-2 expression-associated false-negative (18)F-FDG PET\/CT as a potential prognostic predictor in patients with multiple myeloma","volume":"46","author":"Abe","year":"2019","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_31","first-page":"348","article-title":"Hexokinase-2 Expression in (11)C-Methionine-Positive, (18)F-FDG-Negative Multiple Myeloma","volume":"60","author":"Kircher","year":"2019","journal-title":"J. Nucl. Med. Off. Publ. Soc. Nucl. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1038\/s41375-018-0329-0","article-title":"Combination of flow cytometry and functional imaging for monitoring of residual disease in myeloma","volume":"33","author":"Rasche","year":"2019","journal-title":"Leukemia"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1182\/blood-2018-08-825356","article-title":"Imaging in multiple myeloma: How? When?","volume":"133","author":"Zamagni","year":"2019","journal-title":"Blood"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.3324\/haematol.2012.065698","article-title":"Extramedullary disease portends poor prognosis in multiple myeloma and is over-represented in high-risk disease even in the era of novel agents","volume":"97","author":"Usmani","year":"2012","journal-title":"Haematologica"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.blre.2019.04.002","article-title":"Extramedullary disease in multiple myeloma - controversies and future directions","volume":"36","author":"Sevcikova","year":"2019","journal-title":"Blood Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1016\/j.ejrad.2014.09.012","article-title":"State of the art imaging of multiple myeloma: Comparative review of FDG PET\/CT imaging in various clinical settings","volume":"83","author":"Mesguich","year":"2014","journal-title":"Eur. J. Radiol"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1007\/s00259-017-3909-8","article-title":"Interpretation criteria for FDG PET\/CT in multiple myeloma (IMPeTUs): Final results. IMPeTUs (Italian myeloma criteria for PET USe)","volume":"45","author":"Nanni","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"287","DOI":"10.7150\/thno.14400","article-title":"New Perspectives Offered by Nuclear Medicine for the Imaging and Therapy of Multiple Myeloma","volume":"6","author":"Mesguich","year":"2016","journal-title":"Theranostics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.7150\/thno.19050","article-title":"CXCR4-directed endoradiotherapy induces high response rates in extramedullary relapsed Multiple Myeloma","volume":"7","author":"Lapa","year":"2017","journal-title":"Theranostics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1148\/radiol.2020192621","article-title":"CD38-targeted Immuno-PET of Multiple Myeloma: From Xenograft Models to First-in-Human Imaging","volume":"295","author":"Ulaner","year":"2020","journal-title":"Radiology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1182\/blood-2017-09-807263","article-title":"Copper 64-labeled daratumumab as a PET\/CT imaging tracer for multiple myeloma","volume":"131","author":"Caserta","year":"2018","journal-title":"Blood"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1056\/NEJMoa1607751","article-title":"Daratumumab, Lenalidomide, and Dexamethasone for Multiple Myeloma","volume":"375","author":"Dimopoulos","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1056\/NEJMoa1606038","article-title":"Daratumumab, Bortezomib, and Dexamethasone for Multiple Myeloma","volume":"375","author":"Palumbo","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1158\/0008-5472.CAN-13-1589","article-title":"A preclinical model of CD38-pretargeted radioimmunotherapy for plasma cell malignancies","volume":"74","author":"Green","year":"2014","journal-title":"Cancer Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4692","DOI":"10.18632\/oncotarget.2986","article-title":"alpha-Radioimmunotherapy with (2)(1)(3)Bi-anti-CD38 immunoconjugates is effective in a mouse model of human multiple myeloma","volume":"6","author":"Teiluf","year":"2015","journal-title":"Oncotarget"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/6\/1394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:33:29Z","timestamp":1760175209000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/6\/1394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,28]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["cancers12061394"],"URL":"https:\/\/doi.org\/10.3390\/cancers12061394","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,28]]}}}