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Noto B, Eveslage M, Auf der Springe K, Exler A, Faldum A, Heindel W, Milachowski S, Roll W, Schäfers M, Stegger L, Bauer J. Robustness of apparent diffusion coefficient-based lymph node classification for diagnosis of prostate cancer metastasis. Eur Radiol 2024; 34:4504-4515. [PMID: 38099965 PMCID: PMC11213742 DOI: 10.1007/s00330-023-10406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 10/01/2023] [Indexed: 06/29/2024]
Abstract
OBJECTIVES The aim of this proof-of-principle study combining data analysis and computer simulation was to evaluate the robustness of apparent diffusion coefficient (ADC) values for lymph node classification in prostate cancer under conditions comparable to clinical practice. MATERIALS AND METHODS To assess differences in ADC and inter-rater variability, ADC values of 359 lymph nodes in 101 patients undergoing simultaneous prostate-specific membrane antigen (PSMA)-PET/MRI were retrospectively measured by two blinded readers and compared in a node-by-node analysis with respect to lymph node status. In addition, a phantom and 13 patients with 86 lymph nodes were prospectively measured on two different MRI scanners to analyze inter-scanner agreement. To estimate the diagnostic quality of the ADC in real-world application, a computer simulation was used to emulate the blurring caused by scanner and reader variability. To account for intra-individual correlation, the statistical analyses and simulations were based on linear mixed models. RESULTS The mean ADC of lymph nodes showing PSMA signals in PET was markedly lower (0.77 × 10-3 mm2/s) compared to inconspicuous nodes (1.46 × 10-3 mm2/s, p < 0.001). High inter-reader agreement was observed for ADC measurements (ICC 0.93, 95%CI [0.92, 0.95]). Good inter-scanner agreement was observed in the phantom study and confirmed in vivo (ICC 0.89, 95%CI [0.84, 0.93]). With a median AUC of 0.95 (95%CI [0.92, 0.97]), the simulation study confirmed the diagnostic potential of ADC for lymph node classification in prostate cancer. CONCLUSION Our model-based simulation approach implicates a high potential of ADC for lymph node classification in prostate cancer, even when inter-rater and inter-scanner variability are considered. CLINICAL RELEVANCE STATEMENT The ADC value shows a high diagnostic potential for lymph node classification in prostate cancer. The robustness to scanner and reader variability implicates that this easy to measure and widely available method could be readily integrated into clinical routine. KEY POINTS • The diagnostic value of the apparent diffusion coefficient (ADC) for lymph node classification in prostate cancer is unclear in the light of inter-rater and inter-scanner variability. • Metastatic and inconspicuous lymph nodes differ significantly in ADC, resulting in a high diagnostic potential that is robust to inter-scanner and inter-rater variability. • ADC has a high potential for lymph node classification in prostate cancer that is maintained under conditions comparable to clinical practice.
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Affiliation(s)
- Benjamin Noto
- Clinic for Radiology, University of Münster and University Hospital Münster, Münster, Germany.
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
- West German Cancer Centre (WTZ), University Hospital Münster, Münster, Germany.
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
| | | | - Anne Exler
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Walter Heindel
- Clinic for Radiology, University of Münster and University Hospital Münster, Münster, Germany
- West German Cancer Centre (WTZ), University Hospital Münster, Münster, Germany
| | - Stanislaw Milachowski
- Clinic for Radiology, University of Münster and University Hospital Münster, Münster, Germany
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre (WTZ), University Hospital Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre (WTZ), University Hospital Münster, Münster, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Centre (WTZ), University Hospital Münster, Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University of Münster and University Hospital Münster, Münster, Germany
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Liu X, Tian J, Wu J, Zhang Y, Wang X, Zhang X, Wang X. Utility of diffusion weighted imaging-based radiomics nomogram to predict pelvic lymph nodes metastasis in prostate cancer. BMC Med Imaging 2022; 22:190. [DOI: 10.1186/s12880-022-00905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Preoperative pelvic lymph node metastasis (PLNM) prediction can help clinicians determine whether to perform pelvic lymph node dissection (PLND). The purpose of this research is to explore the feasibility of diffusion-weighted imaging (DWI)-based radiomics for preoperative PLNM prediction in PCa patients at the nodal level.
Methods
The preoperative MR images of 1116 pathologically confirmed lymph nodes (LNs) from 84 PCa patients were enrolled. The subjects were divided into a primary cohort (67 patients with 192 positive and 716 negative LNs) and a held-out cohort (17 patients with 43 positive and 165 negative LNs) at a 4:1 ratio. Two preoperative pelvic lymph node metastasis (PLNM) prediction models were constructed based on automatic LN segmentation with quantitative radiological LN features alone (Model 1) and combining radiological and radiomics features (Model 2) via multiple logistic regression. The visual assessments of junior (Model 3) and senior (Model 4) radiologists were compared.
Results
No significant difference was found between the area under the curve (AUCs) of Models 1 and 2 (0.89 vs. 0.90; P = 0.573) in the held-out cohort. Model 2 showed the highest AUC (0.83, 95% CI 0.76, 0.89) for PLNM prediction in the LN subgroup with a short diameter ≤ 10 mm compared with Model 1 (0.78, 95% CI 0.70, 0.84), Model 3 (0.66, 95% CI 0.52, 0.77), and Model 4 (0.74, 95% CI 0.66, 0.88). The nomograms of Models 1 and 2 yielded C-index values of 0.804 and 0.910, respectively, in the held-out cohort. The C-index of the nomogram analysis (0.91) and decision curve analysis (DCA) curves confirmed the clinical usefulness and benefit of Model 2.
Conclusions
A DWI-based radiomics nomogram incorporating the LN radiomics signature with quantitative radiological features is promising for PLNM prediction in PCa patients, particularly for normal-sized LNM.
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Yoshida S, Takahara T, Arita Y, Sakaino S, Katahira K, Fujii Y. Whole‐body diffusion‐weighted magnetic resonance imaging: Diagnosis and follow up of prostate cancer and beyond. Int J Urol 2021; 28:502-513. [DOI: 10.1111/iju.14497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Soichiro Yoshida
- Department of Urology Tokyo Medical and Dental University TokyoJapan
| | - Taro Takahara
- Department of Biomedical Engineering Tokai University School of Engineering KanagawaJapan
- Department of Radiology Advanced Imaging Center, Yaesu Clinic TokyoJapan
| | - Yuki Arita
- Department of Radiology Keio University School of Medicine TokyoJapan
| | - Shinjiro Sakaino
- Department of Radiation Therapeutics Suzukake Central Hospital ShizuokaJapan
| | | | - Yasuhisa Fujii
- Department of Urology Tokyo Medical and Dental University TokyoJapan
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Van Nieuwenhove S, Van Damme J, Padhani AR, Vandecaveye V, Tombal B, Wuts J, Pasoglou V, Lecouvet FE. Whole-body magnetic resonance imaging for prostate cancer assessment: Current status and future directions. J Magn Reson Imaging 2020; 55:653-680. [PMID: 33382151 DOI: 10.1002/jmri.27485] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
Over the past decade, updated definitions for the different stages of prostate cancer and risk for distant disease, along with the advent of new therapies, have remarkably changed the management of patients. The two expectations from imaging are accurate staging and appropriate assessment of disease response to therapies. Modern, next-generation imaging (NGI) modalities, including whole-body magnetic resonance imaging (WB-MRI) and nuclear medicine (most often prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/computed tomography [CT]) bring added value to these imaging tasks. WB-MRI has proven its superiority over bone scintigraphy (BS) and CT for the detection of distant metastasis, also providing reliable evaluations of disease response to treatment. Comparison of the effectiveness of WB-MRI and molecular nuclear imaging techniques with regard to indications and the definition of their respective/complementary roles in clinical practice is ongoing. This paper illustrates the evolution of WB-MRI imaging protocols, defines the current state-of-the art, and highlights the latest developments and future challenges. The paper presents and discusses WB-MRI indications in the care pathway of men with prostate cancer in specific key situations: response assessment of metastatic disease, "all in one" cancer staging, and oligometastatic disease.
