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Title: The contribution of multiparametric pelvic & whole body MR to interpretation of 18F-fluoromethylcholine or 68Ga-HBED-CC PSMA-11 PET/CT in patients with biochemical failure following radical prostatectomy.
Authors: Metser, Ur;Chua, Sue Siew-Chen;Ho, Bao;Punwani, Shonit;Johnston, Edward;Pouliot, Frederic;Tau, Noam;Hawsawy, Asmaa;Anconina, Reut;Bauman, Glenn;Hicks, Rodney J;Weickhardt, Andrew;Davis, Ian D;Pond, Greg;Scott, Andrew M;Tunariu, Nina;Sidhu, Harbir;Emmett, Louise M
Affiliation: University of Toronto, Canada
St. vincent's Hospital, Sydney, Australia
The Royal Marsden Hospital NHS Foundation Trust, United Kingdom
St Vincent's Hopsital, Australia
Austin Health, Melbourne Australia
Monash University and Eastern Health, Australia
Austin Health, Heidelberg, Victoria, Australia
Peter MacCallum Cancer Institute, Australia
University College London, United Kingdom
University College London, UK
Universite Laval, Quebec, Canada
Joint Department of Medical Imaging, Canada
University of Toronto, Canada
London Health Sciences Center, United Kingdom
McMaster University, Hamilton, ON, Canada
Royal Marsden Hospital, London, UK
University College London, UK
Issue Date: 22-Mar-2019
EDate: 2019-03-22
Citation: Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2019; online first: 22 March
Abstract: Purpose: To assess whether the addition of data from multiparametric pelvic (mpMR) and whole body MR (wbMR) to the interpretation of 18F-fluoromethylcholine (FCH) or 68Ga-HBED-CC PSMA-11 (PSMA) PET/CT (=PET) improves the detection of local tumor recurrence, or nodal and distant metastases in patients following radical prostatectomy with biochemical failure. Methods: The current analysis was performed as part of a prospective, multicenter trial on FCH / PSMA PET, mpMR and wbMR. Eligible men had elevated PSA (>0.2 ng/ml) and high-risk features (Gleason score >7, PSA doubling time < 10 months, or PSA>1.0 ng/ml) with negative/ equivocal conventional imaging. PET was interpreted with mp&wbMR in consensus by 2 radiologists and compared to prospective interpretation of PET or MR alone. Performance measures of each modality (PET, MR & PET/mp-wbMR) were compared for each radiotracer, for each individual patient (for FCH, or PSMA for patients who had PSMA PET), and to a composite reference standard. Results: There were 86 patients with PET (FCH [n = 76] and/or PSMA [n = 26]) who had mp&wbMR. Local tumor recurrence was detected in 20/76 (26.3%) on FCH PET/mpMR vs 11/76 (14.5%) on FCH PET (P = 0.039) and 11/26 (42.3%) on PSMA PET/mpMR vs 6/26 (23.1%) on PSMA PET (P = 0.074). Per patient, PET/mpMR was more often positive for local tumor recurrence than PET (P = 0.039) or mpMR (P = 0.019). There were 20/86 (23.3%) patients with regional nodal metastases on both PET/wbMR, and PET (P = 1.0) but only 12/86 (14%) on wbMR (P = 0.061). Similarly, there were more nonregional metastases detected on PET/wbMR than on PET (P = 0.683) and wbMR (P = 0.074), but these differences did not reach significance. Compared to the composite reference standard for the detection of disease beyond the prostatic fossa PET/wbMR, PET and wbMR had sensitivity of 50%, 50%, 8.3%, respectively & specificity of 97.1%, 97.1%, 94.1%, respectively. Conclusion: Interpretation of PET with mpMR resulted in a higher detection rate for local tumor recurrence in the prostate bed in men with biochemical failure following radical prostatectomy. However, the addition of wbMR to FCH/PSMA PET did not improve detection of regional or distant metastases.
DOI: 10.2967/jnumed.118.225185
ORCID: 0000-0002-6656-295X
PubMed URL: 30902875
Type: Journal Article
Subjects: Biochemical recurrence
Oncology: GU
multiparameteric MR
whole body MR
Appears in Collections:Journal articles

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