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Prospective head-to-head comparison of 11C-choline-PET/MR and 11C-choline-PET/CT for restaging of biochemical recurrent prostate cancer.
Eur J Nucl Med Mol Imaging. 2017 Dec; 44(13):2179-2188.EJ

Abstract

PURPOSE

Whole-body integrated 11C-choline PET/MR might provide advantages compared to 11C-choline PET/CT for restaging of prostate cancer (PC) due to the high soft-tissue contrast and the use of multiparametric MRI, especially for detection of local recurrence and bone metastases.

MATERIALS AND METHODS

Ninety-four patients with recurrent PC underwent a single-injection/dual-imaging protocol with contrast-enhanced PET/CT followed by fully diagnostic PET/MR. Imaging datasets were read separately by two reader teams (team 1 and 2) assessing the presence of local recurrence, lymph node and bone metastases in predefined regions using a five-point scale. Detection rates were calculated. The diagnostic performance of PET/CT vs. PET/MR was compared using ROC analysis. Inter-observer and inter-modality variability, radiation exposure, and mean imaging time were evaluated. Clinical follow-up, imaging, and/or histopathology served as standard of reference (SOR).

RESULTS

Seventy-five patients qualified for the final image analysis. A total of 188 regions were regarded as positive: local recurrence in 37 patients, 87 regions with lymph node metastases, and 64 regions with bone metastases. Mean detection rate between both readers teams for PET/MR was 84.7% compared to 77.3% for PET/CT (p > 0.05). Local recurrence was identified significantly more often in PET/MR compared to PET/CT by team 1. Lymph node and bone metastases were identified significantly more often in PET/CT compared to PET/MR by both teams. However, this difference was not present in the subgroup of patients with PSA values ≤2 ng/ml. Inter-modality and inter-observer agreement (K > 0.6) was moderate to substantial for nearly all categories. Mean reduction of radiation exposure for PET/MR compared to PET/CT was 79.7% (range, 72.6-86.2%). Mean imaging time for PET/CT was substantially lower (18.4 ± 0.7 min) compared to PET/MR (50.4 ± 7.9 min).

CONCLUSIONS

11C-choline PET/MR is a robust imaging modality for restaging biochemical recurrent PC and interpretations between different readers are consistent. It provides a higher diagnostic value for detecting local recurrence compared to PET/CT with the advantage of substantial dose reduction. Drawbacks of PET/MR are a substantially longer imaging time and a slight inferiority in detecting bone and lymph node metastases in patients with PSA values >2 ng/ml. Thus, we suggest the use of 11C-choline PET/MR especially for patients with low (≤2 ng/ml) PSA values, whereas PET/CT is preferable in the subgroup with higher PSA values.

Authors+Show Affiliations

Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany. Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, USA.Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany. isabel.rauscher@tum.de.Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.Department of Urology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.Department of Radiology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany. Department of Nuclear Medicine, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