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Affiliation(s)
- Sandy Van Nieuwenhove
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Julien Van Damme
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anwar R Padhani
- Mount Vernon Cancer Centre, Mount Vernon Hospital, London, UK
| | - Vincent Vandecaveye
- Department of Radiology and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joris Wuts
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Vassiliki Pasoglou
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Frederic E Lecouvet
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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Bialek EJ, Malkowski B. Is the level of diffusion restriction in celiac and cervico-thoracic sympathetic ganglia helpful in their proper recognition on PSMA ligand PET/MR? Nuklearmedizin 2020; 59:300-307. [PMID: 32005043 DOI: 10.1055/a-1079-3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To check if diffusion weighted imaging (DWI) might be helpful in proper recognition of celiac (CG) and cervicothoracic (CTG) sympathetic ganglia on the whole-body multimodal PSMA-ligand PET/MR imaging, in the view of their common misleading avidity on PET potentially suggestive of malignant lesions, including metastatic lymph nodes. METHODS The thickness and the level of diffusion restriction was assessed qualitatively and quantitatively in 406 sympathetic ganglia (189 CTG in 101 males and 217 CG in 116 males) on DWI maps (b-value 0 and 800 s/mm2) and apparent diffusion coefficient (ADC) maps (mean ADC) of the whole-body PET/MR 68Ga-PSMA-11 PET/MR. To form a reference group of a matching ganglia size, the smallest lymph node was chosen from each patient with metastases and underwent the same procedure. RESULTS Very low and low level of diffusion restriction was noted in the majority of sympathetic ganglia (81.0 % CTG, 67.3 % CG, and 73.6 % of all). In the majority (91.7 %) of metastatic lymph nodes the level of diffusion restriction was moderate to high.The mean ADC values in sympathetic ganglia were statistically significantly higher in CTG, CG and all ganglia than in metastatic lymph nodes (p < 0.001; the effect size was large). CONCLUSIONS Sympathetic celiac and cervicothoracic ganglia present very low and low level of diffusion restriction in visual DWI assessment, and significantly higher than metastatic lymph nodes mean ADC values in the majority of cases, which may serve as additional factors aiding differential diagnosis on multimodal PSMA-ligand PET/MR imaging.Therefore, PSMA-ligand PET/MR appears potentially superior to PSMA-ligand PET/CT in proper identification of sympathetic ganglia.
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Affiliation(s)
- Ewa J Bialek
- Department of Nuclear Medicine, The Franciszek Lukaszczyk Oncology Centre, Bydgoszcz, Poland
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
| | - Bogdan Malkowski
- Department of Nuclear Medicine, The Franciszek Lukaszczyk Oncology Centre, Bydgoszcz, Poland
- Department of Positron Emission Tomography and Molecular Diagnostics, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
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Multiparametric MRI - local staging of prostate cancer and beyond. Radiol Oncol 2019; 53:159-170. [PMID: 31103999 PMCID: PMC6572496 DOI: 10.2478/raon-2019-0021] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Accurate local staging is critical for treatment planning and prognosis in patients with prostate cancer (PCa). The primary aim is to differentiate between organ-confined and locally advanced disease with the latter carrying a worse clinical prognosis. Multiparametric MRI (mpMRI) is the imaging modality of choice for the local staging of PCa and has an incremental value in assessing pelvic nodal disease and bone involvement. It has shown superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease. MRI has a high specificity for diagnosing extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node (LN) metastases, however, sensitivity remains poor. As a result, extended pelvic LN dissection remains the gold standard for assessing pelvic nodal involvement, and there has been recent progress in developing advanced imaging techniques for more distal staging. Conclusions T2W-weighted imaging is the cornerstone for local staging of PCa. Imaging at 3T and incorporating both diffusion weighted and dynamic contrast enhanced imaging can further increase accuracy. "Next generation" imaging including whole body MRI and PET-MRI imaging using prostate specific membrane antigen (68Ga-PSMA), has shown promising for assessment of LN and bone involvement as compared to the traditional work-up using bone scintigraphy and body CT.
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Huang SM, Yin L, Yue JL, Li YF, Yang Y, Lin ZC. Direct comparison of choline PET/CT and MRI in the diagnosis of lymph node metastases in patients with prostate cancer. Medicine (Baltimore) 2018; 97:e13344. [PMID: 30557983 PMCID: PMC6320103 DOI: 10.1097/md.0000000000013344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Lymph node detection in prostate cancer is challenging and critical to determine treatment policy. Choline PET/CT (positron emission tomography/computed tomography) and magnetic resonance imaging (MRI) have been used for the evaluation of lymph node metastasis in patients with prostate cancer for the past decade. However, only limited patients underwent direct comparison studies. PURPOSE To evaluate the diagnostic performance of choline PET/CT compared with MRI imaging for detecting lymph node metastases in prostate cancer patients. MATERIAL AND METHODS Relevant English-language articles published before February 2018 were searched in PubMed database, Embase database, and Cochrane Library databases search using the keywords: (Prostate Neoplasm OR Prostate Cancer OR prostate carcinoma) and (Lymph Node) and (PET/CT OR positron emission tomography/computed tomography) and (choline or 2-hydroxy-N,N,N-trimethylethanaminium) and (magnetic resonance imaging OR MRI). Articles were included that directly compare the diagnostic performance and clinical utility of choline PET/CT and MRI for detecting lymph node metastases in prostate cancer patients. Study quality was assessed with QUADAS criteria. Analyses were performed on a per patient and a per node basis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated using Meta-Disc 1.4 software. Summary receiver-operating characteristic (SROC) curves constructed. RESULTS A total of 362 patients from 8 studies involving fulfilled the inclusion criteria. On patient-based analysis, the pooled sensitivity, specificity, and DOR with a 95% confidence interval (CI) for choline PET/CT imaging were 0.59 (95%CI, 0.50-0.67), 0.92 (95%CI, 0.87-0.96), 17.37 (95%CI, 4.42-68.33), and for MRI imaging, they were 0.52 (95%CI, 0.44-0.61), 0.87 (95%CI, 0.81-0.92), 6.05 (95%CI, 3.09-11.85), respectively. On node-based, the corresponding values for choline PET/CT imaging were 0.51 (95%CI, 0.46-0.57), 0.99 (95%CI, 0.98-0.99), 65.55 (95%CI, 23.55-182.45), and for MRI imaging, they were 0.39 (95%CI, 0.34-0.44), 0.97 (95%CI, 0.96-0.97), 15.86 (95%CI, 8.96-28.05), respectively. CONCLUSION Choline PET/CT performed better than MRI imaging in evaluating the lymph nodes metastasis of prostate cancer patients and had the potential to be broadly applied in clinical practice.
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Caglic I, Barrett T. Diffusion-weighted imaging (DWI) in lymph node staging for prostate cancer. Transl Androl Urol 2018; 7:814-823. [PMID: 30456184 PMCID: PMC6212625 DOI: 10.21037/tau.2018.08.04] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In patients with prostate cancer, the presence of lymph node (LN) metastases is a critical prognostic factor and is essential for treatment planning. Conventional cross-sectional imaging performs poorly for nodal staging as both computed tomography (CT) and magnetic resonance imaging (MRI) are mainly dependent on size and basic morphological criteria. Therefore, extended pelvic LN dissection (ePLND) remains the gold standard for LN staging, however, it is an invasive procedure with its own drawbacks, thus creating a need for accurate preoperative imaging test. Incorporating functional MRI by using diffusion-weighted MRI has proven superior to conventional MRI protocol by means of both qualitative and quantitative assessment. Currently, the increased diagnostic performance remains insufficient to replace ePLND and the future role of DWI may be through combination with MR lymphangiography or with novel positron emission tomography (PET) tracers. In this article, the current state of data supporting DWI in LN staging of patients with prostate cancer is discussed.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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The Diagnostic Performance of MRI for Detection of Lymph Node Metastasis in Bladder and Prostate Cancer: An Updated Systematic Review and Diagnostic Meta-Analysis. AJR Am J Roentgenol 2018; 210:W95-W109. [DOI: 10.2214/ajr.17.18481] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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MRI and 11C Acetate PET/CT for Prediction of Regional Lymph Node Metastasis in Newly Diagnosed Prostate Cancer. Radiol Oncol 2018. [PMID: 29520210 PMCID: PMC5839086 DOI: 10.2478/raon-2018-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background The aim of the study was to examine the value of quantitative and qualitative MRI and 11C acetate PET/CT parameters in predicting regional lymph node (LN) metastasis of newly diagnosed prostate cancer (PCa). Patients and methods Patients with intermediate (n = 6) and high risk (n = 47) PCa underwent 3T MRI (40 patients) and 11C acetate PET/CT (53 patients) before extended pelvic LN dissection. For each patient the visually most suspicious LN was assessed for mean apparent diffusion coefficient (ADCmean), maximal standardized uptake value (SUVmax), size and shape and the primary tumour for T stage on MRI and ADCmean and SUVmax in the index lesion. The variables were analysed in simple and multiple logistic regression analysis. Results All variables, except ADCmean and SUVmax of the primary tumor, were independent predictors of LN metastasis. In multiple logistic regression analysis the best model was ADCmean in combintion with MRI T-stage where both were independent predictors of LN metastasis, this combination had an AUC of 0.81 which was higher than the AUC of 0.65 for LN ADCmean alone and the AUC of 0.69 for MRI T-stage alone. Conclusions Several quantitative and qualitative imaging parameters are predictive of regional LN metastasis in PCa. The combination of ADCmean in lymph nodes and T-stage on MRI was the best model in multiple logistic regression with increased predictive value compared to lymph node ADCmean and T-stage on MRI alone.
