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18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

An Editorial Comment to this article was published on 01 June 2018

Abstract

Objective

To investigate the diagnostic potential of simultaneous 18F-fluciclovine PET/MRI for pelvic lymph node (LN) staging in patients with high-risk prostate cancer.

Methods

High-risk prostate cancer patients (n=28) underwent simultaneous 18F-fluciclovine PET/MRI prior to surgery. LNs were removed according to a predefined template of eight regions. PET and MR images were evaluated for presence of LN metastases according to these regions. Sensitivity/specificity for detection of LN metastases were calculated on patient and region basis. Sizes of LN metastases in regions with positive and negative imaging findings were compared with linear mixed models. Clinical parameters of PET-positive and -negative stage N1 patients were compared with the Mann-Whitney U test.

Results

Patient- and region-based sensitivity/specificity for detection of pelvic LN metastases was 40 %/87.5 % and 35 %/95.7 %, respectively, for MRI and 40 %/100 % and 30 %/100 %, respectively, for PET. LN metastases in true-positive regions were significantly larger than metastases in false-negative regions. PET-positive stage N1 patients had higher metastatic burden than PET-negative N1 patients.

Conclusion

Simultaneous 18F-fluciclovine PET/MRI provides high specificity but low sensitivity for detection of LN metastases in high-risk prostate cancer patients. 18F-Fluciclovine PET/MRI scan positive for LN metastases indicates higher metastatic burden than negative scan.

Key Points

• 18F-Fluciclovine PET/MRI has high specificity for detection of lymph node metastasis.

• 18F-Fluciclovine PET/MRI lacks sensitivity to replace ePLND.

• 18F-Fluciclovine PET/MRI may be used to aid surgery and select adjuvant therapy.

• 18F-Fluciclovine PET-positive patients have more extensive disease than PET-negative patients.

• Size of metastatic lymph nodes is an important factor for detection.

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Abbreviations

AC:

Attenuation correction

BP1:

Bed position 1

BP2:

Bed position 2

CT:

Computed tomography

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

ePLND:

Extended pelvic LN dissection

FN:

False negative

FP:

False positive

GS:

Gleason score

ITD:

Index tumour diameter

LN:

Lymph node

MRI:

Magnetic resonance imaging

MRSI:

Magnetic resonance spectroscopic imaging

NPV:

Negative predictive value

PET:

Positron emission tomography

PPV:

Positive-predictive value

PRESS:

Point RESolved Spectroscopy

RARP:

Robot-assisted radical prostatectomy

SPACE:

Sampling perfection with application-optimized contrasts using different flip angle evolution

SS-EPI:

Single-shot echo planar imaging

T1W:

T1-weighted

T2W:

T2-weighted

TE:

Echo time

TN:

True negative

TP:

True positive

TR:

Repetition time

TSE:

Turbo spin cho

VIBE:

Volume interpolated gradient echo

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Author information

Author notes

  1. Kirsten M. Selnæs and Brage Krüger-Stokke contributed equally to this work.

Authors and Affiliations

  1. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Post box 8905, MTFS, 7491, Trondheim, Norway

    Kirsten M. Selnæs, Brage Krüger-Stokke, Mattijs Elschot, Elise Sandsmark, Siver A. Moestue, May-Britt Tessem & Tone F. Bathen

  2. Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Kirsten M. Selnæs, Brage Krüger-Stokke & Sverre Langørgen

  3. Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway

    Frode Willoch

  4. Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Øystein Størkersen

  5. Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Dag Halvorsen, Eirik Kjøbli & Helena Bertilsson

  6. Urologiklinikken AS, Nøtterøy, Norway

    Anders Angelsen

  7. Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, Norway

    Helena Bertilsson

Authors
  1. Kirsten M. Selnæs
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Corresponding author

Correspondence to Kirsten M. Selnæs.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Tone F. Bathen, NTNU – Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study has received funding by ‘The Norwegian Cancer Society’ and ‘The Liaison Committee between the Central Norway Regional Health Authority (RHA) and NTNU’.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Elschot, M., et al., A PET/MRI study towards finding the optimal [18F]Fluciclovine PET protocol for detection and characterisation of primary prostate cancer. Eur J Nucl Med Mol Imaging, 2017

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Selnæs, K.M., Krüger-Stokke, B., Elschot, M. et al. 18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients. Eur Radiol 28, 3151–3159 (2018). https://doi.org/10.1007/s00330-017-5213-1

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  • DOI: https://doi.org/10.1007/s00330-017-5213-1

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