Usefulness of Texture Analysis in 11 C-Choline PET/CT for Patients With Prostate Cancer

Background/Aim: Texture analysis provides quantitative evaluation of intratumoral heterogeneity of radiopharmaceutical uptake. ComBat harmonization, which reduces batch effects, has been applied in several 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) texture analysis studies. In addition, 11C-Choline PET/CT has been reported to be useful for evaluating urological tumors, including prostate cancer. This study investigated whether texture parameters derived from 11C-Choline PET/CT are associated with prostate cancer aggressiveness. Patients and Methods: A retrospective analysis was performed in 18 patients diagnosed with prostate cancer who underwent 11C-Choline PET/CT examinations. Six texture features were evaluated: entropy, homogeneity, dissimilarity, intensity variability (IV), size-zone variability (SZV) and zone percentage (ZP). Correlation coefficients between the six texture parameters and Gleason score were calculated. Results: Among the evaluated texture parameters, SZV showed the strongest correlation with Gleason score (ρ=0.45), followed by IV (ρ=0.44), entropy (ρ=0.08), homogeneity (ρ=0.04), ZP (ρ=0.03), and dissimilarity (ρ=−0.02). Conclusion: SZV and IV derived from 11C-Choline PET/CT showed correlations with Gleason score and warrant further investigation as potential imaging biomarkers of prostate cancer aggressiveness.