Martin T Freitag1, Jan P Radtke2,3, Boris A Hadaschik3, A Kopp-Schneider4, Matthias Eder5, Klaus Kopka5, Uwe Haberkorn6,7, Matthias Roethke2, Heinz-Peter Schlemmer2, Ali Afshar-Oromieh6. 1. Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany. m.freitag@dkfz.de. 2. Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany. 3. Department of Urology, University Hospital Heidelberg, Heidelberg, Germany. 4. Department of Bioinformatics and Statistics, German Cancer Research Center, Heidelberg, Germany. 5. Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany. 6. Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany. 7. Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany.
Abstract
PURPOSE: To evaluate the reproducibility of the combination of hybrid PET/MRI and the (68)Ga-PSMA-11 tracer in depicting lymph node (LN) and bone metastases of prostate cancer (PC) in comparison with that of PET/CT. MATERIALS AND METHODS: A retrospective analysis of 26 patients who were subjected to (68)Ga-PSMA PET/CTlow-dose (1 h after injection) followed by PET/MRI (3 h after injection) was performed. MRI sequences included T1-w native, T1-w contrast-enhanced, T2-w fat-saturated and diffusion-weighted sequences (DWIb800). Discordant PET-positive and morphological findings were evaluated. Standardized uptake values (SUV) of PET-positive LNs and bone lesions were quantified and their morphological size and conspicuity determined. RESULTS: Comparing the PET components, the proportion of discordant PSMA-positive suspicious findings was very low (98.5 % of 64 LNs concordant, 100 % of 28 bone lesions concordant). Two PET-positive bone metastases could not be confirmed morphologically using CTlow-dose, but could be confirmed using MRI. In 12 of 20 patients, 47 PET-positive LNs (71.9 %) were smaller than 1 cm in short axis diameter. There were significant linear correlations between PET/MRI SUVs and PET/CT SUVs in the 64 LN metastases (p < 0.0001) and in the 28 osseous metastases (p < 0.0001) for SUVmean and SUVmax, respectively. The LN SUVs were significantly higher on PET/MRI than on PET/CT (p SUVmax < 0.0001; p SUVmean < 0.0001) but there was no significant difference between the bone lesion SUVs (p SUVmax = 0.495; p SUVmean = 0.381). Visibility of LNs was significantly higher on MRI using the T1-w contrast-enhanced fat-saturated sequence (p = 0.013), the T2-w fat-saturated sequence (p < 0.0001) and the DWI sequence (p < 0.0001) compared with CTlow-dose. For bone lesions, only the overall conspicuity was higher on MRI compared with CTlow-dose (p < 0.006). CONCLUSION: Nodal and osseous metastases of PC are accurately and reliably depicted by hybrid PET/MRI using (68)Ga-PSMA-11 with very low discordance compared with PET/CT including PET-positive LNs of normal size. The correlation between PET/MRI SUVs and PET/CT SUVs was linear in LN and bone metastases but was significantly lower in control (non-metastatic) tissue.
PURPOSE: To evaluate the reproducibility of the combination of hybrid PET/MRI and the (68)Ga-PSMA-11 tracer in depicting lymph node (LN) and bone metastases of prostate cancer (PC) in comparison with that of PET/CT. MATERIALS AND METHODS: A retrospective analysis of 26 patients who were subjected to (68)Ga-PSMA PET/CTlow-dose (1 h after injection) followed by PET/MRI (3 h after injection) was performed. MRI sequences included T1-w native, T1-w contrast-enhanced, T2-w fat-saturated and diffusion-weighted sequences (DWIb800). Discordant PET-positive and morphological findings were evaluated. Standardized uptake values (SUV) of PET-positive LNs and bone lesions were quantified and their morphological size and conspicuity determined. RESULTS: Comparing the PET components, the proportion of discordant PSMA-positive suspicious findings was very low (98.5 % of 64 LNs concordant, 100 % of 28 bone lesions concordant). Two PET-positive bone metastases could not be confirmed morphologically using CTlow-dose, but could be confirmed using MRI. In 12 of 20 patients, 47 PET-positive LNs (71.9 %) were smaller than 1 cm in short axis diameter. There were significant linear correlations between PET/MRI SUVs and PET/CT SUVs in the 64 LN metastases (p < 0.0001) and in the 28 osseous metastases (p < 0.0001) for SUVmean and SUVmax, respectively. The LN SUVs were significantly higher on PET/MRI than on PET/CT (p SUVmax < 0.0001; p SUVmean < 0.0001) but there was no significant difference between the bone lesion SUVs (p SUVmax = 0.495; p SUVmean = 0.381). Visibility of LNs was significantly higher on MRI using the T1-w contrast-enhanced fat-saturated sequence (p = 0.013), the T2-w fat-saturated sequence (p < 0.0001) and the DWI sequence (p < 0.0001) compared with CTlow-dose. For bone lesions, only the overall conspicuity was higher on MRI compared with CTlow-dose (p < 0.006). CONCLUSION: Nodal and osseous metastases of PC are accurately and reliably depicted by hybrid PET/MRI using (68)Ga-PSMA-11 with very low discordance compared with PET/CT including PET-positive LNs of normal size. The correlation between PET/MRI SUVs and PET/CT SUVs was linear in LN and bone metastases but was significantly lower in control (non-metastatic) tissue.