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Schaefferkoetter JD, Wang Z, Stephenson MC, Roy S, Conti M, Eriksson L, Townsend DW, Thamboo T, Chiong E. Quantitative 18F-fluorocholine positron emission tomography for prostate cancer: correlation between kinetic parameters and Gleason scoring. EJNMMI Res 2017; 7:25. [PMID: 28324340 PMCID: PMC5360745 DOI: 10.1186/s13550-017-0269-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/21/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The use of radiolabeled choline as a positron emission tomography (PET) agent for imaging primary tumors in the prostate has been evaluated extensively over the past two decades. There are, however, conflicting reports of its sensitivity and the relationship between choline PET imaging and disease staging is not fully understood. Moreover, relatively few studies have investigated the correlation between tracer uptake and histological tumor grade. This work quantified 18F-fluorocholine in tumor and healthy prostate tissue using pharmacokinetic modeling and stratified uptake parameters by histology grade. Additionally, the effect of scan time on the estimation of the kinetic exchange rate constants was evaluated, and the tracer influx parameters from full compartmental analysis were compared to uptake values quantified by Patlak and standardized uptake value (SUV) analyses. 18F-fluorocholine was administered as a 222 MBq bolus injection to ten patients with biopsy-confirmed prostate tumors, and dynamic PET data were acquired for 60 min. Image-derived arterial input functions were scaled by discrete blood samples, and a 2-tissue, 4-parameter model accounting for blood volume (2T4k+Vb) was used to perform fully quantitative compartmental modeling on tumor, healthy prostate, and muscle tissue. Subsequently, all patients underwent radical prostatectomy, and histological analyses were performed on the prostate specimens; kinetic parameters for tumors were stratified by Gleason score. Correlations were investigated between compartmental K 1 and K i parameters and SUV and Patlak slope; the effect of scan time on parameter bias was also evaluated. RESULTS Choline activity curves in seven tumors, eight healthy prostate regions, and nine muscle regions were analyzed. Net tracer influx was generally higher in tumor relative to healthy prostate, with the values in the highest grade tumors markedly higher than those in lower grade tumors. Influx terms from Patlak and full compartmental modeling showed good correlation within individual tissue groups. Kinetic parameters calculated from the entire 60-min scan data were accurately reproduced from the first 30 min of acquired data (R 2 ≈ 0.9). CONCLUSIONS Strong correlations were observed between K i and Patlak slope in tumor tissue, and K 1 and SUV were also correlated but to a lesser degree. Reliable estimates of all kinetic parameters can be achieved from the first 30 min of dynamic 18F-choline data. Although SUV, K 1, K i, and Patlak slope were found to be poor differentiators of low-grade tumor compared to healthy prostate tissue, they are strong indicators of aggressive disease.
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Affiliation(s)
- Joshua D Schaefferkoetter
- A*STAR-NUS Clinical Imaging Research Centre, Centre for Translational Medicine (MD6), 14 Medical Drive, #B1-01, Singapore, 117599, Singapore.
- Department of Diagnostic Radiology, National University Hospital, Singapore, Singapore.
| | - Ziting Wang
- Department of Urology, National University Health System, Singapore, Singapore
| | - Mary C Stephenson
- A*STAR-NUS Clinical Imaging Research Centre, Centre for Translational Medicine (MD6), 14 Medical Drive, #B1-01, Singapore, 117599, Singapore
| | - Sharmili Roy
- A*STAR-NUS Clinical Imaging Research Centre, Centre for Translational Medicine (MD6), 14 Medical Drive, #B1-01, Singapore, 117599, Singapore
| | - Maurizio Conti
- Siemens Healthcare Molecular Imaging, Knoxville, TN, 37919, USA
| | - Lars Eriksson
- Siemens Healthcare Molecular Imaging, Knoxville, TN, 37919, USA
| | - David W Townsend
- A*STAR-NUS Clinical Imaging Research Centre, Centre for Translational Medicine (MD6), 14 Medical Drive, #B1-01, Singapore, 117599, Singapore
- Department of Diagnostic Radiology, National University Hospital, Singapore, Singapore
| | - Thomas Thamboo
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Edmund Chiong
- Department of Urology, National University Health System, Singapore, Singapore
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Schwarzenböck SM, Stenzel J, Otto T, Helldorff HV, Bergner C, Kurth J, Polei S, Lindner T, Rauer R, Hohn A, Hakenberg OW, Wester HJ, Vollmar B, Krause BJ. [ 68Ga]pentixafor for CXCR4 imaging in a PC-3 prostate cancer xenograft model - comparison with [ 18F]FDG PET/CT, MRI and ex vivo receptor expression. Oncotarget 2017; 8:95606-95619. [PMID: 29221153 PMCID: PMC5707047 DOI: 10.18632/oncotarget.21024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim was to characterize the properties of [68Ga]Pentixafor as tracer for prostate cancer imaging in a PC-3 prostate cancer xenograft mouse model and to investigate its correlation with [18F]FDG PET/CT, magnetic resonance imaging (MRI) and ex vivo analyses. Methods Static [68Ga]Pentixafor and [18F]FDG PET as well as morphological/ diffusion weighted MRI and 1H MR spectroscopy was performed. Imaging data were correlated with ex vivo biodistribution and CXCR4 expression in PC-3 tumors (immunohistochemistry (IHC), mRNA analysis). Flow cytometry was performed for evaluation of localization of CXCR4 receptors (in vitro PC-3 cell experiments). Results Tumor uptake of [68Ga]Pentixafor was significantly lower compared to [18F]FDG. Ex vivo CXCR4 mRNA expression of tumors was shown by PCR. Only faint tumor CXCR4 expression was shown by IHC (immuno reactive score of 3). Accordingly, flow cytometry of PC-3 cells revealed only a faint signal, cell membrane permeabilisation showed a slight signal increase. There was no significant correlation of [68Ga]Pentixafor tumor uptake and ex vivo receptor expression. Spectroscopy showed typical spectra of prostate cancer. Conclusion PC-3 tumor uptake of [68Ga]Pentixafor was existent but lower compared to [18F]FDG. No significant correlation of ex vivo tumor CXCR4 receptor expression and [68Ga]Pentixafor tumor uptake was shown. CXCR4 receptor expression on the surface of PC-3 cells was existent but rather low possibly explaining the limited [68Ga]Pentixafor tumor uptake; receptor localization in the interior of PC-3 cells is presumable as shown by cell membrane permeabilisation. Further studies are necessary to define the role of [68Ga]Pentixafor in prostate cancer imaging.
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Affiliation(s)
- Sarah M Schwarzenböck
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Jan Stenzel
- Core Facility Small Animal Imaging, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Thomas Otto
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Heike V Helldorff
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Carina Bergner
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Jens Kurth
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Stefan Polei
- Core Facility Small Animal Imaging, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Tobias Lindner
- Core Facility Small Animal Imaging, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Romina Rauer
- Core Facility Small Animal Imaging, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Alexander Hohn
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Oliver W Hakenberg
- Department of Urology, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Hans J Wester
- Institute for Radiopharmaceutical Chemistry, Technische Universität München, 85748 Garching, Germany
| | - Brigitte Vollmar
- Institute for Experimental Surgery, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
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Abstract
This review article aims to provide an overview on of diffusion-weighted MR imaging (DW-MR imaging) in the urogenital tract. Compared with conventional cross-sectional imaging methods, the additional value of DW-MR imaging in the detection and further characterization of benign and malignant lesions of the kidneys, bladder, prostate, and pelvic lymph nodes is discussed as well as the role of DW-MR imaging in the evaluation of treatment response.
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Affiliation(s)
- Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Kirsi Hannele Härmä
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Harriet Thoeny
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland.
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16
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Paparo F, Piccardo A, Bacigalupo L, Piccazzo R, Rollandi L, Galletto Pregliasco A, Filauro M, DeCensi A, Rollandi GA. Multimodality fusion imaging in abdominal and pelvic malignancies: current applications and future perspectives. ACTA ACUST UNITED AC 2016; 40:2723-37. [PMID: 25952574 DOI: 10.1007/s00261-015-0435-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Medicine is evolving toward personalized care and this development entails the integration, amalgamation, and synchronized analysis of data from multiple sources. Multimodality fusion imaging refers to the simultaneous visualization of spatially aligned and juxtaposed medical images obtained by two or more image modalities. PET/MRI scanners and MMFI platforms are able to improve the diagnostic workflow in oncologic patients and provide exquisite images that aid physicians in the molecular profiling and characterization of tissues. Advanced navigation platforms involving real-time ultrasound are promising tools for guiding personalized and tailored mini-invasive interventional procedures on technically challenging targets. The main objective of the present essay was to describe the current applications and future perspectives of multimodality fusion imaging for both diagnostic and interventional purposes in the field of abdominal and pelvic malignancies. We also outlined the technical differences between fusion imaging achieved by means of simultaneous bimodal acquisition (i.e., integrated PET/MRI scanners), retrospective co-registration, and multimodality fusion imaging involving ultrafast or real-time imaging modalities.
