Combined PET imaging and diffusion-weighted imaging of intermediate and high-risk primary prostate carcinomas with simultaneous [18F] choline PET/MRI (original) (raw)
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The Prostate, 2015
Index lesion characterization is important in the evaluation of primary prostate carcinoma (PPC). The aim of this study was to analyze the contribution of (11) C-Choline PET/CT and the Apparent Diffusion Coefficient maps (ADC) in detecting the Index Lesion and clinically significant tumors in PPC. Twenty-one untreated patients with biopsy-proven PPC and candidates for radical prostatectomy (RP) were prospectively evaluated by means of Ultra-High Definition PET/CT and 3T MRI, which included T2-weighted imaging (T2WI) and ADC maps obtained from diffusion weighted imaging (DWI). Independent experts analyzed all the images separately and were unaware of the pathological data. In each case, the Index lesion was defined as the largest tumor measured on histopathology (Index H). In addition, the largest lesion observed on MRI (Index MRI) and the highest avid (11) C-Choline uptake lesion (Index PET) were obtained. The Gleason scores (GS) of the tumors were determined. PET/CT and ADC map qua...
Journal of Pharmacy and Pharmacology 7 (2017) 391-400, 2017
Purpose: The aim of this study was to determine whether PET (positron emission tomography) imaging parameters from simultaneous 11 C-choline PET/MRI (magnetic resonance imaging) could be used to characterize primary prostate cancer. Methods: Forty-six patients with biopsy-proven high-risk prostate cancer (clinical T stage ≥ cT2c, a Gleason score ≥ 8, or PSA (prostate-specific antigen) level > 20 ng/mL) were prospectively enrolled. A SUV (standardized uptake value) histogram analysis including maximum SUV, mean SUV, SUV variance, SUV entropy, MTV (metabolic tumor volume), and UVP (uptake volume product) was applied for the calculation of PET imaging parameters. Correlations between the PSA level and Gleason score were then evaluated. Results: Maximum SUV, mean SUV, MTV, UVP, and SUV variance were significantly correlated with PSA level, whereas SUV variance was the only parameter negatively correlated with the Gleason score. Multivariate logistic regression analysis demonstrated that MTV and PSA level at diagnosis were independent predictors of positive distant metastasis status. Conclusions: PET imaging parameters from simultaneous 11 C-choline PET/MRI were correlated with PSA level. However, 11 C-choline metabolic tumor heterogeneity was not associated with biospecimen-derived Gleason scores in prostate cancer. To apply PET texture quantification analysis to prostate cancer, a more specific PET radiotracer is required.
Molecular Imaging and Biology, 2011
Purpose: 11 C-Choline-positron emission tomography (PET)/computed tomography (CT) is increasingly used in patients with prostate cancer. Another promising technique for assessment of tumor biology is diffusion-weighted MR imaging (DWI). The aim of the study was to compare the functional parameters standardized uptake value (SUV) in PET and apparent diffusion coefficient (ADC) value in DWI of lymph nodes in prostate cancer patients. Procedures: Fourteen patients with prostate cancer underwent DWI at 1.5T and 11 C-Choline-PET/CT. ADC values and SUVs of all lymph nodes larger than 5 mm (n=55) were compared by using linear regression analysis. Performance of DWI and 11 C-Choline PET was assessed by receiver operator characteristic curve analysis using histopathology or clinical follow-up as standard of reference. Results: ADC values and SUV showed a moderate but highly significant inverse correlation (r=−0.5144, pG0.0001). In lymph nodes with low ADC values, the dispersion of SUV was more pronounced. Moreover, a highly significant difference was observed for mean ADC values and SUV in lymph nodes considered as benign or malignant by follow-up/histopathology (ADC 1.60±0.24 vs. 1.09±0.23×10 −3 mm 2 /s; SUV 1.82±0.57 vs. 4.68±03.12; pG0.0001, respectively). Conclusion: These pilot data propose the ADC value in DWI as a new potential imaging biomarker which might provide additional information on tumor pathophysiology compared to the SUV in 11 C-Choline PET/CT.
Molecular Imaging and Radionuclide Therapy
Objectives: Gallium-68 (Ga-68) prostate specific membrane antigen (PSMA) positron emission tomography (PET) has been shown to be more accurate than multiparametric prostate magnetic resonance imaging (MRI) in detection of primary prostate lesions. Using hybrid PET/MRI we aim to detect the correlation between SUV max and apparent diffusion coefficient (ADC) in primary prostate lesions and to assess their prognostic value in detection of lymph node (LN) metastasis. Methods: Twenty-six patients, who were diagnosed as having prostate cancer with biopsy and underwent Ga-68 PSMA PET/MRI together with biparametric prostate MRI (bpMRI) were included. SUV max , SUV mean and ADC were recorded for index lesions drawing a region of interest (ROI) of 1 cm 2 around the pixel with the highest SUV max (ROI-1) and another ROI following borders of prostate tumor detected by bpMRI (ROI-2). Presence of LN metastasis was recorded according to PSMA PET/MRI. Results: SUV max was inversely correlated with ADC (ROI-1: p=0.010; ROI-2: p=0.017 for b=800). SUV max and SUV means were both higher in patients with LN metastasis and ADC was lower in patients with LN metastasis for ROI-1. SUV max cutoff value of 19.8 for ROI-1 and 20.9 for ROI-2 had sensitivity and specificity of 77.8% and 76.5%, respectively for detection of LN metastasis, whereas ADC (b=800) cutoff value of 0.92x10-3 mm 2 /s had sensitivity and specificity of 87.5% and 76.5%, respectively. SUV max /ADC (b=800) ratio increased the sensitivity and specificity to 100% and 82.4%, respectively. Conclusion: SUV and ADC values are inversely correlated in primary prostate lesions and the combined use of both values increases the diagnostic accuracy of hybrid PET/MRI in the detection of primary prostate lesions.
