Advertisement

European Radiology

, Volume 30, Issue 1, pp 328–336 | Cite as

Comparison between pelvic PSMA-PET/MR and whole-body PSMA-PET/CT for the initial evaluation of prostate cancer: a proof of concept study

  • Liran Domachevsky
  • Hanna Bernstine
  • Natalia Goldberg
  • Meital Nidam
  • Onofrio A. Catalano
  • David GrosharEmail author
Magnetic Resonance
  • 110 Downloads

Abstract

Objectives

Despite the advantages of prostate-specific membrane antigen (PSMA)-PET/MR over PSMA-PET/CT, its relatively long scanning time and suboptimal PET attenuation correction necessitate careful assessment of the most appropriate setting for this type of study. We assessed lesion agreement between PSMA-PET/MR and PSMA-PET/CT in patients undergoing initial evaluation of prostate cancer.

Methods

This was a prospective study of consecutive patients with histological biopsy-proven prostate cancer who underwent pelvic PSMA-PET/MR followed by whole-body PSMA-PET/CT. All conspicuous PSMA-avid foci were counted on PSMA-PET/CT and PSMA-PET/MR with CT or MR correlation. Analysis was performed for intra-prostatic lesions, capsular invasion, seminal vesicle involvement and lymph node and bone involvement. Incidental and significant findings seen on PSMA-PET/CT outside the PSMA-PET/MR field of view were also analysed. Agreements between PSMA-PET/CT and PSMA-PET/MR findings were performed using Cohen’s kappa test.

Results

Image analysis was performed on 140 patients (mean age, 67.3 ± 8.2 years). Agreement between PSMA PET/CT and PSMA-PET/MR was very good for intra-prostatic PSMA-avid foci (K = 0.85) and pelvic lymph nodes (K = 0.98), good for PSMA-avid bone metastases (K = 0.76) and fair for prostatic capsular invasion (K = 0.25) and seminal vesicle involvement (K = 0.31). Twelve patients (8.5%) had incidental findings and two patients (1.4%) had clinically significant findings.

Conclusion

Limited pelvic PSMA-PET/MR has very good agreement with PET/CT regarding PSMA-avid prostatic, regional lymph nodes and bone lesions, and is superior to PET/CT with regard to capsular invasion and seminal vesicle involvement.

Key Points

• Limited pelvic PSMA-PET/MR is superior to whole-body PSMA-PET/CT in detecting extensions of localised disease, mainly due to the high soft tissue resolution of MR.

• Limited pelvic PSMA-PET/MR may be useful for initial evaluation of histological biopsy-proven prostate cancer.

• Further studies are warranted to evaluate limited pelvic PSMA-PET/MR for screening and active surveillance in selected populations.

Keywords

Prostate cancer Prostate-specific membrane antigen PET/MR PET/CT 

Abbreviations

18F

18-Fluorine

68Ga

68-Gallium

CI

Confidence interval

CT

Computed tomography

FOV

Field of view

GS

Gleason score

mp-MRI

Multi-parametric magnetic resonance imaging

MR

Magnetic resonance

OSEM

Ordered subset expectation maximisation

PET

Positron emission tomography

PI-RADS

Prostate Imaging-Reporting and Data System

PSMA

Prostate-specific membrane antigen

SE

Standard error

Notes

Acknowledgements

The authors acknowledge Zohar Nitsan, Inbal Machcat and Hagai Baruch for their excellent work in patient scanning, Dr. Limor Shaharabani-Gargir for patient management and Dr. Sharon Furman-Assaf for editing.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. David Groshar.

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.

Statistics and biometry

One of the authors (Meital Nidam) has significant statistical expertise.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