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Affiliation(s)
- Francesco Paparo
- Unit of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy.
| | - Arnoldo Piccardo
- Nuclear Medicine Unit, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy
| | - Lorenzo Bacigalupo
- Unit of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy
| | - Riccardo Piccazzo
- Unit of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy
| | - Ludovica Rollandi
- Unit of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy
| | | | - Marco Filauro
- Department of General and Hepatobiliary Surgery, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy
| | - Andrea DeCensi
- Unit of Oncology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy
| | - Gian Andrea Rollandi
- Unit of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128, Genoa, Italy
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Paparo F, Piccardo A, Bacigalupo L, Romagnoli A, Piccazzo R, Monticone M, Cevasco L, Campodonico F, Conzi GM, Carmignani G, Rollandi GA. Value of bimodal (18)F-choline-PET/MRI and trimodal (18)F-choline-PET/MRI/TRUS for the assessment of prostate cancer recurrence after radiation therapy and radical prostatectomy. ACTA ACUST UNITED AC 2016; 40:1772-87. [PMID: 25579170 DOI: 10.1007/s00261-014-0345-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between 27% and 53% of all patients who undergo radical prostatectomy (RP) or radiation therapy (RT) as the first-line treatment of prostate cancer (PCa) develop a biochemical recurrence. Imaging plays a pivotal role in restaging by helping to distinguish between local relapse and metastatic disease (i.e., lymph-node and skeletal metastases). At present, the most promising tools for assessing PCa patients with biochemical recurrence are multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET)/computed tomography (CT) with radio-labeled choline derivatives. The main advantage of mpMRI is its high diagnostic accuracy in detecting local recurrence, while choline-PET/CT is able to identify lymph-node metastases when they are not suspicious on morphological imaging. The most recent advances in the field of fusion imaging have shown that multimodal co-registration, synchronized navigation, and combined interpretation are more valuable than the individual; separate assessment offered by different diagnostic techniques. The objective of the present essay was to describe the value of bimodal choline-PET/mpMRI fusion imaging and trimodal choline-PET/mpMRI/transrectal ultrasound (TRUS) in the assessment of PCa recurrence after RP and RT. Bimodal choline-PET/mpMRI fusion imaging allows morphological, functional, and metabolic information to be combined, thereby overcoming the limitations of each separate imaging modality. In addition, trimodal real-time choline-PET/mpMRI/TRUS fusion imaging may be useful for the planning and real-time guidance of biopsy procedures in order to obtain histological confirmation of the local recurrence.
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Affiliation(s)
- Francesco Paparo
- Unit of Radiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy,
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von Below C, Daouacher G, Wassberg C, Grzegorek R, Gestblom C, Sörensen J, Ahlström H, Waldén M. Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer. Clin Radiol 2016; 71:328-34. [PMID: 26774372 DOI: 10.1016/j.crad.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/13/2015] [Accepted: 12/02/2015] [Indexed: 12/14/2022]
Abstract
AIM To prospectively validate 3 T magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) for preoperative lymph node (LN) staging in a clinical setting, in intermediate- and high-risk prostate cancer (PCa) patients using laparoscopic extended LN dissection (ePLND) as the reference standard. MATERIALS AND METHODS Between August 2011 and May 2013, 40 newly diagnosed intermediate and high-risk PCa patients underwent preoperative LN staging with 3 T MRI DWI using histopathology of ePLND as the reference standard. The sensitivity, specificity, and accuracy of MRI DWI were calculated. A subgroup analysis of proven LN-positive patients was made to investigate differences in PSA, Gleason score, number, and size of LN metastases, estimated risk of LN involvement, and if curative treatment was indicated, between the true-positive and the false-negative groups. RESULTS A total of 728 LN were harvested from six anatomical regions per patient (external, obturator, internal) with a mean number of 18 LNs per patient (range 11-40). Twenty patients had histologically proven LN-positive disease. MRI DWI was true positive in 11 patients, false negative in nine patients, false positive in two patients, and true negative in 18 patients, resulting in 90% specificity, 55% sensitivity, and 72.5% accuracy. The true-positive patients had significantly more involved LNs (mean 6.9 versus 2.7, p=0.017), with larger diameter (mean 12.3 versus 5.2 mm, p=0.048) and fewer were treated with curative intent (six versus nine, p=0.03), compared with the false-negative group. CONCLUSION MRI DWI LN staging has a low sensitivity but high specificity. The true-positive patients have a considerably higher burden of LN metastases compared to false-negative patients.
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Affiliation(s)
- C von Below
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | - G Daouacher
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
| | - C Wassberg
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - R Grzegorek
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
| | - C Gestblom
- Department of Pathology, Central Hospital of Karlstad, Karlstad, Sweden
| | - J Sörensen
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - H Ahlström
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - M Waldén
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
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Abstract
An early and correct diagnosis together with accurate staging of prostate cancer is necessary in order to plan the most appropriate treatment strategy. Morphological imaging modalities such as transrectal ultrasonography (TRUS), CT, and MRI can have some limitations regarding their accuracy for primary diagnosis and staging of prostate cancer; for instance, they have limited specificity in differentiating cancer from benign prostatic conditions and, by using size as the only criterion to characterize lymph node metastases, they might not be accurate enough for tumour characterization. In this scenario, PET-CT with (11)C-labelled or (18)F-labelled choline derivatives provides morphological and functional characterization and could overcome the limitations of the conventional imaging techniques. PET-CT is one of the most investigated molecular imaging modalities for prostate cancer diagnosis and staging. Currently, the main investigations on the role of PET-CT in the diagnosis and staging of prostate cancer have been performed on a retrospective basis and this type of analysis might be one of the main reasons why different results regarding its diagnostic accuracy have been reported.
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Winter A, Henke RP, Wawroschek F. Targeted salvage lymphadenectomy in patients treated with radical prostatectomy with biochemical recurrence: complete biochemical response without adjuvant therapy in patients with low volume lymph node recurrence over a long-term follow-up. BMC Urol 2015; 15:10. [PMID: 25881245 PMCID: PMC4344760 DOI: 10.1186/s12894-015-0004-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 02/05/2015] [Indexed: 11/13/2022] Open
Abstract
Background Choline positron emission tomography/computed tomography (PET/CT) represents an option in restaging of prostate cancer patients with disease relapse after local treatment. The present study assess whether salvage resection of lymph node metastases detected on choline PET/CT imaging in prostate cancer patients with biochemical recurrence after radical prostatectomy can result in a long-term complete biochemical remission, without adjuvant therapy. Methods We analysed 13 patients with prostate specific antigen (PSA) recurrence (PSA median 1.64 ng/ml, range 0.5-9.55) after radical prostatectomy and suspicious lymph nodes (median 1; range 1–3) detected on [11C]choline and [18F]fluoroethylcholine PET/CT scans. An open salvage lymphadenectomy of positive lymph nodes in a PET/CT scan and nearby lymph nodes was carried out. We examined PSA outcome without adjuvant therapy; defined complete biochemical remission as PSA <0.01 ng/ml. Histological and PET/CT findings were compared. Results Ten of 11 patients with histologically confirmed lymph node metastases showed a PSA response. Three of ten patients with single lymph node metastases had a complete biochemical remission (median follow-up 72 months, range 31.0-83). In five cases with single lymph node metastasis PSA decreased <0.02 ng/ml. Histologically confirmed 13 of 16 metastasis suspicious lymph nodes. No lymph node metastases were detected in two patients. All of the additionally removed 30 lymph nodes were correctly negative. Conclusions This is the first confirmation of a complete biochemical remission after PET/CT guided secondary resection of a single lymph node metastasis in prostate cancer patients with biochemical recurrence after radical prostatectomy, over the long-term (>6.5 years), without adjuvant therapy. In order to improve these promising results, longer-term studies with more patients are required.
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Affiliation(s)
- Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany.
| | | | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany.