Entities:
Keywords:
68Ga-PSMA; Bone metastases; Lymph node metastases; PET/CT; PET/MRI; PSMA
Authors: Michael Souvatzoglou; Matthias Eiber; Toshiki Takei; Sebastian Fürst; Tobias Maurer; Florian Gaertner; Hans Geinitz; Alexander Drzezga; Sibylle Ziegler; Stephan G Nekolla; Ernst J Rummeny; Markus Schwaiger; Ambros J Beer Journal: Eur J Nucl Med Mol Imaging Date: 2013-07-02 Impact factor: 9.236
Authors: Sebastian Mannweiler; Peter Amersdorfer; Slave Trajanoski; Jonathan A Terrett; David King; Gabor Mehes Journal: Pathol Oncol Res Date: 2008-09-18 Impact factor: 3.201
Authors: Sune H Keller; Søren Holm; Adam E Hansen; Bernhard Sattler; Flemming Andersen; Thomas L Klausen; Liselotte Højgaard; Andreas Kjær; Thomas Beyer Journal: MAGMA Date: 2012-09-21 Impact factor: 2.310
Authors: A Afshar-Oromieh; U Haberkorn; H P Schlemmer; M Fenchel; M Eder; M Eisenhut; B A Hadaschik; A Kopp-Schneider; M Röthke Journal: Eur J Nucl Med Mol Imaging Date: 2013-12-19 Impact factor: 9.236
Authors: Tom Budiharto; Steven Joniau; Evelyne Lerut; Laura Van den Bergh; Felix Mottaghy; Christophe M Deroose; Raymond Oyen; Filip Ameye; Kris Bogaerts; Karin Haustermans; Hendrik Van Poppel Journal: Eur Urol Date: 2011-01-18 Impact factor: 20.096
Authors: James L Mohler; Philip W Kantoff; Andrew J Armstrong; Robert R Bahnson; Michael Cohen; Anthony Victor D'Amico; James A Eastham; Charles A Enke; Thomas A Farrington; Celestia S Higano; Eric Mark Horwitz; Christopher J Kane; Mark H Kawachi; Michael Kuettel; Timothy M Kuzel; Richard J Lee; Arnold W Malcolm; David Miller; Elizabeth R Plimack; Julio M Pow-Sang; David Raben; Sylvia Richey; Mack Roach; Eric Rohren; Stan Rosenfeld; Edward Schaeffer; Eric J Small; Guru Sonpavde; Sandy Srinivas; Cy Stein; Seth A Strope; Jonathan Tward; Dorothy A Shead; Maria Ho Journal: J Natl Compr Canc Netw Date: 2014-05 Impact factor: 11.908
Authors: A Afshar-Oromieh; A Malcher; M Eder; M Eisenhut; H G Linhart; B A Hadaschik; T Holland-Letz; F L Giesel; C Kratochwil; S Haufe; U Haberkorn; C M Zechmann Journal: Eur J Nucl Med Mol Imaging Date: 2012-11-24 Impact factor: 9.236
Authors: Ali Afshar-Oromieh; Maya Wolf; Uwe Haberkorn; Marc Kachelrieß; Regula Gnirs; Klaus Kopka; Heinz-Peter Schlemmer; Martin T Freitag Journal: Eur J Nucl Med Mol Imaging Date: 2017-05-15 Impact factor: 9.236
Authors: Simona Malaspina; Ugo De Giorgi; Jukka Kemppainen; Angelo Del Sole; Giovanni Paganelli Journal: Radiol Med Date: 2018-08-16 Impact factor: 3.469