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Prospective comparison of simultaneous [68Ga]Ga-PSMA-11 PET/MR versus PET/CT in patients with biochemically recurrent prostate cancer

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Abstract

Objectives

PSMA-PET has become the PET technique of choice to localise the site of biochemically recurrent prostate cancer (PCa). With hybrid PET/MRI, the advantages of MRI are added to molecular characteristic of PET. The aim of this study was to investigate the incremental value of PET/MR versus PET/CT in patients with biochemically recurrent PCa by head-to-head comparison.

Methods

Thirty-four patients with biochemically recurrent PCa were prospectively included. They underwent [68Ga]Ga-PSMA-11 PET/CT, followed by simultaneous PET/MR. All PET (PETCT, PETMR), CT and MR images were evaluated for number of lesions and location. The number of lesions at specific sites was compared using Wilcoxon-sign-rank test. For PET, the maximum and mean standardised uptake values (SUVs) were calculated for each lesion compared using a two-sided paired t test.

Results

PETCT and PETMR scans were positive in 19 and 20 patients, detecting 73 and 79 lesions respectively. All lesions detected on PETCT were also detected on PETMR. CT and MRI only were positive in 14 and 17 patients, detecting 38 and 50 lesions, respectively, which was significantly lower than PETCT and PETMR respectively. Combined interpretation showed more lesions on PET/MR than on PET/CT (88 vs 81). No significant difference in detection of presence of local recurrence nor distant metastases was found. SUVmean and SUVmax values were significantly higher on PETMR than on PETCT in local recurrence and lymph node metastases.

Conclusions

[68Ga]Ga-PSMA-11 PET/MR was able to detect biochemically recurrent PCa at least as accurately as PET/CT for local recurrence, lymph node metastasis and distant metastasis.

Key Points

• PSMA PET/MRI detects the location of biochemical recurrence at least as accurately as PET/CT.

• Substitution of PET/CT by PET/MRI adds sensitivity in PSMA lesion detection also in the setting of distant recurrence due to both the MR and TOF PET components.

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Abbreviations

AC:

Attenuation correction

DWI:

Diffusion-weighted imaging

ICC:

Intraclass correlation coefficient

LN:

Lymph nodes

MLEM:

Maximum likelihood estimation method

Non-SC:

Non-scatter corrected

PCa:

Prostate cancer

PET:

Positron emission tomography

PSMA:

Prostate specific membrane antigen

SC:

Scatter correction

SiPM:

Silicon photomultipliers

SUV:

Standardised uptake value

SUVmax:

Maximum standardised uptake value

SUVmean:

Mean standardised uptake value

ToF:

Time-of-flight

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Acknowledgements

The authors wish to thank the radiopharmacy production team, especially Dr. Apr. Bert Vanbilloen, and Mrs. Marva Bex, for the radiolabeling of [68Ga]Ga-PSMA-11. We also thank Mr. Kwinten Porters, Mr. Jef Van Loock, Mr. Guido Putseys, Mr. Stefan Ghysels and Mr. Kris Byloos for their skilled help in PET/MR scan acquisition and Prof. Kristof Baete and Mr. Wies Deckers for their skilled help in PET/CT scan acquisition.

Funding

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

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Authors and Affiliations

  1. Nuclear Medicine, UZ Leuven, Herestraat, 49 3000, Leuven, Belgium

    Sander Jentjens, Niloefar Ahmadi Bidakhvidi, Liesbeth De Coster, Koen Van Laere & Karolien Goffin

  2. Radiology, UZ Leuven, Leuven, Belgium

    Cindy Mai & Raymond Oyen

  3. Department of Imaging and Pathology, KU Leuven, Leuven, Belgium

    Nathalie Mertens, Michel Koole, Raymond Oyen, Koen Van Laere & Karolien Goffin

  4. Urology, UZ Leuven, Leuven, Belgium

    Wouter Everaerts & Steven Joniau

  5. Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Wouter Everaerts & Steven Joniau

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  1. Sander Jentjens
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  2. Cindy Mai
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Correspondence to Sander Jentjens.

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Guarantor

The scientific guarantor of this publication is Prof. Dr. Karolien Goffin, University Hospitals Leuven, Belgium.

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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

No complex statistical methods were necessary for this paper.

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

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Institutional Review Board approval was obtained

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• Prospective

• Cross sectional study

• Performed at one institution

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Koen Van Laere and Karolien Goffin are joint last authors.

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Jentjens, S., Mai, C., Ahmadi Bidakhvidi, N. et al. Prospective comparison of simultaneous [68Ga]Ga-PSMA-11 PET/MR versus PET/CT in patients with biochemically recurrent prostate cancer. Eur Radiol 32, 901–911 (2022). https://doi.org/10.1007/s00330-021-08140-0

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