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21
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Pinaquy JB, De Clermont-Galleran H, Pasticier G, Rigou G, Alberti N, Hindie E, Mokrane Y, Fernandez P. Comparative effectiveness of [(18) F]-fluorocholine PET-CT and pelvic MRI with diffusion-weighted imaging for staging in patients with high-risk prostate cancer. Prostate 2015; 75:323-31. [PMID: 25393215 DOI: 10.1002/pros.22921] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/09/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Accurate staging is important before surgical decision in patients with high-risk prostate cancer (PCa). The purpose of this study was to prospectively compare the diagnostic performance of (18) F-FCholine and MRI with diffusion weighted imaging (DWIMRI) for local and regional lymph node (LN) staging before radical prostatectomy (RP) with extended pelvic lymphadenectomy (PLND). METHODS We identified 47 patients who underwent (18) F-FCholine and DWIMRI followed by surgical treatment (either prostatectomy or LN dissection or an association of prostatectomy and LN dissection) between May 2010 and December 2012 at Bordeaux University Hospital. These patients were part of a prospective study (EudraCT number 2009-014839-21) evaluating the interest of (18) F-FCholine in staging of high-risk PCa. Diagnostic performances were retrospectively determined for each of (18) F-FCholine and DWIMRI considering LN invasion, each of prostate sextants, capsular invasion and extension to seminal vesicles. (18) F-FCholine and MR findings were correlated with histological findings. RESULTS In a region-based LN analysis, the sensitivity and positive predictive value specificity were respectively, 56% and 98% for (18) F-Choline, and 17% and 97% for DWIMRI. In a patient-based analysis the sensitivity and positive predictive value were respectively 78% and 94% for (18) F-Choline and 33% and 84% for DWIMRI (P = 0.015). For tumor staging, DWIMRI showed better performances with a better specificity (69%) for sextants analysis and sensitivity to detect seminal vesicle invasion (73% vs. 36%). CONCLUSIONS (18) F-FCholine imaging appears to provide helpful additional information in the staging of high-risk PCa. It appears essential for predicting LN status due to its higher sensitivity and specificity for LN involvement. However, despite excellent performance, it cannot replace MRI that remains better for tumoral localization and local evaluation, especially for seminal vesicle invasion. PATIENT SUMMARY This study highlights the interest of (18) F-Choline in the staging of high risk prostate cancer in addition with DWI MRI, especially so in the evaluation of lymph node involvement due to its high sensitivity and excellent specificity.
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22
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Van den Bergh L, Lerut E, Haustermans K, Deroose CM, Oyen R, Isebaert S, Budiharto T, Ameye F, Mottaghy FM, Bogaerts K, Van Poppel H, Joniau S. Final analysis of a prospective trial on functional imaging for nodal staging in patients with prostate cancer at high risk for lymph node involvement. Urol Oncol 2015; 33:109.e23-31. [PMID: 25655681 DOI: 10.1016/j.urolonc.2014.11.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/29/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE Accurate staging modalities to diagnose lymph node involvement in patients with prostate cancer (PCa) are lacking. We wanted to prospectively assess sensitivity, specificity, and positive predictive value (PPV) and negative predictive value of (11)C-choline positron emission tomography (PET)-computed tomography (CT) and diffusion-weighted (DW) magnetic resonance imaging (MRI) for nodal staging in patients with PCa at high risk for lymph node involvement. MATERIAL AND METHODS In total, 75 patients with a risk≥10% but<35% for lymph node (LN) metastases (Partin tables) who had N0 lesions based on the findings of contrast-enhanced CT scans were included. Patients underwent (11)C-choline PET-CT and DW MRI before surgery, which consisted of a superextended lymph node dissection followed by radical prostatectomy. LNs were serially sectioned and histopathologically examined after pankeratin staining. These results were used as the gold standard to compare with the imaging results. RESULTS Of 1,665 resected LNs (median = 21, range: 7-49), 106 affected LNs (median = 2, range: 1-10) were found in 37 of 75 patients (49%). On a region-based analysis, we found a low sensitivity of 8.2% and 9.5% and a PPV of 50.0% and 40.0% for (11)C-choline PET-CT and DW MRI, respectively. The patient-based analysis showed a sensitivity of 18.9% and 36.1% for and a PPV of 63.6% and 86.7% (11)C-choline PET-CT and DW MRI, respectively. Even when both imaging modalities were combined, sensitivity values remained too low to be clinically useful. CONCLUSIONS Because of the low sensitivity, there is no indication for routine clinical use of either (11)C-choline PET-CT or DW MRI for LN staging in patients with PCa, in whom CT scan findings were normal.
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Affiliation(s)
- Laura Van den Bergh
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Evelyne Lerut
- Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Karin Haustermans
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Christophe M Deroose
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Oyen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Radiology, University Hospitals Leuven, Belgium
| | - Sofie Isebaert
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Tom Budiharto
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiotherapy, Catharinaziekenhuis Eindhoven, Eindhoven, the Netherlands
| | - Filip Ameye
- Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Felix M Mottaghy
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Hendrik Van Poppel
- Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Steven Joniau
- Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Yoshida S, Koga F, Kobayashi S, Tanaka H, Satoh S, Fujii Y, Kihara K. Diffusion-weighted magnetic resonance imaging in management of bladder cancer, particularly with multimodal bladder-sparing strategy. World J Radiol 2014; 6:344-354. [PMID: 24976935 PMCID: PMC4072819 DOI: 10.4329/wjr.v6.i6.344] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 05/14/2014] [Indexed: 02/07/2023] Open
Abstract
Bladder-sparing strategy for muscle-invasive bladder cancer (MIBC) is increasingly demanded instead of radical cystectomy plus urinary diversion. Multimodal therapeutic approaches consisting of transurethral resection, chemotherapy, radiotherapy and/or partial cystectomy improve patients’ quality of life by preserving their native bladder and sexual function without compromising oncological outcomes. Because a favorable response to chemoradiotherapy (CRT) is a prerequisite for successful bladder preservation, predicting and monitoring therapeutic response is an essential part of this approach. Diffusion-weighted magnetic resonance imaging (DW-MRI) is a functional imaging technique increasingly applied to various types of cancers. Contrast in this imaging technique derives from differences in the motion of water molecules among tissues and this information is useful in assessing the biological behavior of cancers. Promising results in predicting and monitoring the response to CRT have been reported in several types of cancers. Recently, growing evidence has emerged showing that DW-MRI can serve as an imaging biomarker in the management of bladder cancer. The qualitative analysis of DW-MRI can be applied to detecting cancerous lesion and monitoring the response to CRT. Furthermore, the potential role of quantitative analysis by evaluating apparent diffusion coefficient values has been shown in characterizing bladder cancer for biological aggressiveness and sensitivity to CRT. DW-MRI is a potentially useful tool for the management of bladder cancer, particularly in multimodal bladder-sparing approaches for MIBC.
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Vag T, Heck MM, Beer AJ, Souvatzoglou M, Weirich G, Holzapfel K, Rummeny EJ, Schwaiger M, Krause BJ, Eiber M. Preoperative lymph node staging in patients with primary prostate cancer: comparison and correlation of quantitative imaging parameters in diffusion-weighted imaging and 11C-choline PET/CT. Eur Radiol 2014; 24:1821-6. [PMID: 24889997 DOI: 10.1007/s00330-014-3240-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 05/03/2014] [Accepted: 05/13/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To compare the diagnostic performance of DWI and 11C-choline PET/CT in the assessment of preoperative lymph node status in patients with primary prostate cancer. MATERIAL AND METHODS Thirty-three patients underwent DWI and 11C-choline PET/CT prior to prostatectomy and extended pelvic lymph node dissection. Mean standardised uptake value (SUV(mean)) and mean apparent diffusion coefficient (ADC) of 76 identified lymph nodes (LN) were measured and correlated with histopathology. ADC values and SUVs were compared using linear regression analysis. RESULTS A significant difference between benign and malignant LN was observed for ADC values (1.17 vs. 0.96 × 10(-3) mm(2)/s; P < 0.001) and SUV(mean) (1.61 vs. 3.20; P < 0.001). ROC analysis revealed an optimal ADC threshold of 1.01 × 10(-3) mm(2)/s for differentiating benign from malignant LN with corresponding sensitivity/specificity of 69.70%/78.57% and an area under the curve (AUC) of 0.785. The optimal threshold for SUV(mean) was 2.5 with corresponding sensitivity/specificity of 69.72%/90.48% and with an AUC of 0.832. ADC values and SUV(mean) showed a moderate significant inverse correlation (r = -0.63). CONCLUSION Both modalities reveal similar moderate diagnostic performance for preoperative lymph node staging of prostate cancer, not justifying their application in routine clinical practice at this time. The only moderate inverse correlation between ADC values and SUV(mean) suggests that both imaging parameters might provide complementary information on tumour biology. KEY POINTS • Conventional imaging shows low performance for lymph node staging in prostate cancer. • DWI and 11C-choline PET/CT both provide additional functional information • Both functional modalities reveal only moderate diagnostic performance.
