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Value of fused 18F-Choline-PET/MRI to evaluate prostate cancer relapse in patients showing biochemical recurrence after EBRT: preliminary results.

Piccardo A, Paparo F, Picazzo R, Naseri M, Ricci P, Marziano A, Bacigalupo L, Biscaldi E, Rollandi GA, Grillo-Ruggieri F, Farsad M - Biomed Res Int (2014)

Bottom Line: In terms of DR the only significant difference was between (18)F-Choline-PET/MRI and CeCT.Accuracy, sensitivity, and NPV of (18)F-Choline-PET/MRI were significantly higher than those of both mMRI and CeCT.On whole-body assessment of bone metastases, the sensitivity of (18)F-Choline-PET/CT and (18)F-Fluoride-PET/CT was significantly higher than that of CeCT.

View Article: PubMed Central - PubMed

Affiliation: Nuclear Medicine Department, E.O. Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.

ABSTRACT

Purpose: We compared the accuracy of (18)F-Choline-PET/MRI with that of multiparametric MRI (mMRI), (18)F-Choline-PET/CT, (18)F-Fluoride-PET/CT, and contrast-enhanced CT (CeCT) in detecting relapse in patients with suspected relapse of prostate cancer (PC) after external beam radiotherapy (EBRT). We assessed the association between standard uptake value (SUV) and apparent diffusion coefficient (ADC).

Methods: We evaluated 21 patients with biochemical relapse after EBRT. Patients underwent (18)F-Choline-PET/contrast-enhanced (Ce)CT, (18)F-Fluoride-PET/CT, and mMRI. Imaging coregistration of PET and mMRI was performed.

Results: (18)F-Choline-PET/MRI was positive in 18/21 patients, with a detection rate (DR) of 86%. DRs of (18)F-Choline-PET/CT, CeCT, and mMRI were 76%, 43%, and 81%, respectively. In terms of DR the only significant difference was between (18)F-Choline-PET/MRI and CeCT. On lesion-based analysis, the accuracy of (18)F-Choline-PET/MRI, (18)F-Choline-PET/CT, CeCT, and mMRI was 99%, 95%, 70%, and 85%, respectively. Accuracy, sensitivity, and NPV of (18)F-Choline-PET/MRI were significantly higher than those of both mMRI and CeCT. On whole-body assessment of bone metastases, the sensitivity of (18)F-Choline-PET/CT and (18)F-Fluoride-PET/CT was significantly higher than that of CeCT. Regarding local and lymph node relapse, we found a significant inverse correlation between ADC and SUV-max.

Conclusion: (18)F-Choline-PET/MRI is a promising technique in detecting PC relapse.

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Related in: MedlinePlus

72-year-old man with biopsy-proven local PC recurrence after EBRT. T2-weighted axial image (a) demonstrates a hypointense focal area close to the midline (arrow). The ADC map (b) demonstrates that the nodular area (arrow) has significantly lower ADC values than the surrounding parenchyma. The wash-in perfusion map (c) shows a high wash-in rate (arrow). On the 18F-Choline-PET/CT axial image (d) a doubtful PET-positive focus (arrow) is appreciable, while the lesion is not detectable on CeCT axial image (e). Fused 18F-Choline-PET/MRI image (f) demonstrates precise correspondence between PET-positive focus and MRI finding (arrow).
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fig1: 72-year-old man with biopsy-proven local PC recurrence after EBRT. T2-weighted axial image (a) demonstrates a hypointense focal area close to the midline (arrow). The ADC map (b) demonstrates that the nodular area (arrow) has significantly lower ADC values than the surrounding parenchyma. The wash-in perfusion map (c) shows a high wash-in rate (arrow). On the 18F-Choline-PET/CT axial image (d) a doubtful PET-positive focus (arrow) is appreciable, while the lesion is not detectable on CeCT axial image (e). Fused 18F-Choline-PET/MRI image (f) demonstrates precise correspondence between PET-positive focus and MRI finding (arrow).

Mentions: The accuracy, sensitivity, and NPV of fused 18F-Choline-PET/MRI were significantly higher than those of both mMRI (P < 0.05) and CeCT (P < 0.05). No differences in terms of specificity (P > 0.05) and PPV (P > 0.05) were observed between the different diagnostic modalities. A lesion-based analysis to determine the sensitivity of each modality in detecting recurrent lesions according to different anatomical locations (i.e., local recurrence, lymph nodes, and bone metastases) was also performed; these results are summarized in Table 3. 18F-Choline-PET/MRI was more useful in detecting local relapse, identifying more local recurrences (6/6, 100%), than 18F-Choline-PET/CT (4/6, 67%). Two cases of local recurrence are illustrated in Figures 1 and 2. However, the statistical difference between these two modalities was not significant, owing to the low number of local recurrences (P = 0.45). Fused 18F-Choline-PET/MRI showed significantly higher sensitivity in locating lymph node metastases than mMRI (P = 0.0002) and CeCT (P < 0.0001). One case is illustrated in Figure 3. On the other hand, multimodality fusion 18F-Choline-PET/MRI and 18F-Choline-PET/CT detected the same number of lymph node metastases. With regard to whole-body assessment, we compared 18F-Choline-PET/CT, CeCT, and 18F-Fluoride-PET/CT in terms of their ability to detect bone metastases. Two cases of skeletal metastases are illustrated in Figures 4 and 5. The data regarding sensitivity are summarized in Table 4.


