Prostate-Specific Membrane Antigen PET for Assessment of Primary and Recurrent Prostate Cancer with Histopathology as Reference Standard

Hernes, Eivor; Revheim, Mona-Elisabeth; Hole, Knut Håkon; Tulipan, Andreas Julius; Strømme, Hilde; Lilleby, Wolfgang; Seierstad, Therese

doi:10.1016/j.cpet.2020.12.001

Cited by 6 publications

(9 citation statements)

References 105 publications

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“…Sensitivity is hindered by the spatial resolution of PET/CT of 4–5 mm, 14 which makes it difficult to detect small LNMs. In concordance, PET-positive LNMs are reported larger (median, 4.0–13.6 mm) than false PET-negative LNMs (median, 2.5–5.0 mm) 15 . Although the sensitivity of PSMA-PET/CT is not yet sufficient to completely replace ePLND for nodal staging, the negative predictive value seems sufficient to safely omit this procedure in men with a low risk of nodal involvement 13 …”

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confidence: 73%

“…In concordance, PET-positive LNMs are reported larger (median, 4.0-13.6 mm) than false PET-negative LNMs (median, 2.5-5.0 mm). 15 Although the sensitivity of PSMA-PET/CT is not yet sufficient to completely replace ePLND for nodal staging, the negative predictive value seems sufficient to safely omit this procedure in men with a low risk of nodal involvement. 13 Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) is another noninvasive functional imaging technique.…”

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confidence: 99%

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The Potential of Iron Oxide Nanoparticle-Enhanced MRI at 7 T Compared With 3 T for Detecting Small Suspicious Lymph Nodes in Patients With Prostate Cancer

Tenbergen,

Fortuin,

van Asten

et al. 2023

Invest Radiol

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Background Accurate detection of lymph node (LN) metastases in prostate cancer (PCa) is a challenging but crucial step for disease staging. Ultrasmall superparamagnetic iron oxide (USPIO)–enhanced magnetic resonance imaging (MRI) enables distinction between healthy LNs and nodes suspicious for harboring metastases. When combined with MRI at an ultra-high magnetic field, an unprecedented spatial resolution can be exploited to visualize these LNs. Purpose The aim of this study was to explore USPIO-enhanced MRI at 7 T in comparison to 3 T for the detection of small suspicious LNs in the same cohort of patients with PCa. Materials and Methods Twenty PCa patients with high-risk primary or recurrent disease were referred to our hospital for an investigational USPIO-enhanced 3 T MRI examination with ferumoxtran-10. With consent, they underwent a 7 T MRI on the same day. Three-dimensional anatomical and T2*-weighted images of both examinations were evaluated blinded, with an interval, by 2 readers who annotated LNs suspicious for metastases. Number, size, and level of suspicion (LoS) of LNs were paired within patients and compared between field strengths. Results At 7 T, both readers annotated significantly more LNs compared with 3 T (474 and 284 vs 344 and 162), with 116 suspicious LNs on 7 T (range, 1–34 per patient) and 79 suspicious LNs on 3 T (range, 1–14 per patient) in 17 patients. For suspicious LNs, the median short axis diameter was 2.6 mm on 7 T (1.3–9.5 mm) and 2.8 mm for 3 T (1.7–10.4 mm, P = 0.05), with large overlap in short axis of annotated LNs between LoS groups. At 7 T, significantly more suspicious LNs had a short axis <2.5 mm compared with 3 T (44% vs 27%). Magnetic resonance imaging at 7 T provided better image quality and structure delineation and a higher LoS score for suspicious nodes. Conclusions In the same cohort of patients with PCa, more and more small LNs were detected on 7 T USPIO-enhanced MRI compared with 3 T MRI. Suspicious LNs are generally very small, and increased nodal size was not a good indication of suspicion for the presence of metastases. The high spatial resolution of USPIO-enhanced MRI at 7 T improves structure delineation and the visibility of very small suspicious LNs, potentially expanding the in vivo detection limits of pelvic LN metastases in PCa patients.

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confidence: 73%

mentioning

confidence: 99%

The Potential of Iron Oxide Nanoparticle-Enhanced MRI at 7 T Compared With 3 T for Detecting Small Suspicious Lymph Nodes in Patients With Prostate Cancer

Tenbergen,

Fortuin,

van Asten

et al. 2023

Invest Radiol

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“…The median interval between USPIO administration and ePLND was 46 hours (interquartile range [IQR], 46-51). The median time between 111 In-PSMA-I&T administration and ex vivo μSPECT imaging was 28 hours (IQR, [26][27][28][29][30][31]. No adverse events occurred during the administration of ferumoxtran-10 or 111 In-PSMA-I&T.…”

Section: Resultsmentioning

confidence: 99%

“…26 This is also why true PET-positive nodal metastases (median, 4.0-13.6 mm) are on average larger than false PET-negative metastases (median, 2.5-5.0 mm). 27 The detection limit of USPIO-MRI is determined by the spatial resolution of the 3-dimensional MRI, which is 0.8-mm isotropic, resulting in the detection of many small suspicious nodes with short-axis diameter <3 mm LNs. For these small LNs, histopathological evaluation is difficult and time-consuming.…”

Section: Discussionmentioning

confidence: 99%

Subnodal Correspondence of PSMA Expression and USPIO-MRI in Metastatic Pelvic Lymph Nodes in Prostate Cancer