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Affiliation(s)
- Tibor Vag
- Clinic of Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany,
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Value of fused 18F-Choline-PET/MRI to evaluate prostate cancer relapse in patients showing biochemical recurrence after EBRT: preliminary results. BIOMED RESEARCH INTERNATIONAL 2014; 2014:103718. [PMID: 24877053 PMCID: PMC4022120 DOI: 10.1155/2014/103718] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/10/2014] [Indexed: 11/17/2022]
Abstract
Purpose. We compared the accuracy of 18F-Choline-PET/MRI with that of multiparametric MRI (mMRI), 18F-Choline-PET/CT, 18F-Fluoride-PET/CT, and contrast-enhanced CT (CeCT) in detecting relapse in patients with suspected relapse of prostate cancer (PC) after external beam radiotherapy (EBRT). We assessed the association between standard uptake value (SUV) and apparent diffusion coefficient (ADC). Methods. We evaluated 21 patients with biochemical relapse after EBRT. Patients underwent 18F-Choline-PET/contrast-enhanced (Ce)CT, 18F-Fluoride-PET/CT, and mMRI. Imaging coregistration of PET and mMRI was performed. Results. 18F-Choline-PET/MRI was positive in 18/21 patients, with a detection rate (DR) of 86%. DRs of 18F-Choline-PET/CT, CeCT, and mMRI were 76%, 43%, and 81%, respectively. In terms of DR the only significant difference was between 18F-Choline-PET/MRI and CeCT. On lesion-based analysis, the accuracy of 18F-Choline-PET/MRI, 18F-Choline-PET/CT, CeCT, and mMRI was 99%, 95%, 70%, and 85%, respectively. Accuracy, sensitivity, and NPV of 18F-Choline-PET/MRI were significantly higher than those of both mMRI and CeCT. On whole-body assessment of bone metastases, the sensitivity of 18F-Choline-PET/CT and 18F-Fluoride-PET/CT was significantly higher than that of CeCT. Regarding local and lymph node relapse, we found a significant inverse correlation between ADC and SUV-max. Conclusion. 18F-Choline-PET/MRI is a promising technique in detecting PC relapse.
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Maurer T, Eiber M, Krause BJ. [Molecular multimodal hybrid imaging in prostate and bladder cancer]. Urologe A 2014; 53:469-83. [PMID: 24700188 DOI: 10.1007/s00120-014-3440-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Since the introduction of combined radiologic-nuclear imaging procedures like PET/CT and PET/MRI, new and promising diagnostic tools in bladder and prostate cancer imaging are available to physicians. Although PET-based hybrid imaging in bladder cancer is currently utilized only in selected cases, an increase in PET imaging can be observed in prostate cancer due to the development of cancer-specific PET tracers. Especially novel ligands of prostate-specific membrane antigen (PSMA) exhibit great potential to effectively influence future staging of prostate cancer. However, before recommendations for implication in routine staging can be given, evaluation in the context of prospective multicenter clinical trials are mandatory.
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Affiliation(s)
- T Maurer
- Urologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81671, München, Deutschland,
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Abdollah F, Briganti A, Montorsi F, Stenzl A, Stief C, Tombal B, Van Poppel H, Touijer K. Contemporary role of salvage lymphadenectomy in patients with recurrence following radical prostatectomy. Eur Urol 2014; 67:839-49. [PMID: 24698524 DOI: 10.1016/j.eururo.2014.03.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/17/2014] [Indexed: 11/17/2022]
Abstract
CONTEXT Prostate cancer (PCa) patients with isolated clinical lymph node (LN) relapse, limited to the regional and/or retroperitoneal LNs, may represent a distinct group of patients who have a more favorable outcome than men with progression to the bone or to other visceral organs. Some data indirectly denote a beneficial impact of pelvic LN dissection on survival in these patients. OBJECTIVE To provide an overview of the currently available literature regarding salvage LN dissection (SLND) in PCa patients with clinical relapse limited to LNs after radical prostatectomy (RP). EVIDENCE ACQUISITION A systematic literature search was conducted using the Medline, Embase, and Web of Science databases to identify original articles, review articles, and editorials regarding SLND. Articles published between 2000 and 2012 were reviewed and selected with the consensus of all the authors. EVIDENCE SYNTHESIS Contemporary imaging techniques, such as 11C-choline positron emission tomography and diffusion-weighted magnetic resonance imaging, appear to enhance the accuracy in identifying LN relapse in patients with biochemical recurrence (BCR) and after RP. In these individuals, SLND can be considered as a treatment option. The currently available data suggest that SLND can delay clinical progression and postpone hormonal therapy in almost one-third of the patients, although the majority will have BCR. An accurate and attentive preoperative patient selection may help improve these outcomes. The most frequent complication after SLND was lymphorrhea (15.3%), followed by fever (14.5%) and ileus (11.2%). It is noteworthy that all examined cohorts originated from retrospective single-institution series, with limited sample size and short follow-up. Consequently, the current findings cannot be generalized and warrant further investigation in future prospective trials. CONCLUSIONS The current data suggest that SLND represents an option in patients with disease relapse limited to the LNs after RP; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population. PATIENT SUMMARY Salvage lymph node dissection (SLND) represents a treatment option in for patients with prostate cancer relapse limited to the lymph nodes; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population.
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Affiliation(s)
- Firas Abdollah
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
| | - Alberto Briganti
- Department of Urology, Vita-Salute University, San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute University, San Raffaele, Milan, Italy
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Christian Stief
- Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany
| | - Bertrand Tombal
- Service d'Urologie, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Hein Van Poppel
- Department of Urology, Leuven Cancer Institute, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Quantitative evaluation of bone metastases from prostate cancer with simultaneous [18F] choline PET/MRI: combined SUV and ADC analysis. Ann Nucl Med 2014; 28:405-10. [DOI: 10.1007/s12149-014-0825-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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Heck MM, Souvatzoglou M, Retz M, Nawroth R, Kübler H, Maurer T, Thalgott M, Gramer BM, Weirich G, Rondak IC, Rummeny EJ, Schwaiger M, Gschwend JE, Krause B, Eiber M. Prospective comparison of computed tomography, diffusion-weighted magnetic resonance imaging and [11C]choline positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer patients. Eur J Nucl Med Mol Imaging 2013; 41:694-701. [PMID: 24297503 DOI: 10.1007/s00259-013-2634-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/06/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to prospectively compare diffusion-weighted magnetic resonance imaging (DWI) and [(11)C]choline positron emission tomography/computed tomography (PET/CT) with computed tomography (CT) for preoperative lymph node (LN) staging in prostate cancer (PCa) patients. METHODS Between June 2010 and May 2012, CT, DWI and [(11)C]choline PET/CT were performed preoperatively in 33 intermediate- and high-risk PCa patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) including obturator fossa and internal, external and common iliac fields. Patient- and field-based performance characteristics for all three imaging techniques based on histopathological results are reported. Imaging techniques were compared by means of the area under the curve (AUC). RESULTS LN metastases were detected in 92 of 1,012 (9%) LNs from 14 of 33 (42%) patients. On patient-based analysis, sensitivity, specificity and accuracy for CT were 57, 68 and 64%, respectively, for DWI were 57, 79 and 70%, respectively, and for [(11)C]choline PET/CT were 57, 90 and 76%, respectively. On field-based analysis, these numbers for CT were 47, 94 and 88%, respectively, for DWI were 56, 97 and 92%, respectively, and for [(11)C]choline PET/CT were 62, 96 and 92%, respectively. Neither DWI nor [(11)C]choline PET/CT performed significantly better than CT on pairwise comparison of patient- and field-based results. CONCLUSION All three imaging techniques exhibit a rather low sensitivity with less than two thirds of LN metastases being detected on patient- and field-based analysis. Overall diagnostic efficacy did not differ significantly between imaging techniques, whereas distinct performance characteristics, esp. patient-based specificity, were best for [(11)C]choline PET/CT followed by DWI and CT.
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Affiliation(s)
- Matthias M Heck
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany,
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Fortuin A, de Rooij M, Zamecnik P, Haberkorn U, Barentsz J. Molecular and functional imaging for detection of lymph node metastases in prostate cancer. Int J Mol Sci 2013; 14:13842-75. [PMID: 23823804 PMCID: PMC3742221 DOI: 10.3390/ijms140713842] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/21/2013] [Accepted: 06/21/2013] [Indexed: 12/11/2022] Open
Abstract
Knowledge on lymph node metastases is crucial for the prognosis and treatment of prostate cancer patients. Conventional anatomic imaging often fails to differentiate benign from metastatic lymph nodes. Pelvic lymph node dissection is an invasive technique and underestimates the extent of lymph node metastases. Therefore, there is a need for more accurate non-invasive diagnostic techniques. Molecular and functional imaging has been subject of research for the last decades, in this respect. Therefore, in this article the value of imaging techniques to detect lymph node metastases is reviewed. These techniques include scintigraphy, sentinel node imaging, positron emission tomography/computed tomography (PET/CT), diffusion weighted magnetic resonance imaging (DWI MRI) and magnetic resonance lymphography (MRL). Knowledge on pathway and size of lymph node metastases has increased with molecular and functional imaging. Furthermore, improved detection and localization of lymph node metastases will enable (focal) treatment of the positive nodes only.
