Abstract
PurposeTo compare the detection efficacy of 11C-choline positron emission tomography and computed tomography (PET/CT) with whole-body magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) in patients with suspected recurrent prostate cancer.Materials and MethodsFifty-seven patients (mean age 68, range 54-80 years) underwent 11C-choline PET/CT and MRI using T1-weighted (T1w), short-tau inversion recovery (STIR), and DWI. Two readers visually rated suspicious lesions on a 5-point scale in 20 different regions. Clinical follow-up and histopathology served as the standard of reference (SOR).ResultsFifty patients (mean PSA 29.9, range 1.0-670 ng/mL) had at least one positive lesion according to the SOR. Twenty-four patients had local recurrence (LR), 27 had lymph node (LN) involvement, and 22 had bone metastases. The overall detection rates for PET/CT and MRI on a patient basis were 94% and 88%, respectively (p = 0.07). The PSA level (>2 ng/mL vs ≤2 ng/mL) significantly influenced the overall performance of PET/CT (p = 0.003) and MRI (p = 0.03). PET/CT was significantly superior to MRI in detecting LR (p = 0.03) and bone metastasis (p = 0.02). We found no difference with respect to the detection of LN metastasis (p = 0.65).Conclusion11C-choline PET/CT was superior in the detection of local recurrence and bone metastasis on a regional basis. Whole-body MRI including DWI showed similar diagnostic accuracy only for detecting lymph node metastases. Compared with 11C-choline PET/CT, therefore, whole-body MRI including DWI cannot serve as alternative imaging modality for restaging prostate cancer.
Highlights
Prostate cancer is the third most common cause of death from cancer in men (9.5%) in Europe and is associated with a high rate of recurrence [1]
performed in combination with computed tomography (PET/CT) was significantly superior to magnetic resonance imaging (MRI) in detecting local recurrence (LR) (p = 0.03) and bone metastasis (p = 0.02)
We found no difference with respect to the detection of lymph node (LN) metastasis (p = 0.65)
Summary
Prostate cancer is the third most common cause of death from cancer in men (9.5%) in Europe and is associated with a high rate of recurrence [1]. Positron emission tomography (PET) using 11C-choline has been shown to be promising in both staging and follow-up of patients with prostate cancer [4, 5]. PET is usually performed in combination with computed tomography (PET/CT), which provides a comprehensive anatomical and molecular whole-body survey in a single imaging session [6]. In the case of recurrent prostate cancer, combining the two modalities facilitates the anatomical localization of PET-positive findings [7]. C11-cholin fails to identify a positive lesion in a substantial number of cases, especially in patients with PSA values lower than 2 ng/mL. Initial PET studies using Prostate-specific membrane antigen ligands (e.g. 68Ga-PSMA HBED-CC) recently achieved superior detection rates compared to 11C-choline even at low PSA [8]
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