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Does 11C-choline PET-CT contribute to multiparametric MRI for prostate cancer localisation?

Trägt 11C-Cholin-PET-CT zur multiparametrischen MR-Bildgebung zur Lokalisierung von Prostatakrebs bei?

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Abstract

Background and purpose

The aim of this work was to determine whether 11C-choline positron emission tomography (PET)–computed tomography (CT) makes a positive contribution to multiparametric magnetic resonance imaging (MRI) for localisation of intraprostatic tumour nodules.

Patients and methods

A total of 73 patients with biopsy-proven intermediate- and high-risk prostate cancer were enrolled in a prospective imaging study consisting of T2-weighted (T2w), dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI and 11C-choline PET-CT before radical prostatectomy. Cancerous regions were delineated on the whole-mount prostatectomy sections and on the different MRI modalities and analysed in 24 segments per patient (3 sections, 8 segments each). To analyse PET-CT images, standardized uptake values (SUV) were calculated per segment.

Results

In total, 1,752 segments were analyzed of which 708 (40.4 %) were found to be malignant. A high specificity (94.7, 93.6 and 92.2 %) but relatively low sensitivity (31.2, 24.9 and 44.1 %) for tumour localisation was obtained with T2w, DCE and DW MRI, respectively. Sensitivity values significantly increased when combining all MRI modalities (57.2 %). For PET-CT, mean SUVmax of malignant octants was significantly higher than mean SUVmax of benign octants (3.68 ± 1.30 vs. 3.12 ± 1.02, p < 0.0001). In terms of accuracy, the benefit of adding PET-CT to (multiparametric) MRI was less than 1 %.

Conclusion

The additional value of 11C-choline PET-CT to MRI in localising intraprostatic tumour nodules is limited, especially when multiparametric MRI is used.

Zusammenfassung

Hintergrund und Ziel

Es galt festzustellen, ob die 11C-Cholin-Positronenemissionstomographie-Computertomographie (11C-Cholin-PET-CT) bei der multiparametrischen Magnetresonanztomographie (MR) für die Lokalisierung von intraprostatischen Tumorknoten einen Mehrwert darstellt.

Patienten und Methodik

Insgesamt 73 Patienten mit durch Biopsie nachgewiesenem Prostatakarzinom von mittlerem und hohem Risiko nahmen an einer prospektiven bildgebenden Studie, bestehend aus T2-gewichteter (T2w), dynamischen Kontrast- (DCE) und diffusionsgewichteter (DW) MR und 11C-Cholin-PET-CT vor radikaler Prostatektomie, teil. Krebsartige Regionen wurden auf den „Whole-mount“-Prostatektomieschnitten und auf den verschiedenen MR-Modalitäten abgegrenzt. Pro Patient wurden 24 Segmente analysiert (3 Schnitte mit jeweils 8 Segmenten). Um PET-CT-Bilder zu analysieren, wurden standardisierte Uptake-Values (SUV) pro Segment berechnet.

Ergebnisse

Insgesamt wurden 1752 Segmente analysiert, wovon 708 (40,4 %) als bösartig klassifiziert wurden. Mit T2w, DCE und DW-MR wurde jeweils eine hohe Spezifität (94,7%, 93,6% und 92,2 %) aber eine relativ geringe Sensitivität (31,2%, 24,9% und 44,1 %) für die Tumorlokalisation erzielt. Die Sensitivität nahm bei der Kombination aller MR-Modalitäten (57,2 %) signifikant zu. Für die PET-CT war der mittlere SUVmax von malignen Oktanten signifikant höher als der mittlere SUVmax von gutartigen Oktanten (3,68 ± 1,30 vs. 3,12 ± 1,02; p < 0,0001). Hinsichtlich der Genauigkeit betrug der zusätzliche Nutzen der PET-CT zur (multiparametrischen) MR weniger als 1 %.

Schlussfolgerung

Der Mehrwert von 11C-Cholin-PET-CT bei der MR zur Lokalisierung von intraprostatischen Tumorknoten ist begrenzt, vor allem bei der Verwendung von multiparametrischer MR.

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Acknowledgment

This work was supported through a research grant of IWT (Institute for the Promotion of Innovation by Science and Technology in Flanders; IWT TBM 060793), The National Cancer Plan 29–Belgium and by the “Stichting Emmanuel van der Schueren—VLK”.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospitals Leuven, campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    L. Van den Bergh, S. Isebaert & K. Haustermans

  2. Department of Nuclear Medicine, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    M. Koole & C.M. Deroose

  3. Department of Radiology, University Hospitals Leuven, campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    R. Oyen & F. De Keyzer

  4. Department of Urology, University Hospitals Leuven, campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    S. Joniau & H. Van Poppel

  5. Department of Histopathology, University Hospitals Leuven, campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    E. Lerut

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  1. L. Van den Bergh
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  2. S. Isebaert
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  3. M. Koole
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Correspondence to L. Van den Bergh.

Additional information

Van den Bergh Laura and Isebaert Sofie contributed equally to the work.

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Van den Bergh, L., Isebaert, S., Koole, M. et al. Does 11C-choline PET-CT contribute to multiparametric MRI for prostate cancer localisation?. Strahlenther Onkol 189, 789–795 (2013). https://doi.org/10.1007/s00066-013-0359-5

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  • DOI: https://doi.org/10.1007/s00066-013-0359-5

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