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Affiliation(s)
- Ansje Fortuin
- Department of Radiology, Nijmegen Medical Center, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; E-Mails: (M.R.); (P.Z.); (J.B.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +31-24-3611-111; Fax: +31-24-3540-866
| | - Maarten de Rooij
- Department of Radiology, Nijmegen Medical Center, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; E-Mails: (M.R.); (P.Z.); (J.B.)
- Department of Operation Rooms, Nijmegen Medical Center, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Patrik Zamecnik
- Department of Radiology, Nijmegen Medical Center, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; E-Mails: (M.R.); (P.Z.); (J.B.)
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; E-Mail:
| | - Jelle Barentsz
- Department of Radiology, Nijmegen Medical Center, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; E-Mails: (M.R.); (P.Z.); (J.B.)
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Current Staging Procedures in Urinary Bladder Cancer. Diagnostics (Basel) 2013; 3:315-24. [PMID: 26824925 PMCID: PMC4665464 DOI: 10.3390/diagnostics3030315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/13/2013] [Accepted: 06/18/2013] [Indexed: 01/20/2023] Open
Abstract
Currently computed tomography (CT) represents the most widely used standard imaging modality in muscle-invasive urinary bladder cancer. Visualization of local tumor or depth of invasion as well as lymph node staging, however, is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of superparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor or lymph node involvement and therefore might play a role in routine staging of urinary bladder cancer in the future. Likewise, positron emission tomography (PET) with the currently utilized tracers 18F-FDG, 11C-choline and 11C-acetate is investigated in bladder cancer patients—mostly in combination with diagnostic CT. Although promising results could be obtained for these PET/CT examinations in smaller series, their true value cannot be determined at present.
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Grant K, Lindenberg ML, Shebel H, Pang Y, Agarwal HK, Bernardo M, Kurdziel KA, Turkbey B, Choyke PL. Functional and molecular imaging of localized and recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2013; 40 Suppl 1:S48-59. [PMID: 23649462 DOI: 10.1007/s00259-013-2419-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 01/17/2023]
Abstract
Prostate cancer is the most common malignancy among American men. Imaging of localized and recurrent prostate cancer is challenging since conventional imaging techniques are limited. New imaging techniques such as multiparametric MRI and PET with targeted tracers have been investigated extensively in the last decade. As a result, the role of novel imaging techniques for the detection of localized and recurrent prostate cancer has recently expanded. In this review, novel functional and molecular imaging techniques used in the management of localized and recurrent prostate cancer are discussed.
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Affiliation(s)
- Kinzya Grant
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD 20892-1088, USA
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Hardie AD, Rieter WJ, Bradshaw ML, Gordon LL, Young MA, Keane TE. Improved performance of SPECT-CT In-111 capromab pendetide by correlation with diffusion-weighted magnetic resonance imaging for identifying metastatic pelvic lymphadenopathy in prostate cancer. World J Urol 2013; 31:1327-32. [PMID: 23595605 DOI: 10.1007/s00345-013-1079-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 04/10/2013] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To preliminarily evaluate the potential for an improvement in diagnostic performance by a combined interpretation of In-111 capromab pendetide single photon emission computed tomography (SPECT) including computed tomography (CT) image fusion with magnetic resonance diffusion-weighted imaging (MR-DWI) for identifying prostate cancer in pelvic lymph nodes thru correlation with histopathology. MATERIALS AND METHODS This institutional approved, retrospective study identified patients with available histopathology of lymph nodes removed at the time of radical prostatectomy and who had undergone staging with In-111 capromab pendetide SPECT-CT and/or pelvic MRI (including DWI). The performance of In-111 capromab pendetide SPECT for identifying malignant lymph nodes was assessed. Subsequently, a combined reading of In-111 capromab pendetide SPECT and prostate MRI with DWI was performed and the performance assessed. RESULTS 18 patients underwent In-111 capromab pendetide SPECT-CT. Of these, 12 patients had also undergone imaging with MR-DWI. In-111 capromab pendetide SPECT-CT had a sensitivity of 40.0% and specificity of 96.7% for identification of malignant lymph nodes. However, In-111 capromab pendetide SPECT-CT combined with MRI with DWI had a sensitivity of 88.9% and specificity of 98.5%. CONCLUSIONS The addition of MR-DWI to the interpretation of In-111 capromab pendetide SPECT-CT may increase the sensitivity for detecting malignant lymph nodes in prostate cancer. Future prospective evaluation of combined In-111 capromab pendetide SPECT-CT and MR-DWI is indicated and may improve clinical evaluation of nodal disease in prostate cancer.
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Punwani S, Taylor SA, Saad ZZ, Bainbridge A, Groves A, Daw S, Shankar A, Halligan S, Humphries PD. Diffusion-weighted MRI of lymphoma: prognostic utility and implications for PET/MRI? Eur J Nucl Med Mol Imaging 2012. [DOI: 10.1007/s00259-012-2293-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oprea-Lager DE, Vincent AD, van Moorselaar RJA, Gerritsen WR, van den Eertwegh AJM, Eriksson J, Boellaard R, Hoekstra OS. Dual-phase PET-CT to differentiate [18F]Fluoromethylcholine uptake in reactive and malignant lymph nodes in patients with prostate cancer. PLoS One 2012; 7:e48430. [PMID: 23119014 PMCID: PMC3485217 DOI: 10.1371/journal.pone.0048430] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/25/2012] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate whether time-trends of enhanced [18F]Fluoromethylcholine ([18F]FCH) in lymph nodes (LN) of prostate cancer (PCa) patients can help to discriminate reactive from malignant ones, and whether single time point standardized uptake value (SUV) measurements also suffice. Procedures 25 PCa patients with inguinal (presumed benign) and enlarged pelvic LN (presumed malignant) showing enhanced [18F]FCH uptake at dual-phase PET-CT were analyzed. Associations between LN status (benign versus malignant) and SUVmax and SUVmeanA50, determined at 2 min (early) and 30 min (late) post injection, were assessed. We considered two time-trends of [18F]FCH uptake: type A (SUV early > SUV late) and type B (SUV late ≥ SUV early). Histopathology and/or follow-up were used to confirm the assumption that LN with type A pattern are benign, and LN with type B pattern malignant. Results Analysis of 54 nodes showed that LN status, time-trends, and ‘late’ (30 min p.i.) SUVmax and SUVmeanA50 parameters were strongly associated (P<0.0001). SUVmax relative difference was the best LN status predictor. All but one inguinal LN showed a decreasing [18F]FCH uptake over time (pattern A), while 95% of the pelvic nodes presented a stable or increasing uptake (pattern B) type. Conclusions Time-trends of enhanced [18F]FCH uptake can help to characterize lymph nodes in prostate cancer patients. Single time-point SUV measurements, 30 min p.i., may be a reasonable alternative for predicting benign versus malignant status of lymph nodes, but this remains to be validated in non-enlarged pelvic lymph nodes.
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Affiliation(s)
- Daniela E Oprea-Lager
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
OBJECTIVE Recent advances in the fundamental understanding of the complex biology of prostate cancer have provided an increasing number of potential targets for imaging and treatment. The imaging evaluation of prostate cancer needs to be tailored to the various phases of this remarkably heterogeneous disease. CONCLUSION In this article, I review the current state of affairs on a range of PET radiotracers for potential use in the imaging evaluation of men with prostate cancer.
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Kalemis A, Delattre BMA, Heinzer S. Sequential whole-body PET/MR scanner: concept, clinical use, and optimisation after two years in the clinic. The manufacturer’s perspective. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 26:5-23. [DOI: 10.1007/s10334-012-0330-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 01/08/2023]
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Rechichi G, Galimberti S, Oriani M, Perego P, Valsecchi MG, Sironi S. ADC maps in the prediction of pelvic lymph nodal metastatic regions in endometrial cancer. Eur Radiol 2012; 23:65-74. [PMID: 22821394 DOI: 10.1007/s00330-012-2575-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 05/31/2012] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the usefulness of apparent diffusion coefficient (ADC) in discriminating metastatic from non-metastatic pelvic lymph nodal sites in endometrial cancer. MATERIALS AND METHODS This retrospective study included 40 patients with endometrial cancer who underwent MRI [T2-weighted, dynamic T1-weighted images and diffusion-weighted images with body background suppression (DWIBS), b-values 0 and 1,000 s/mm(2)], total hysterectomy and pelvic lymphadenectomy. Lymph nodes identifiable on DWIBS were evaluated, classified into six nodal regions, and for each node ADC values, short- and long-axis diameters were measured by two readers. Histopathological findings and follow-up information served as the reference standard. RESULTS Average (± standard deviation) mean and minimum ADC region value (0.87 ± 0.15 and 0.74 ± 0.07 × 10(-3) mm(2)/s) of metastatic sites (n = 7) were significantly lower than those of non-metastatic ones (n = 89; 1.07 ± 0.20 and 1.02 ± 0.20; p-value = 0.010 and 0.0004). Mean short-axis and short-to-long axis ratios of metastatic nodes were 7.47 mm and 0.68. Using the minimum ADC region value with threshold 0.807 × 10(-3) mm(2)/s, sensitivity, specificity, positive and negative predictive value and accuracy were 100 %, 98.3 %, 63.6 %, 100 % and 98.3 %, respectively (reader 1). CONCLUSION In endometrial cancer, mean and minimum ADC region values of metastatic nodal sites are significantly lower than those found at normal sites.
