Abstract
Accurate assessment of lymph node (LN) metastases in prostate cancer (PCa) patients is critical for prognosis and patient management. Both prostate-specific membrane antigen (PSMA) PET/CT and ferumoxtran-10 nanoparticle-enhanced MRI (nano-MRI) are imaging modalities with high potential to identify LN metastases in PCa patients. The aim of this study was to compare the results of these imaging technologies in terms of characteristics and anatomic localization of suspicious LNs in order to assess the feasibility of their complementary use for imaging in PCa patients. Methods: In total, 45 patients with either primary PCa (n = 8) or recurrence (n = 36) were included in this retrospective study. All patients underwent both 68Ga-PSMA PET/CT and nano-MRI between October 2015 and July 2017 within 3 wk. Both scans were performed at the same institution according to local clinical protocols. All scans were analyzed independently by experienced nuclear medicine physicians and radiologists. The size, anatomic location, and level of suspicion were determined for all visible LNs. Subsequently, the findings from 68Ga-PSMA PET/CT and nano-MRI were compared without respect to a reference standard. Results: In total, 179 suspicious LNs were identified. Significantly more suspicious LNs per patient were detected by nano-MRI (P < 0.001): 160 were identified in 33 patients by nano-MRI, versus 71 in 25 patients by 68Ga-PSMA PET/CT. Of all suspicious LNs, 108 were identified only by nano-MRI (60%), 19 (11%) only by 68Ga-PSMA PET/CT, and 52 (29%) by both methods. The mean size of the suspicious LNs as identified by nano-MRI was significantly smaller (5.3 mm) than that by 68Ga-PSMA PET/CT (6.0 mm; P = 0.006). The median level of suspicion did not differ significantly. Both modalities identified suspicious LNs in all anatomic regions of the pelvis. Conclusion: Both modalities identified suspicious LNs that were missed by the other. Both modalities identified suspicious LNs in all anatomic regions of the pelvis; however, nano-MRI appeared to be superior in detecting smaller suspicious LNs. These findings suggest that nano-MRI has a potential role as a complement to PSMA PET/CT. However, since the clinical implications of the different results are not well established yet, further investigation of this complementary use is encouraged.
Highlights
Detecting lymph node (LN) metastases in prostate cancer (PCa) patients is critical for prognosis and patient management
Previous research demonstrated that in a substantial number of patients (60%–85%), LN metastases were located outside the extended pelvic LN dissection (PLND) template [2,3,4], illustrating the demand and increasing role for noninvasive imaging techniques to detect LN metastases in PCa patients
Since conventional imaging techniques—that is, CT and MRI— use only morphologic criteria for LN assessment, and in PCa more than 60% of LN metastases are present in normal-sized LNs (,8 mm), these techniques are of limited value in LN staging [5,6], leading to the development of advanced functional and molecular imaging techniques
Summary
Detecting lymph node (LN) metastases in prostate cancer (PCa) patients is critical for prognosis and patient management. In nanoMRI, ultra-small superparamagnetic iron oxide particles (ferumoxtran-10 [Ferrotran; SPL Medical BV]) are used as a contrast agent Through accumulation of these particles in normal lymphatic tissue after intravenous drip infusion, nano-MRI allows differentiation of metastatic LNs from benign LNs, irrespective of nodal size [5,12]. Published data suggest that PSMA PET/CT and nano-MRI are the imaging modalities with the highest reported accuracy to detect LN metastases [9,14,15]. Since both modalities rely on different technical and biologic features, it was hypothesized that a combined use could even improve LN detection. The goal of this study was to investigate the feasibility of a potential complementary role for these imaging modalities by comparing their results in the same patient and identifying differences and similarities in detected LN characteristics without respect to a reference standard
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