Evaluation of Prostate Cancer with PET/MRI

Lindenberg, Liza; Ahlman, Mark A.; Türkbey, Barış; Mena, Esther; Choyke, Peter L.

doi:10.2967/jnumed.115.169763

Cited by 33 publications

(35 citation statements)

References 49 publications

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“…Given the ordinal scale of PIRADS classification and Likert scale, calculating diagnostic accuracy using ROC analysis might be more adequate than doing it using fourfold tables. The improved diagnostic accuracy of PET/MRI and PET underlines the potential of integrated PET/MRI to further improve PCa diagnostics and is also mirrored in the present literature regarding integrated PET/MRI in primary PCa [3,19,26,27]. In particular, a recently published study from Eiber et al [19] reported of a significantly improved detection of PCa lesions and improved diagnostic accuracy as well as a reduced rate of uncertain lesions by using 68 Ga-PSMA PET and PET/MRI when compared to sole mpMRI.…”

Section: Discussionmentioning

confidence: 64%

Integrated <sup>68</sup>Gallium Labelled Prostate-Specific Membrane Antigen-11 Positron Emission Tomography/Magnetic Resonance Imaging Enhances Discriminatory Power of Multi-Parametric Prostate Magnetic Resonance Imaging

Al-Bayati¹,

Grueneisen²,

Lütje³

et al. 2018

Urol Int

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Purpose: To evaluate diagnostic accuracy of integrated ⁶⁸Gallium labelled prostate-specific membrane antigen (⁶⁸Ga-PSMA)-11 positron emission tomography (PET)/MRI in patients with primary prostate cancer (PCa) as compared to multi-parametric MRI. Material and Methods: A total of 22 patients with recently diagnosed primary PCa underwent clinically indicated ⁶⁸Ga-PSMA-11 PET/CT for initial staging followed by integrated ⁶⁸Ga-PSMA-11 PET/MRI. Images of multi-parametric magnetic resonance imaging (mpMRI), PET and PET/MRI were evaluated separately by applying Prostate Imaging Reporting and Data System (PIRADSv2) for mpMRI and a 5-point Likert scale for PET and PET/MRI. Results were compared with pathology reports of biopsy or resection. Statistical analyses including receiver operating characteristics analysis were performed to compare the diagnostic performance of mpMRI, PET and PET/MRI. Results: PET and integrated PET/MRI demonstrated a higher diagnostic accuracy than mpMRI (area under the curve: mpMRI: 0.679, PET and PET/MRI: 0.951). The proportion of equivocal results (PIRADS 3 and Likert 3) was considerably higher in mpMRI than in PET and PET/MRI. In a notable proportion of equivocal PIRADS results, PET led to a correct shift towards higher suspicion of malignancy and enabled correct lesion classification. Conclusion: Integrated ⁶⁸Ga-PSMA-11 PET/MRI demonstrates higher diagnostic accuracy than mpMRI and is particularly valuable in tumours with equivocal results from PIRADS classification.

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Section: Discussionmentioning

confidence: 64%

Integrated <sup>68</sup>Gallium Labelled Prostate-Specific Membrane Antigen-11 Positron Emission Tomography/Magnetic Resonance Imaging Enhances Discriminatory Power of Multi-Parametric Prostate Magnetic Resonance Imaging

Al-Bayati¹,

Grueneisen²,

Lütje³

et al. 2018

Urol Int

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“…Newly developed tracers exhibit increased accuracy for the detection of small, incipient metastatic foci [28][29]. Improvements in MRI techniques, and particularly in functional imaging, have enabled radiologists to play an important role in the risk stratification and management of patients [30][31][32]. 18 F-FDG PET/CT is primarily useful in the diagnosis and staging of prostate cancer because it combines the metabolic information of PET with the anatomic information of CT.…”

Section: Discussionmentioning

confidence: 99%

Positron emission tomography/computed tomography-guided percutaneous trans-pararectal space prostate biopsy for the diagnosis of prostate cancer: A retrospective study

Luo

Ruan

Pang

et al. 2019

Preprint

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Oncology 2 KEYWORDS positron emission tomography/computed tomography, prostate cancer, percutaneous trans-pararectal space prostate biopsy Abstract Background: Biopsy is considered the gold-standard technique for prostate cancer diagnosis and is recommended in patients with a high clinical indication of prostate cancer. In this study, we aimed to determine the diagnostic efficacy of a novel positron emission tomography (PET)/computed tomography (CT)-guided percutaneous trans-pararectal space-based approach to targeted prostate biopsy. Methods: PET/CT-guided percutaneous trans-pararectal space prostate biopsies were performed in 14 consecutive patients with indications of prostate cancer. Whole-body 18F-FDG PET/CT indicated the presence of 18F-fluorodeoxyglucose (FDG)-avid focal prostate lesions. Two tissue specimens were obtained from each patient. The final diagnoses were established based on the results of a histopathological analysis and clinical follow-up, and these findings were used to verify the diagnostic accuracy of 18F-FDG PET/CT for prostate cancer. Results: The diagnostic accuracy of 18F-FDG PET/CT for prostate cancer was 81.8%. Further analyses of the two biopsied samples per patient led to confirmed histopathological and immunohistochemical diagnoses of prostate cancer in all 14 patients. Consequently, the success rate of PET/CT-guided percutaneous trans-pararectal space prostate-targeted biopsy for the diagnosis of prostate cancer was 100.0% (14/14). Regarding safety, the average duration of biopsy was 20 min, and no serious complications occurred.Conclusions: PET/CT-guided percutaneous trans-pararectal space prostate biopsy may yield a new approach to targeted prostate biopsy for the diagnosis of prostate cancer. Moreover, this biopsy procedure can be performed safely without complications, and is more cost-effective than conventional trans-rectal and trans-perineal prostate biopsy methods.

