Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Multimodality imaging using proton magnetic resonance spectroscopic imaging and 18F-fluorodeoxyglucose-positron emission tomography in local prostate cancer
Amita Shukla-Dave, Cecilia Wassberg, Darko Pucar, Heiko Schöder, Debra A Goldman, Yousef Mazaheri, Victor E Reuter, James Eastham, Peter T Scardino, Hedvig Hricak
Amita Shukla-Dave, Heiko Schöder, Yousef Mazaheri, Hedvig Hricak, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
Amita Shukla-Dave, Yousef Mazaheri, Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
Cecilia Wassberg, Department of Diagnostic Radiology, Karolinska University Hospital, 17176 Solna, Sweden
Darko Pucar, Department of Radiology, Augusta University, Augusta, GA 30912, United States
Debra A Goldman, Department of Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
Victor E Reuter, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
James Eastham, Peter T Scardino, Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
Author contributions: Shukla-Dave A, Wassberg C, Pucar D, Schöder H, Mazaheri Y and Hricak H designed the study, performed MRI and PET research, analyzed the data and wrote the paper; Goldman DA performed the statistical analysis; Reuter VE performed the pathology assessment for the study; Eastham J and Scardino PT enrolled patients, and performed clinical assessment as per standard of care; all authors reviewed the final manuscript.
Supported by National Institutes of Health grant, No. #R01 CA76423; and in part through the NIH/NCI Cancer Center Support grant, No. P30 CA008748.
Institutional review board statement: Our study was compliant with the Health Insurance Portability and Accountability Act. Twenty-two patients who were referred from the Urology department for endorectal MRI/MRSI examinations and 18F-FDG-PET/CT and then underwent prostatectomy as primary or salvage treatment were included in the study.
Informed consent statement: Patient data were collected and handled in accordance with institutional and federal guidelines.
Conflict-of-interest statement: All authors have no conflicts of interest with regard to this manuscript.
Data sharing statement: Upon formal request and with proper motivation, all original data in anonymized format is available from the corresponding author for local inspection, but cannot leave Memorial Sloan Kettering Cancer Center.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amita Shukla-Dave, PhD, Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. davea@mskcc.org
Telephone: +1-212-6393184 Fax: +1-212-7173010
Received: October 31, 2016
Peer-review started: November 2, 2016
First decision: December 15, 2016
Revised: December 22, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: March 28, 2017
AIM
To assess the relationship using multimodality imaging between intermediary citrate/choline metabolism as seen on proton magnetic resonance spectroscopic imaging (1H-MRSI) and glycolysis as observed on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in prostate cancer (PCa) patients.
METHODS
The study included 22 patients with local PCa who were referred for endorectal magnetic resonance imaging/1H-MRSI (April 2002 to July 2007) and 18F-FDG-PET/CT and then underwent prostatectomy as primary or salvage treatment. Whole-mount step-section pathology was used as the standard of reference. We assessed the relationships between PET parameters [standardized uptake value (SUVmax and SUVmean)] and MRSI parameters [choline + creatine/citrate (CC/Cmax and CC/Cmean) and total number of suspicious voxels] using spearman’s rank correlation, and the relationships of PET and 1H-MRSI index lesion parameters to surgical Gleason score.
RESULTS
Abnormal intermediary metabolism on 1H-MRSI was present in 21/22 patients, while abnormal glycolysis on 18F-FDG-PET/CT was detected in only 3/22 patients. Specifically, index tumor localization rates were 0.95 (95%CI: 0.77-1.00) for 1H-MRSI and 0.14 (95%CI: 0.03-0.35) for 18F-FDG-PET/CT. Spearman rank correlations indicated little relationship (ρ = -0.36-0.28) between 1H-MRSI parameters and 18F-FDG-PET/CT parameters. Both the total number of suspicious voxels (ρ = 0.55, P = 0.0099) and the SUVmax (ρ = 0.46, P = 0.0366) correlated weakly with the Gleason score. No significant relationship was found between the CC/Cmax, CC/Cmean or SUVmean and the Gleason score (P = 0.15-0.79).
CONCLUSION
The concentration of intermediary metabolites detected by 1H MRSI and glycolytic flux measured 18F-FDG PET show little correlation. Furthermore, only few tumors were FDG avid on PET, possibly because increased glycolysis represents a late and rather ominous event in the progression of PCa.
Core tip: Although metabolic imaging is increasingly utilized in prostate cancer (PCa), the mechanisms leading to cancer-related metabolic rearrangements and consequent imaging findings remain poorly understood. This study compared two modalities utilizing distinct metabolic pathways, proton magnetic resonance spectroscopic imaging (1H-MRSI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT), in local PCa. Abnormal intermediary metabolism on 1H-MRSI was present in 21/22 patients, while abnormal glycolysis on 18F-FDG-PET/CT was detected in only 3/22 patients. This study provides an insight why metabolic PET agents promising for detection of PCa target intermediary metabolism. On the other hand, elevated glycolysis may have ominous prognostic implications in PCa.
