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68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study

  • Oncology
  • Published:
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Abstract

Objectives

To determine the diagnostic accuracy of 68gallium prostate-specific membrane antigen (PSMA)-based positron emission tomography/computed tomography (PET/CT) in comparison with 18F-fluoride-based PET/CT (NaF-PET/CT) and whole-body magnetic resonance imaging (WB-MRI) for the detection of bone metastases in patients with prostate cancer.

Methods

Sixty patients with prostate cancer were included in the period May 2016 to June 2017. The participants underwent three scans (index tests) within 30 days: a NaF-PET/CT, a WB-MRI and a PSMA-PET/CT. Experienced specialists assessed the scans. In the absence of a histological reference standard, the final diagnosis was determined as a panel diagnosis. Measures of the diagnostic performances of the index tests were calculated from patient-based dichotomous outcomes (0 or ≥ 1 bone metastasis) and pairwise compared (McNemar test). For each index test, the agreement with the final diagnosis with regard to the number of bone metastases detected (0, 1–5, > 5) and the inter-reader agreement was calculated (kappa coefficients).

Results

Fifty-five patients constituted the final study population; 20 patients (36%) were classified as having bone metastatic disease as their final diagnosis. The patient-based diagnostic performances were (sensitivity, specificity, overall accuracy) PSMA-PET/CT (100%, 100%, 100%), NaF-PET/CT (95%, 97%, 96%) and WB-MRI (80%, 83%, 82%). The overall accuracy of PSMA-PET/CT was significantly more favourable compared to WB-MRI (p = 0.004), but not to NaF-PET/CT (p = 0.48). PSMA-PET/CT classified the number of bone metastases reliably compared to the final diagnosis (kappa coefficient 0.97) and with an “almost perfect” inter-reader agreement (kappa coefficient 0.93).

Conclusions

The overall accuracy of PSMA-PET/CT was significantly more advantageous compared to WB-MRI, but not to NaF-PET/CT.

Key Points

• PSMA-PET/CT assessed the presence of bone metastases correctly in all 55 patients

• PSMA-PET/CT was more advantageous compared to WB-MRI

• No difference was found between PSMA-PET/CT and NaF-PET/CT

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Abbreviations

ADC:

Apparent diffusion coefficient

ADT:

Androgen deprivation therapy

BVC:

Best valuable comparator

CT:

Computed tomography

DWI:

Diffusion-weighted images

eGFR:

Estimated glomerular filtration rate

HBED-CC:

N,N′-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N′-diacetic acid

MRI:

Magnetic resonance imaging

NaF:

Sodium fluoride

PET:

Positron emission tomography

PSA:

Prostate-specific antigen

PSMA:

Prostate-specific membrane antigen

SPECT:

Single-photon emission computed tomography

STARD:

Standards for Reporting of Diagnostic Accuracy Studies

STIR:

Short-T1 inversion recovery

T1w:

T1-weighted

WB:

Whole-body

95%CI:

95% confidence interval

18F:

Fluoride-18

68Ga:

Gallium-68

68Ge:

Germanium-68

177Lu:

Lutetium-177

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Funding

This study has received funding by the University of Copenhagen and from Poul Lundbeck and Wife’s Foundation for the Promotion of Radiology in Denmark.

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Authors and Affiliations

  1. Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, DK-2730, Herlev, Denmark

    Eva Dyrberg, Vibeke B. Løgager & Henrik S. Thomsen

  2. Department of Clinical Physiology and Nuclear Medicine, PET and Cyclotron, Copenhagen University Hospital Herlev and Gentofte, DK-2730, Herlev, Denmark

    Eva Dyrberg, Helle W. Hendel, Tri Hien Viet Huynh, Claus Madsen & Maria Pedersen

  3. Department of Hematology, Copenhagen University Hospital Herlev and Gentofte, DK-2730, Herlev, Denmark

    Tobias Wirenfeldt Klausen

  4. Department of Radiology, Aarhus University Hospital, DK-8000, Aarhus C, Denmark

    Erik M. Pedersen

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  1. Eva Dyrberg
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Corresponding author

Correspondence to Eva Dyrberg.

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Guarantor

The scientific guarantor of this publication is Eva Dyrberg.

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

Tobias W. Klausen and Stig S. Mortensen kindly provided statistical advice for this manuscript.

Informed consent

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

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Dyrberg, E., Hendel, H.W., Huynh, T.H.V. et al. 68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study. Eur Radiol 29, 1221–1230 (2019). https://doi.org/10.1007/s00330-018-5682-x

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  • DOI: https://doi.org/10.1007/s00330-018-5682-x

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