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“…In addition, the combination of the imaging techniques versus choline PET/CT alone achieved a significantly higher detection rate for LR. It is worth highlighting the increasing clinical and diagnostic role of the integrated PET/MRI scanner, an advanced technique that combines the anatomical and functional information provided by MRI with the higher specificity of PET [17]. This hybrid PET-MRI system has shown promising results in terms of tumor detection compared to MRI or PET alone [17].…”

Section: Discussionmentioning

confidence: 99%

“…It is worth highlighting the increasing clinical and diagnostic role of the integrated PET/MRI scanner, an advanced technique that combines the anatomical and functional information provided by MRI with the higher specificity of PET [17]. This hybrid PET-MRI system has shown promising results in terms of tumor detection compared to MRI or PET alone [17]. For this reason, the high detection rate for MRI and choline PET/CT allows us to define the site of recurrence, assess for metastatic disease, and personalize salvage therapy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of tumor recurrences after radical prostatectomy using 18F-Choline PET/CT and 3T multiparametric MRI without endorectal coil: a single center experience

et al. 2016

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BackgroundTo evaluate and compare the utility of 18F-fluorocholine (18F-CH) PET/CT versus 3-Tesla multiparametric MRI (mpMRI) without endorectal coil to detect tumor recurrences in patients with biochemical relapse following radical prostatectomy (RP). Secondarily, to identify possible prognostic variables associated with mpMRI and 18F-CH PET/CT findings.MethodsRetrospective study of 38 patients who developed biochemical recurrence after RP between the years 2011 and 2015 at our institution. PET/CT and mpMRI were both performed within 30 days of each other in all patients. The PET/CT was reviewed by a nuclear medicine specialist while the mpMRI was assessed by a radiologist, both of whom were blinded to outcomes.ResultsThe median prostate-specific antigen (PSA) value pre-MRI/PET-CT was 0.9 ng/mL (interquartile range 0.4–2.2 ng/mL). There were no differences in the detection rate between 18F-CH PET/CT and mpMRI for local recurrence (LR), lymph node recurrence (LNR) and bone metastases (BM). Separately, mpMRI and 18F-CH PET/CT were positive for recurrence in 55.2% and 52.6% of cases, respectively, and in 65.7% of cases when findings from both modalities were considered together. The detection of LR was better with combined mpMRI and choline PET/CT versus choline PET/CT alone (34.2% vs 18.4%, p = 0.04). Salvage treatment was modified in 22 patients (57.8%) based on the imaging findings. PSA values on the day of biochemical failure were significantly associated with mpMRI positivity (adjusted odds ratio (OR): 30.9; 95% confidence interval (CI): 1.5–635.8). Gleason score > 7 was significantly associated with PET/CT positivity (OR: 13.9; 95% CI: 1.5–125.6). A significant association was found between PSA doubling time (PSADT) (OR: 1.3; 95% CI: 1.0–1.7), T stage (OR: 21.1; 95% CI: 1.6–272.1), and LR.ConclusionsMultiparametric MRI and 18F-CH PET/CT yield similar detection rates for LR, LNR and pelvic BM. The combination of both imaging techniques provides a better LR detection versus choline PET/CT alone. The initially planned salvage treatment was modified in 57.8% of patients due to imaging findings. In addition to PSA values, Gleason score, T stage, and PSADT may provide valuable data to identify those patients that are most likely to benefit from undergoing both imaging procedures.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0099-8) contains supplementary material, which is available to authorized users.

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Evaluation of Prostate Cancer with PET/MRI

Cited by 33 publications

References 49 publications

Integrated <sup>68</sup>Gallium Labelled Prostate-Specific Membrane Antigen-11 Positron Emission Tomography/Magnetic Resonance Imaging Enhances Discriminatory Power of Multi-Parametric Prostate Magnetic Resonance Imaging

Integrated <sup>68</sup>Gallium Labelled Prostate-Specific Membrane Antigen-11 Positron Emission Tomography/Magnetic Resonance Imaging Enhances Discriminatory Power of Multi-Parametric Prostate Magnetic Resonance Imaging

Positron emission tomography/computed tomography-guided percutaneous trans-pararectal space prostate biopsy for the diagnosis of prostate cancer: A retrospective study

Evaluation of tumor recurrences after radical prostatectomy using 18F-Choline PET/CT and 3T multiparametric MRI without endorectal coil: a single center experience

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