18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients

Abstract

• F-Fluciclovine PET/MRI has high specificity for detection of lymph node metastasis. •F-Fluciclovine PET/MRI lacks sensitivity to replace ePLND. • F-Fluciclovine PET/MRI may be used to aid surgery and select adjuvant therapy. •F-Fluciclovine PET-positive patients have more extensive disease than PET-negative patients. • Size of metastatic lymph nodes is an important factor for detection.

The Effect of Including Bone in Dixon-Based Attenuation Correction for 18F-Fluciclovine PET/MRI of Prostate Cancer

“…The investigated method for atlas-based inclusion of bone in DIXON-based attenuation correction of 18 F-fluciclovine PET/MRI has only a small effect on the SUVs of soft-tissue prostate cancer lesions, and no effect on their lesion-to-bone marrow SUVRs when using signal from L3 as a reference. The attenuation maps should always be checked for bone registration errors when evaluating lesions in or close to the bones.…”

“…In the remaining 8 primary prostate tumors, 7 locally recurrent lesions, and 28 lymph node metastases without bone registration errors, using the 5-compartment attenuation map was associated with small but significant increases in SUVmax [2.5%; 95% confidence interval (CI) 2.0%-3.0%; p<0.001] and SUViso (2.5%; 95% CI 1.9%-3.0%; p<0.001), but not SUVRmax (0.2%; 95% CI -0.5%-0.9%; p=0.604) and SUVRiso (0.2%; 95% CI -0.6%-1.0%; p=0.581), in comparison to the 4-compartment attenuation map. Conclusion: The investigated method for atlas-based inclusion of bone in 18 F-fluciclovine PET/MRI attenuation correction has only a small effect on the SUVs of soft-tissue prostate cancer lesions, and no effect on their lesion-to-bone marrow SUVRs when using signal from L3 as a reference. The attenuation maps should always be checked for registration artefacts for lesions in or close to the bones.…”

“…(4,18,22,23), and detection of disease recurrence after initial treatment with curative intent, e.g. (24)(25)(26)(27).…”

“…The objective of this study was to evaluate the effect of including bone in DIXON-based attenuation correction for 18 F-fluciclovine Positron Emission Tomography (PET) / Magnetic Resonance Imaging (MRI) of primary and recurrent prostate cancer.…”

Editorial Comment: Advances in MRI and PET of the prostate: concurrence or complementarity?

“…The diagnostic performance of PET imaging, using ligands of PSMA labelled with gallium-68 or more recently fluorine-18 in a PCa workup (initial staging and recurrence) has been reported in several concordant studies to be superior to that of radiolabeled 11 C-choline or its fluorinated analogues [9,10]. Compared with the radioligands of PSMA, the regulatory status of the amino-acid analogue 18 Ffluciclovine, which has been developed in the USA, is quite different [11]. It is currently registered in the USA and EU, even though the published data about comparison with PET choline are currently limited to one study with 11 C-choline [12] but none with 18 F-fluorocholine.…”