Comparison of hybrid 68Ga-PSMA PET/MRI and 68Ga-PSMA PET/CT in the evaluation of lymph node and bone metastases of prostate cancer

  • Martin T. FreitagEmail author
  • Jan P. Radtke
  • Boris A. Hadaschik
  • A. Kopp-Schneider
  • Matthias Eder
  • Klaus Kopka
  • Uwe Haberkorn
  • Matthias Roethke
  • Heinz-Peter Schlemmer
  • Ali Afshar-Oromieh
Original Article



To evaluate the reproducibility of the combination of hybrid PET/MRI and the 68Ga-PSMA-11 tracer in depicting lymph node (LN) and bone metastases of prostate cancer (PC) in comparison with that of PET/CT.

Materials and methods

A retrospective analysis of 26 patients who were subjected to 68Ga-PSMA PET/CTlow-dose (1 h after injection) followed by PET/MRI (3 h after injection) was performed. MRI sequences included T1-w native, T1-w contrast-enhanced, T2-w fat-saturated and diffusion-weighted sequences (DWIb800). Discordant PET-positive and morphological findings were evaluated. Standardized uptake values (SUV) of PET-positive LNs and bone lesions were quantified and their morphological size and conspicuity determined.


Comparing the PET components, the proportion of discordant PSMA-positive suspicious findings was very low (98.5 % of 64 LNs concordant, 100 % of 28 bone lesions concordant). Two PET-positive bone metastases could not be confirmed morphologically using CTlow-dose, but could be confirmed using MRI. In 12 of 20 patients, 47 PET-positive LNs (71.9 %) were smaller than 1 cm in short axis diameter. There were significant linear correlations between PET/MRI SUVs and PET/CT SUVs in the 64 LN metastases (p < 0.0001) and in the 28 osseous metastases (p < 0.0001) for SUVmean and SUVmax, respectively. The LN SUVs were significantly higher on PET/MRI than on PET/CT (p SUVmax < 0.0001; p SUVmean < 0.0001) but there was no significant difference between the bone lesion SUVs (p SUVmax = 0.495; p SUVmean = 0.381). Visibility of LNs was significantly higher on MRI using the T1-w contrast-enhanced fat-saturated sequence (p = 0.013), the T2-w fat-saturated sequence (p < 0.0001) and the DWI sequence (p < 0.0001) compared with CTlow-dose. For bone lesions, only the overall conspicuity was higher on MRI compared with CTlow-dose (p < 0.006).


Nodal and osseous metastases of PC are accurately and reliably depicted by hybrid PET/MRI using 68Ga-PSMA-11 with very low discordance compared with PET/CT including PET-positive LNs of normal size. The correlation between PET/MRI SUVs and PET/CT SUVs was linear in LN and bone metastases but was significantly lower in control (non-metastatic) tissue.


68Ga-PSMA PSMA PET/MRI PET/CT Lymph node metastases Bone metastases 



We are grateful to our technicians Regula Gnirs, Gabi Kühnemund, Heike Streib-Retzbach and Rene Hertel for their excellent support.

Compliance with ethical standards


U.H. was supported by a grant from the Klaus Tschira Foundation (grant number 00.198.2012). M.T.F. was supported by a grant from the Deutsche Forschungsgesellschaft (DFG, grant number LA 2804/1-3).

Conflicts of interest

H.P.S., M.R. and A.A.-O. have received honoraria from Siemens Healthcare for educational talks and workshops. M.T.F., J.P.R., B.A.H., A.K.-S., M.E., K.K. and U.H. declare no conflicts of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study has been approved as a retrospective study by the local ethics committee of Heidelberg (S-485/2012).

The article does not describe any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Martin T. Freitag
    • 1
    Email author
  • Jan P. Radtke
    • 1
    • 2
  • Boris A. Hadaschik
    • 2
  • A. Kopp-Schneider
    • 3
  • Matthias Eder
    • 4
  • Klaus Kopka
    • 4
  • Uwe Haberkorn
    • 5
    • 6
  • Matthias Roethke
    • 1
  • Heinz-Peter Schlemmer
    • 1
  • Ali Afshar-Oromieh
    • 5
  1. 1.Department of RadiologyGerman Cancer Research CenterHeidelbergGermany
  2. 2.Department of UrologyUniversity Hospital HeidelbergHeidelbergGermany
  3. 3.Department of Bioinformatics and StatisticsGerman Cancer Research CenterHeidelbergGermany
  4. 4.Division of Radiopharmaceutical ChemistryGerman Cancer Research CenterHeidelbergGermany
  5. 5.Department of Nuclear MedicineUniversity Hospital HeidelbergHeidelbergGermany
  6. 6.Clinical Cooperation Unit Nuclear MedicineGerman Cancer Research CenterHeidelbergGermany

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