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Diffusion-weighted MRI, 11C-choline PET and 18F-fluorodeoxyglucose PET for predicting the Gleason score in prostate carcinoma



To evaluate the accuracy of transrectal ultrasound-guided (TRUS) biopsy, diffusion-weighted (DW) magnetic resonance imaging (MRI), 11C-choline (CHOL) positron emission tomography (PET), and 18F-fluorodeoxyglucose (FDG) PET in predicting the prostatectomy Gleason risk (GR).


The study included 21 patients who underwent TRUS biopsy and multi-technique imaging before radical prostatectomy. Values from five different tests (TRUS biopsy, DW MRI, CHOL PET, FDG PET, and combined DW MRI/CHOL PET) were correlated with the prostatectomy GR using Spearman’s ρ. Tests that were found to have significant correlations were used to classify patients into GR groups.


The following tests had significant correlations with prostatectomy GR: TRUS biopsy (ρ = 0.617, P = 0.003), DW MRI (ρ = –0.601, P = 0.004), and combined DW MRI/CHOL PET (ρ = –0.623, P = 0.003). CHOL PET alone and FDG PET only had weak correlations. The correct GR classification rates were 67 % with TRUS biopsy, 67 % with DW MRI, and 76 % with combined DW MRI/CHOL PET.


DW MRI and combined DW MRI/CHOL PET have significant correlations and high rates of correct classification of the prostatectomy GR, the strength and accuracy of which are comparable with TRUS biopsy.

Key Points

Accurate determination of the Gleason score is essential for prostate cancer management.

DW MRI ± CHOL PET correlated significantly with prostatectomy Gleason score.

These correlations are similar to that between TRUS biopsy and prostatectomy.

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This study was supported by grant 487916 through Cancer Australia, Prostate Cancer Foundation Australia, Australian Government Department of Health and Aging. IDD was an Australian National Health and Medical Research Council Practitioner Fellow (487907). The authors gratefully acknowledge the contributions of Graham Hepworth from the Statistical Consulting Centre, University of Melbourne and the staff of the Radiation Oncology Centre, PET Centre and Department of Radiology, Austin Health.

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Correspondence to Ian D. Davis.

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Chang, J.H., Lim Joon, D., Lee, S.T. et al. Diffusion-weighted MRI, 11C-choline PET and 18F-fluorodeoxyglucose PET for predicting the Gleason score in prostate carcinoma. Eur Radiol 24, 715–722 (2014).

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  • Diffusion magnetic resonance imaging
  • Positron-emission tomography
  • Prostate cancer
  • Gleason grading