Advances in Molecular Imaging, 2016
Introduction: [ 18 F]-fluoro-methylcholine (FCH) PET/CT and MRI with diffusion-weighted MRI (DW-MRI) have insufficient performance in lymph node staging of primary prostate cancer by themselves, but the combination may perform better. We aim to prospectively determine the diagnostic performance of combined FCH PET and MRI for lymph node staging. Methods: This was a single site study of diagnostic accuracy in a well-defined group of 21 consecutive high-risk primary prostate cancer patients (>30% chance of lymph node metastases) in a large community hospital. We performed FCH PET/CT and MRI with DW-MRI prior to endoscopic extended pelvic lymph node dissection (EPLND). PET was fused and interpreted together with various MRI image sets (T1, T2, DWIBS) and was only scored positive when a lymph node seen on MRI coincided with increased focal FCH uptake on PET. Findings were compared with detailed histological evaluation, on a per-patient and per-region level. We calculated sensitivity, specificity, positive and negative predictive value of combined PET-MRI. Results: 14 out of 21 patients had metastatic lymph nodes with 37 out of 164 evaluable regions harboring metastases. On a per-patient analysis, PET-MRI had a sensitivity/specificity of 79/100% with a PPV/NPV of 100/77%. On a per-region analysis (n = 164) these figure were 65/99% and 96/91%, respectively. Conclusions: Combined DW-MRI and FCH PET/CT has a very high positive predictive value in high risk prostate cancer patients. If confirmed in larger series a positive combined scan may safely allow cancellation of surgical staging
2008
Purpose The accuracy of positron emission tomography (PET)/CT with [ 11 C]choline for the detection of prostate cancer is not well established. We assessed the dependence of [ 11 C]choline maximum standardized uptake values (SUV max ) in the prostate gland on cell malignancy, prostate-specific antigen (PSA) levels, Gleason score, tumour stage and anti-androgenic hormonal therapy. Methods In this prospective study, PET/CT with [ 11 C] choline was performed in 19 prostate cancer patients who subsequently underwent prostatectomy with histologic sextant analysis (group A) and in six prostate cancer patients before and after anti-androgenic hormonal therapy (bicalutamide 150 mg/day; median treatment of 4 months; group B). Results In group A, based on a sextant analysis with a [ 11 C]choline SUV max cutoff of 2.5 (as derived from a receiver-operating characteristic analysis), PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 72, 43, 64, 51 and 60%, respectively. In the patient-by-patient analysis, no significant correlation was detected between SUV max and PSA levels, Gleason score or pathological stage. On the contrary, a significant (P<0.05) negative correlation was detected between SUV max and anti-androgenic therapy both in univariate (r 2 =0.24) and multivariate (r 2 =0.48) analyses. Prostate [ 11 C]choline uptake after bicalutamide therapy significantly (P<0.05) decreased compared to baseline (6.4±4.6 and 11.8±5.3, respectively; group B). Conclusion PET/CT with [ 11 C]choline is not suitable for the initial diagnosis and local staging of prostate cancer. PET/CT with [ 11 C]choline could be used to monitor the response to anti-androgenic therapy.
Comparison of integrated whole-body [11C]choline PET/MR with PET/CT in patients with prostate cancer
2013
Purpose To evaluate the performance of conventional [ 11 C]choline PET/CT in comparison to that of simultaneous whole-body PET/MR. Methods The study population comprised 32 patients with prostate cancer who underwent a single-injection dualimaging protocol with PET/CT and subsequent PET/MR. PET/CT scans were performed applying standard clinical protocols (5 min after injection of 793±69 MBq [ 11 C]choline, 3 min per bed position, intravenous contrast agent). Subsequently (52±15 min after injection) PET/MR was performed (4 min per bed position). PET images were reconstructed iteratively (OSEM 3D), scatter and attenuation correction of emission data and regional allocation of [ 11 C]choline foci were performed using CT data for PET/CT and segmented Dixon MR, T1 and T2 sequences for PET/MR. Image quality of the respective PET scans and PET alignment with the respective morphological imaging modality were compared using a four point scale (0-3).
BioMed Research International, 2014
Purpose. (1) To evaluate a new acquisition protocol of18F-choline (FCH) PET/CT for prostate cancer patients (PC), (2) to review acquisition18F-choline PET/CT methodology, and (3) to propose a standardized acquisition protocol on FCH PET/CT in PC patients.Materials. 100 consecutive PC patients (mean age 70.5 years, mean PSA 21.35 ng/mL) were prospectively evaluated. New protocol consisted of an early scan of the pelvis immediately after the injection of the tracer (1 bed position of 4 min) followed by a whole body scan at one 1 hour. Early and 1 hour images were compared for interfering activity and pathologic findings.Results. The overall detection rate of FCH PET/CT was 64%. The early static images of the pelvis showed absence of radioactive urine in ureters, bladder, or urethra which allowed a clean evaluation of the prostatic fossae. Uptake in the prostatic region was better visualized in the early phase in 26% (7/30) of cases. Other pelvic pathologic findings (bone and lymph nod...