Value of fused 18F-Choline-PET/MRI to evaluate prostate cancer relapse in patients showing biochemical recurrence after EBRT: preliminary results.

Piccardo A, Paparo F, Picazzo R, Naseri M, Ricci P, Marziano A, Bacigalupo L, Biscaldi E, Rollandi GA, Grillo-Ruggieri F, Farsad M - Biomed Res Int (2014)

72-year-old man with biopsy-proven local PC recurrence after EBRT. T2-weighted axial image (a) demonstrates a hypointense focal area close to the midline (arrow). The ADC map (b) demonstrates that the nodular area (arrow) has significantly lower ADC values than the surrounding parenchyma. The wash-in perfusion map (c) shows a high wash-in rate (arrow). On the 18F-Choline-PET/CT axial image (d) a doubtful PET-positive focus (arrow) is appreciable, while the lesion is not detectable on CeCT axial image (e). Fused 18F-Choline-PET/MRI image (f) demonstrates precise correspondence between PET-positive focus and MRI finding (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4022120&req=5

fig1: 72-year-old man with biopsy-proven local PC recurrence after EBRT. T2-weighted axial image (a) demonstrates a hypointense focal area close to the midline (arrow). The ADC map (b) demonstrates that the nodular area (arrow) has significantly lower ADC values than the surrounding parenchyma. The wash-in perfusion map (c) shows a high wash-in rate (arrow). On the 18F-Choline-PET/CT axial image (d) a doubtful PET-positive focus (arrow) is appreciable, while the lesion is not detectable on CeCT axial image (e). Fused 18F-Choline-PET/MRI image (f) demonstrates precise correspondence between PET-positive focus and MRI finding (arrow).
Mentions: The accuracy, sensitivity, and NPV of fused 18F-Choline-PET/MRI were significantly higher than those of both mMRI (P < 0.05) and CeCT (P < 0.05). No differences in terms of specificity (P > 0.05) and PPV (P > 0.05) were observed between the different diagnostic modalities. A lesion-based analysis to determine the sensitivity of each modality in detecting recurrent lesions according to different anatomical locations (i.e., local recurrence, lymph nodes, and bone metastases) was also performed; these results are summarized in Table 3. 18F-Choline-PET/MRI was more useful in detecting local relapse, identifying more local recurrences (6/6, 100%), than 18F-Choline-PET/CT (4/6, 67%). Two cases of local recurrence are illustrated in Figures 1 and 2. However, the statistical difference between these two modalities was not significant, owing to the low number of local recurrences (P = 0.45). Fused 18F-Choline-PET/MRI showed significantly higher sensitivity in locating lymph node metastases than mMRI (P = 0.0002) and CeCT (P < 0.0001). One case is illustrated in Figure 3. On the other hand, multimodality fusion 18F-Choline-PET/MRI and 18F-Choline-PET/CT detected the same number of lymph node metastases. With regard to whole-body assessment, we compared 18F-Choline-PET/CT, CeCT, and 18F-Fluoride-PET/CT in terms of their ability to detect bone metastases. Two cases of skeletal metastases are illustrated in Figures 4 and 5. The data regarding sensitivity are summarized in Table 4.

Bottom Line: In terms of DR the only significant difference was between (18)F-Choline-PET/MRI and CeCT.Accuracy, sensitivity, and NPV of (18)F-Choline-PET/MRI were significantly higher than those of both mMRI and CeCT.On whole-body assessment of bone metastases, the sensitivity of (18)F-Choline-PET/CT and (18)F-Fluoride-PET/CT was significantly higher than that of CeCT.

View Article: PubMed Central - PubMed

Affiliation: Nuclear Medicine Department, E.O. Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.

ABSTRACT

Purpose: We compared the accuracy of (18)F-Choline-PET/MRI with that of multiparametric MRI (mMRI), (18)F-Choline-PET/CT, (18)F-Fluoride-PET/CT, and contrast-enhanced CT (CeCT) in detecting relapse in patients with suspected relapse of prostate cancer (PC) after external beam radiotherapy (EBRT). We assessed the association between standard uptake value (SUV) and apparent diffusion coefficient (ADC).

Methods: We evaluated 21 patients with biochemical relapse after EBRT. Patients underwent (18)F-Choline-PET/contrast-enhanced (Ce)CT, (18)F-Fluoride-PET/CT, and mMRI. Imaging coregistration of PET and mMRI was performed.

Results: (18)F-Choline-PET/MRI was positive in 18/21 patients, with a detection rate (DR) of 86%. DRs of (18)F-Choline-PET/CT, CeCT, and mMRI were 76%, 43%, and 81%, respectively. In terms of DR the only significant difference was between (18)F-Choline-PET/MRI and CeCT. On lesion-based analysis, the accuracy of (18)F-Choline-PET/MRI, (18)F-Choline-PET/CT, CeCT, and mMRI was 99%, 95%, 70%, and 85%, respectively. Accuracy, sensitivity, and NPV of (18)F-Choline-PET/MRI were significantly higher than those of both mMRI and CeCT. On whole-body assessment of bone metastases, the sensitivity of (18)F-Choline-PET/CT and (18)F-Fluoride-PET/CT was significantly higher than that of CeCT. Regarding local and lymph node relapse, we found a significant inverse correlation between ADC and SUV-max.

Conclusion: (18)F-Choline-PET/MRI is a promising technique in detecting PC relapse.

Show MeSH
Related in: MedlinePlus