Performance of 18F-fluciclovine PET/MR in the evaluation of osseous metastases from castration-resistant prostate cancer

  • Barbara J. Amorim
  • Vinay Prabhu
  • Sara S. Marco
  • Debra Gervais
  • Willian E. Palmer
  • Pedram Heidari
  • Mark Vangel
  • Philip J. Saylor
  • Onofrio A. CatalanoEmail author
Original Article
Part of the following topical collections:
  1. Oncology – Genitourinary



18F-Fluciclovine is indicated for evaluation of suspected prostate cancer (PCa) biochemical recurrence. There are few studies investigating fluciclovine with PET/MR and none evaluated osseous metastases. Our aim was to assess the performance of 18F-fluciclovine PET/MR (fluciclovine-PET/MR) for detecting osseous metastases in patients with castration-resistant prostate cancer (CRPC). We also investigated possible correlations between SUVmax and ADCmean.


We evaluated 8 patients with CRPC metastatic to bones, some before and some after radium therapy, who underwent 13 fluciclovine-PET/MR studies. We analyzed the performance of radionuclide bone scan (RBS), MR alone, fluciclovine-PET alone, and fluciclovine-PET/MR in detecting osseous metastases. Lesion size, characteristics (early sclerotic, late sclerotic, mixed, lytic), SUVmax, and ADCmean were assessed. The reference standard was a combination of clinical information and correlation with both prior and follow-up imaging.


Of 347 metastatic bony lesions in 13 studies, 238/347 (68%) were detected by fluciclovine-PET alone, 286/347 (82%) by RBS, 344/347 (99%) by MR alone, and 347/347 (100%) by fluciclovine-PET/MR. Fluciclovine-PET/MR and MR had the best performance (p < 0.001). There was no statistically significant difference between fluciclovine-PET/MR and MR alone (p = 0.25). Fluciclovine-PET had a lower detection rate especially with late sclerotic lesions (p < 0.001). There was a moderate inverse correlation between lesion SUVmax and ADCmean (r = − 0.49; p < 0.001).


This study suggests that fluciclovine-PET/MR and MR have high sensitivity for detecting osseous metastases in CRPC. Fluciclovine-PET alone underperformed in detecting late sclerotic lesions. The inverse correlation between SUVmax and ADCmean suggests a possible relationship between tumor metabolism and cellularity.


PET/MR Fluciclovine Prostate cancer Osseous metastases 


Funding information

This study was financially supported by grant funding from Bayer and by provision of fluciclovine dosing from Blue Earth Diagnostics.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by our local Institutional Review Board and all patients signed written, informed consent.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Martinos Center for Biomedical Imaging, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Division of Nuclear MedicineState University of Campinas (UNICAMP)CampinasBrazil
  4. 4.Division of Nuclear MedicinePuerta de Hierro University HospitalMadridSpain
  5. 5.Biostatistics Center, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  6. 6.Massachusetts General Hospital Cancer CenterHarvard Medical SchoolBostonUSA
  7. 7.Department of RadiologyUniversity of Naples “Parthenope”NaplesItaly

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