References

  1. 1.
    Rauscher I, Maurer T, Beer AJ et al (2016) Value of 68Ga-PSMA HBED-CC PET for the assessment of lymph node metastases in prostate cancer patients with biochemical recurrence: comparison with histopathology after salvage lymphadenectomy. J Nucl Med 57(11):1713–1719CrossRefGoogle Scholar
  2. 2.
    Eiber M, Maurer T, Souvatzoglou M et al (2015) Evaluation of hybrid (6)(8)Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 56(5):668–674CrossRefGoogle Scholar
  3. 3.
    Schwarzenboeck SM, Rauscher I, Bluemel C et al (2017) PSMA ligands for PET imaging of prostate cancer. J Nucl Med 58(10):1545–1552CrossRefGoogle Scholar
  4. 4.
    Maurer T, Gschwend JE, Rauscher I et al (2016) Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 195(5):1436–1443CrossRefGoogle Scholar
  5. 5.
    Pyka T, Okamoto S, Dahlbender M et al (2016) Comparison of bone scintigraphy and (68)Ga-PSMA PET for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging 43(12):2114–2121CrossRefGoogle Scholar
  6. 6.
    Giesel FL, Sterzing F, Schlemmer HP et al (2016) Intra-individual comparison of (68)Ga-PSMA-11-PET/CT and multi-parametric MR for imaging of primary prostate cancer. Eur J Nucl Med Mol Imaging 43(8):1400–1406CrossRefGoogle Scholar
  7. 7.
    Berger I, Annabattula C, Lewis J et al (2018) (68)Ga-PSMA PET/CT vs. mpMRI for locoregional prostate cancer staging: correlation with final histopathology. Prostate Cancer Prostatic Dis 21(2):204–211CrossRefGoogle Scholar
  8. 8.
    Park SY, Zacharias C, Harrison C et al (2018) Gallium 68 PSMA-11 PET/mr imaging in patients with intermediate- or high-risk prostate cancer. Radiology. 288(2):495–505CrossRefGoogle Scholar
  9. 9.
    Eiber M, Weirich G, Holzapfel K et al (2016) Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol 70(5):829–836CrossRefGoogle Scholar
  10. 10.
    Al-Bayati M, Grueneisen J, Lütje S et al (2018) Integrated 68gallium labelled prostate-specific membrane antigen-11 positron emission tomography/magnetic resonance imaging enhances discriminatory power of multi-parametric prostate magnetic resonance imaging. Urol Int 100(2):164–171CrossRefGoogle Scholar
  11. 11.
    Domachevsky L, Goldberg N, Bernstine H, Nidam M, Groshar D (2018) Quantitative characterisation of clinically significant intra-prostatic cancer by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11. Eur Radiol 28(12):5275–5283CrossRefGoogle Scholar
  12. 12.
    Öbek C, Doğanca T, Demirci E et al (2017) The accuracy of (68)Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer. Eur J Nucl Med Mol Imaging 44(11):1806–1812CrossRefGoogle Scholar
  13. 13.
    Freitag MT, Radtke JP, Hadaschik BA et al (2016) Comparison of hybrid (68)Ga-PSMA PET/MRI and (68)Ga-PSMA PET/CT in the evaluation of lymph node and bone metastases of prostate cancer. Eur J Nucl Med Mol Imaging 43(1):70–83CrossRefGoogle Scholar
  14. 14.
    Domachevsky L, Bernstine H, Goldberg N et al (2017) Early (68)GA-PSMA PET/MRI acquisition: assessment of lesion detectability and PET metrics in patients with prostate cancer undergoing same-day late PET/CT. Clin Radiol 72(11):944–950CrossRefGoogle Scholar
  15. 15.
    Thalgott M, Düwel C, Rauscher I et al (2018) One-stop shop whole-body (68)Ga-PSMA-11 PET/MRI compared to clinical nomograms for preoperative T- and N-staging of high-risk prostate cancer. J Nucl Med 59(12):1850–1856CrossRefGoogle Scholar
  16. 16.
    Verburg FA, Pfestroff A (2016) Imaging: PSMA PET-CT in initial prostate cancer staging. Nat Rev Urol 13(9):498–499CrossRefGoogle Scholar
  17. 17.
    Zhang Q, Zang S, Zhang C et al (2017) Comparison of (68)Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med 15(1):230CrossRefGoogle Scholar
  18. 18.
    Afshar-Oromieh A, Haberkorn U, Schlemmer HP et al (2014) Comparison of PET/CT and PET/MRI hybrid systems using a 68Ga-labelled PSMA ligand for the diagnosis of recurrent prostate cancer: initial experience. Eur J Nucl Med Mol Imaging 41(5):887–897CrossRefGoogle Scholar
  19. 19.
    Kabasakal L, Demirci E, Ocak M et al (2015) Evaluation of PSMA PET/CT imaging using a 68Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging. Nucl Med Commun 36(6):582–587CrossRefGoogle Scholar
  20. 20.
    Perveen G, Arora G, Damle NA et al (2018) Role of early dynamic positron emission tomography/computed tomography with 68Ga-prostate-specific membrane antigen-HBED-CC in patients with adenocarcinoma prostate: initial results. Indian J Nucl Med 33(2):112–117CrossRefGoogle Scholar
  21. 21.
    Uprimny C, Kroiss AS, Decristoforo C et al (2017) Early dynamic imaging in (68)Ga- PSMA-11 PET/CT allows discrimination of urinary bladder activity and prostate cancer lesions. Eur J Nucl Med Mol Imaging 44(5):765–775CrossRefGoogle Scholar
  22. 22.
    Hofman MS, Iravani A, Nzenza T, Murphy DG (2018) Advances in urologic imaging: prostate-specific membrane antigen ligand PET imaging. Urol Clin North Am 45(3):503–524CrossRefGoogle Scholar
  23. 23.
    Fendler WP, Schmidt DF, Wenter V et al (2016) 68Ga-PSMA PET/CT detects the location and extent of primary prostate cancer. J Nucl Med 57(11):1720–1725CrossRefGoogle Scholar
  24. 24.
    Muehlematter UJ, Rupp NJ, Mueller J, Eberli D, Burger IA (2018) 68Ga-PSMA PET/MR-positive, histopathology-proven prostate cancer in a patient with negative multiparametric prostate MRI. Clin Nucl Med 43(8):e282–e2e4CrossRefGoogle Scholar
  25. 25.
    Beheshti M, Paymani Z, Brilhante J et al (2018) Optimal time-point for (68)Ga-PSMA-11 PET/CT imaging in assessment of prostate cancer: feasibility of sterile cold-kit tracer preparation? Eur J Nucl Med Mol Imaging 45(7):1188–1196CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Nuclear MedicineAssuta Medical CentersTel AvivIsrael
  2. 2.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolCharlestownUSA

Personalised recommendations