28803358

Citation

Eiber, Matthias, et al. "Prospective Head-to-head Comparison of 11C-choline-PET/MR and 11C-choline-PET/CT for Restaging of Biochemical Recurrent Prostate Cancer." European Journal of Nuclear Medicine and Molecular Imaging, vol. 44, no. 13, 2017, pp. 2179-2188.
Eiber M, Rauscher I, Souvatzoglou M, et al. Prospective head-to-head comparison of 11C-choline-PET/MR and 11C-choline-PET/CT for restaging of biochemical recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2017;44(13):2179-2188.
Eiber, M., Rauscher, I., Souvatzoglou, M., Maurer, T., Schwaiger, M., Holzapfel, K., & Beer, A. J. (2017). Prospective head-to-head comparison of 11C-choline-PET/MR and 11C-choline-PET/CT for restaging of biochemical recurrent prostate cancer. European Journal of Nuclear Medicine and Molecular Imaging, 44(13), 2179-2188. https://doi.org/10.1007/s00259-017-3797-y
Eiber M, et al. Prospective Head-to-head Comparison of 11C-choline-PET/MR and 11C-choline-PET/CT for Restaging of Biochemical Recurrent Prostate Cancer. Eur J Nucl Med Mol Imaging. 2017;44(13):2179-2188. PubMed PMID: 28803358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective head-to-head comparison of 11C-choline-PET/MR and 11C-choline-PET/CT for restaging of biochemical recurrent prostate cancer. AU - Eiber,Matthias, AU - Rauscher,Isabel, AU - Souvatzoglou,Michael, AU - Maurer,Tobias, AU - Schwaiger,Markus, AU - Holzapfel,Konstantin, AU - Beer,Ambros J, Y1 - 2017/08/12/ PY - 2017/04/10/received PY - 2017/07/27/accepted PY - 2017/8/15/pubmed PY - 2018/6/14/medline PY - 2017/8/14/entrez KW - Biochemical recurrence KW - Hybrid imaging KW - Prostate cancer SP - 2179 EP - 2188 JF - European journal of nuclear medicine and molecular imaging JO - Eur. J. Nucl. Med. Mol. Imaging VL - 44 IS - 13 N2 - PURPOSE: Whole-body integrated 11C-choline PET/MR might provide advantages compared to 11C-choline PET/CT for restaging of prostate cancer (PC) due to the high soft-tissue contrast and the use of multiparametric MRI, especially for detection of local recurrence and bone metastases. MATERIALS AND METHODS: Ninety-four patients with recurrent PC underwent a single-injection/dual-imaging protocol with contrast-enhanced PET/CT followed by fully diagnostic PET/MR. Imaging datasets were read separately by two reader teams (team 1 and 2) assessing the presence of local recurrence, lymph node and bone metastases in predefined regions using a five-point scale. Detection rates were calculated. The diagnostic performance of PET/CT vs. PET/MR was compared using ROC analysis. Inter-observer and inter-modality variability, radiation exposure, and mean imaging time were evaluated. Clinical follow-up, imaging, and/or histopathology served as standard of reference (SOR). RESULTS: Seventy-five patients qualified for the final image analysis. A total of 188 regions were regarded as positive: local recurrence in 37 patients, 87 regions with lymph node metastases, and 64 regions with bone metastases. Mean detection rate between both readers teams for PET/MR was 84.7% compared to 77.3% for PET/CT (p > 0.05). Local recurrence was identified significantly more often in PET/MR compared to PET/CT by team 1. Lymph node and bone metastases were identified significantly more often in PET/CT compared to PET/MR by both teams. However, this difference was not present in the subgroup of patients with PSA values ≤2 ng/ml. Inter-modality and inter-observer agreement (K > 0.6) was moderate to substantial for nearly all categories. Mean reduction of radiation exposure for PET/MR compared to PET/CT was 79.7% (range, 72.6-86.2%). Mean imaging time for PET/CT was substantially lower (18.4 ± 0.7 min) compared to PET/MR (50.4 ± 7.9 min). CONCLUSIONS: 11C-choline PET/MR is a robust imaging modality for restaging biochemical recurrent PC and interpretations between different readers are consistent. It provides a higher diagnostic value for detecting local recurrence compared to PET/CT with the advantage of substantial dose reduction. Drawbacks of PET/MR are a substantially longer imaging time and a slight inferiority in detecting bone and lymph node metastases in patients with PSA values >2 ng/ml. Thus, we suggest the use of 11C-choline PET/MR especially for patients with low (≤2 ng/ml) PSA values, whereas PET/CT is preferable in the subgroup with higher PSA values. SN - 1619-7089 UR - https://www.unboundmedicine.com/medline/citation/28803358/Prospective_head_to_head_comparison_of_11C_choline_PET/MR_and_11C_choline_PET/CT_for_restaging_of_biochemical_recurrent_prostate_cancer_ L2 - https://dx.doi.org/10.1007/s00259-017-3797-y DB - PRIME DP - Unbound Medicine ER -