Schilham,

Somford,

Veltien

et al. 2023

Invest Radiol

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Objectives Two advanced imaging modalities used to detect lymph node (LN) metastases in prostate cancer patients are prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography and ultrasmall superparamagnetic iron oxide (USPIO)–enhanced magnetic resonance imaging (MRI). As these modalities use different targets, a subnodal comparison is needed to interpret both their correspondence and their differences. The aim of this explorative study was to compare ex vivo 111In-PSMA μSPECT images with high-resolution 7 T USPIO μMR images and histopathology of resected LN specimens from prostate cancer patients to assess the degree of correspondence at subnodal level. Materials and Methods Twenty primary prostate cancer patients who underwent pelvic LN dissection were included and received USPIO contrast and 111In-PSMA. A total of 41 LNs of interest (LNOIs) were selected for ex vivo imaging based on γ-probe detection or palpation. μSPECT and μMRI acquisition were performed immediately after resection. Overlay of μSPECT images on MR images was performed, and the level of correspondence (LoC) between μSPECT and μMR findings was assessed according to a 4-point Likert classification scheme. Results Forty-one LNOIs could be matched to an LN on ex vivo μMRI. Coregistration of μSPECT and USPIO-enhanced water-selective multigradient echo MR images was successful for all 41 LNOIs. Ninety percent of the lesions showed excellent correspondence regarding the presence of metastatic tissue and affected subnodal site (LoC 4; 37/41). In only 1 of 41 LNOIs, a small metastasis was misclassified by both techniques. Three LNOIs were classified as LoC 3 (7%) and 1 LNOI as LoC 2. All LoC 2 and LoC 3 lesions had PSMA-expressing metastases on final histopathology Conclusions Coregistration of μSPECT and USPIO-μMRI showed excellent subnodal correspondence in the majority (90%) of LNs. Ex vivo imaging may thus help localize small cancer deposits within resected LNs and could contribute to improved interpretation of in vivo imaging of LNs.

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“…Radiolabeled ligands to prostate-specific membrane antigen (PSMA) have revolutionized imaging of patients with suspected recurrence of prostate cancer (PC) after initial radical therapy [1]. Using state of the art tracers such as [ 18 F]PSMA-1007, recurrences in the prostate bed and metastases to pelvic lymph nodes as well as other sites can be readily identified, allowing for re-operation or external beam radiotherapy [2,3,4,5]. In addition, radiopeptide therapy with [ 117 Lu]PSMA-617 and other PSMA ligands is available as a systemic treatment option, which has been shown to improve survival in a recent prospective randomized trial in 813 patients with castration-resistant PC [6].…”

Section: Introductionmentioning

confidence: 99%

Enhancing PSMA-PET/CT with intravenous contrast: Improved tracer clearance in the prostate bed

et al. 2022

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Aims We observed hitherto unreported layering of radioactivity in the bladder on PET/CT in prostate cancer (PC) when combined with contrast-enhanced CT (CECT). This effect facilitates assessment of the prostate bed in PC. Methods Among 128 patients imaged with [18F]PSMA-1007, we selected all 8 studies without and 28 studies with CECT. 20 patients also underwent PET/MR. As controls, we chose 20 and 16 males studied with [18F]FDG for extrapelvic disease with and without CECT. Posterior anterior (PA) ratio was calculated as SUVpost/SUVant * 100 % based on maximal standard uptake values (SUV) in 20 mm spheres in the anterior and posterior bladder. Four nuclear physicians scored assessibility of the bladder base on a 3-point Likert scale (3 = optimal, 1 = poor). We acquired serial PET/CT over 4 hours of a flask with layering of 100 ml intravenous contrast agent and 100 ml physiological saline with 40 MBq of [18F]PSMA-1007, while a control flask was shaken at the start of the experiment. Results Layering of tracer was observed in all PET/CT studies with CE-CT, but not in studies without contrast. Median PA ratios were 44 % (interquartile range 33–62) for [18F]PSMA-1007 and 73 % (52–67) for [18F]FDG, respectively. Intravenous contrast improved assessibility scores in PET of the bladder base, but the effect only reached significance in the PET/MR data. In the in vitro data, radioactivity was retained in the aqueous supernatant over the entire experiment whereas there was no separation of phases in the control flask over time. Conclusion When performing PET combined with CECT, sedimentation of contrast agent in the bladder leads to upward displacement of radioactivity, enhancing clarity of PET images in the posterior bladder and the prostate bed on both PET/CT and PET/MR.

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Prostate-Specific Membrane Antigen PET for Assessment of Primary and Recurrent Prostate Cancer with Histopathology as Reference Standard

Cited by 6 publications

References 105 publications

The Potential of Iron Oxide Nanoparticle-Enhanced MRI at 7 T Compared With 3 T for Detecting Small Suspicious Lymph Nodes in Patients With Prostate Cancer

The Potential of Iron Oxide Nanoparticle-Enhanced MRI at 7 T Compared With 3 T for Detecting Small Suspicious Lymph Nodes in Patients With Prostate Cancer

Subnodal Correspondence of PSMA Expression and USPIO-MRI in Metastatic Pelvic Lymph Nodes in Prostate Cancer

Enhancing PSMA-PET/CT with intravenous contrast: Improved tracer clearance in the prostate bed

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