The aim of the present study is to evaluate the role of (11)C-choline positron emission tomography/computed tomography (PET/CT) in detecting tumor recurrence and predicting survival in post-treatment patients with high-grade gliomas. A total of 16 previously treated histopathologically proven high-grade glioma patients were subjected to (11)C-choline PET/CT scan and survival analysis. We found that the sensitivity and specificity of (11)C-choline PET/CT were 100 and 70 %, whereas those of Gd-MRI were 83.3 and 60 %, respectively. By Cox regression analysis, (11)C-choline T/N ratio correlated obviously with overall survival (OS) (hazard ratio = 2.644, 95 % confidence interval [CI] = 1.027-6.807, p = 0.044) independent of Karnofsky performance score. Patients with lower T/N ratio (tumor uptake/normal brain tissue uptake) (≤1.42) had longer survival times than patients with higher T/N ratio (median OS = 15.4 vs. 5.3 months, p < 0.001; progression-free survival (PFS) =4.5 vs. 0.8 months, p = 0.004). Thus, this preliminary study suggests that (11)C-choline PET/CT is highly sensitive in detecting tumor recurrence in post-treatment patients with high-grade gliomas. Moreover, our preliminary results suggest that T/N ratio measured by (11)C-choline maybe serves as a predictor of patients' survival with suspected recurrent glioma.