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Affiliation(s)
- Gilda Rechichi
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
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Fornasa F, Nesoti MV, Bovo C, Bonavina MG. Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer. J Magn Reson Imaging 2012; 36:858-64. [DOI: 10.1002/jmri.23706] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 04/16/2012] [Indexed: 02/06/2023] Open
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Schwarzenböck S, Souvatzoglou M, Krause BJ. Choline PET and PET/CT in Primary Diagnosis and Staging of Prostate Cancer. Theranostics 2012; 2:318-30. [PMID: 22448198 PMCID: PMC3311230 DOI: 10.7150/thno.4008] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 02/26/2012] [Indexed: 12/23/2022] Open
Abstract
PET and PET/CT using [(11)C]- and [(18)F]-labelled choline derivates is increasingly being used for imaging of primary and recurrent prostate cancer. While PET and PET/CT with [(11)C]- and [(18)F]-labelled choline derivates in patients suffering from biochemical recurrence of prostate cancer has been examined in many studies that demonstrate an increasing importance, its role in the primary staging of prostate cancer is still a matter of debate.Morphological and functional imaging techniques such as CT, MRI and TRUS have demonstrated only limited accuracy for the diagnosis of primary prostate cancer. Molecular imaging with PET and PET/CT could potentially increase accuracy to localize primary prostate cancer. A considerable number of studies have examined the value of PET/CT with [(11)C]- and [(18)F]- labelled choline derivates for the diagnosis of primary prostate cancer with mixed results. Primary prostate cancer can only be detected with moderate sensitivity using [(11)C]- and [(18)F]choline PET and PET/CT. The detection rate depends on the tumour configuration. Detection is also limited by a considerable number of microcarcinomas that cannot be detected due to partial volume effects. Therefore small and in part rind-like tumours can often not be visualized. Furthermore, the differentiation between benign changes like prostatitis, high-grade intraepithelial neoplasia (HGPIN) or prostatic hyperplasia is not always possible. Therefore, at the present time, the routine use of PET/CT with [(11)C]- and [(18)F]-labelled choline derivates cannot be recommended as a first-line screening procedure for primary prostate cancer in men at risk. A potential application of choline PET and PET/CT may be to increase the detection rate of clinically suspected prostate cancer with multiple negative prostate biopsies, for example in preparation of a focused re-biopsy and may play a role in patient stratification with respect to primary surgery and radiation therapy in the future.
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Affiliation(s)
- S. Schwarzenböck
- 1. Department of Nuclear Medicine, Universitätsmedizin Rostock, Universität Rostock, Rostock, GERMANY
| | - M. Souvatzoglou
- 2. Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, GERMANY
| | - B. J. Krause
- 1. Department of Nuclear Medicine, Universitätsmedizin Rostock, Universität Rostock, Rostock, GERMANY
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Park H, Wood D, Hussain H, Meyer CR, Shah RB, Johnson TD, Chenevert T, Piert M. Introducing parametric fusion PET/MRI of primary prostate cancer. J Nucl Med 2012; 53:546-51. [PMID: 22419751 DOI: 10.2967/jnumed.111.091421] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED We assessed the performance of parametric fusion PET/MRI based on (11)C-choline PET/CT and apparent diffusion coefficient (ADC) maps derived from diffusion-weighted MRI for the identification of primary prostate cancer. METHODS (11)C-choline PET/CT and MRI were performed in 17 patients with untreated primary prostate cancer, followed by prostatectomy. Registration of in vivo imaging with histology was achieved using a mutual-information objective function and by performing ex vivo MRI of the prostatectomy specimen (obtained at 3 T) and whole-mount sectioning with block-face photography as intermediate steps. Data analysis included volumetrically registered whole-mount histology with Gleason scoring, (11)C-choline, and ADC data (obtained at 1.5 T). Volumes of interest were defined on the basis of histologically proven tumor tissue to calculate tumor-to-benign prostate background ratios (TBRs) for (11)C-choline, ADC, and a derived fusion PET/MRI parameter calculating the quotient of (11)C-choline over ADC (P(CHOL/ADC)). RESULTS Fifty-one tumor nodules were identified at pathology. The TBRs for (11)C-choline (P < 0.05) and P(CHOL/ADC) (P < 0.005) were significantly higher in prostate cancers with a Gleason score of ≥3 + 4 than with a Gleason score of ≤3 + 3 disease and controls. For Gleason ≥ 3 + 4, the ADC TBRs were significantly lower than controls and Gleason ≤ 3 + 3 disease (P < 0.05). The absolute value of TBRs obtained from Gleason ≥ 3 + 4 cancers increased from ADC to (11)C-choline PET/CT and from (11)C-choline PET/CT to P(CHOL/ADC), with each step being statistically significant. CONCLUSION Our data indicate that parametric PET/MRI using P(CHOL/ADC) improves lesion-to-background contrast (TBRs) of Gleason ≥ 3 + 4 disease, compared with (11)C-choline PET/CT or diffusion-weighted MRI, and thus hold promise that parametric imaging performed on hybrid PET/MRI may further improve identification and localization of significant primary prostate cancer.
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Affiliation(s)
- Hyunjin Park
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Giannarini G, Petralia G, Thoeny HC. Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature. Eur Urol 2011; 61:326-40. [PMID: 22000497 DOI: 10.1016/j.eururo.2011.09.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 09/16/2011] [Indexed: 12/12/2022]
Abstract
CONTEXT Diagnosis, staging, and treatment monitoring are still suboptimal for most genitourinary tumours. Diffusion-weighted magnetic resonance imaging (DW-MRI) has already shown promise as a noninvasive imaging modality in the early detection of microstructural and functional changes in several pathologies of various organs. OBJECTIVE To assess the potential and limitations of DW-MRI in the management of patients with kidney, prostate, and bladder cancer. EVIDENCE ACQUISITION A nonsystematic literature search using the Medline/PubMed and Embase databases for full-length papers reporting on DW-MRI for kidney, prostate, and bladder cancer was performed up to August 1, 2011. Only those articles with complete data reporting on DW-MRI applications with potential implications in solving commonly encountered clinical challenges relating to tumour detection, staging, and treatment monitoring were finally examined. EVIDENCE SYNTHESIS For kidney tumours DW-MRI is a reasonable alternative to conventional cross-sectional imaging to detect and characterise focal renal lesions, especially in patients with impaired renal function. For prostate cancer, DW-MRI applied in addition to conventional T2-weighted and contrast-enhanced magnetic resonance imaging (MRI) improves tumour detection and localisation. In addition, it has shown promise for the assessment of tumour aggressiveness and for treatment monitoring during active surveillance, radiation therapy, and focal therapy. For bladder cancer, DW-MRI may improve the performance of conventional T2-weighted and contrast-enhanced MRI in the work-up of bladder cancer, helping to differentiate non-muscle-invasive from muscle-invasive tumours. For pelvic lymph nodes, initial results showed the potential to improve nodal staging of prostate and bladder cancer compared with conventional cross-sectional imaging. CONCLUSIONS DW-MRI holds promise to ameliorate the management of patients with kidney, prostate, and bladder cancer including pelvic lymph node staging. Current limitations include the lack of standardisation of the technique across multiple centres and the still limited expertise.
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Affiliation(s)
- Gianluca Giannarini
- Department of Urology, University Hospital of Bern, Inselspital, Bern, Switzerland
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Park SH, Moon WK, Cho N, Chang JM, Im SA, Park IA, Kang KW, Han W, Noh DY. Comparison of diffusion-weighted MR imaging and FDG PET/CT to predict pathological complete response to neoadjuvant chemotherapy in patients with breast cancer. Eur Radiol 2011; 22:18-25. [PMID: 21845462 DOI: 10.1007/s00330-011-2236-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/15/2011] [Accepted: 07/28/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the use of diffusion-weighted MR imaging (DWI) and (18)F-FDG PET/CT to predict pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy. METHODS Thirty-four women with 34 invasive breast cancers underwent DWI and PET/CT before and after chemotherapy and before surgery. The percentage changes in the apparent diffusion coefficient (ADC) and the standardised uptake value (SUV) were calculated, and the diagnostic performances for predicting pCR were evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS After surgery, 7/34 patients (20.6%) were found to have pCR. A( z ) values for DWI, PET/CT and the combined use of DWI and PET/CT were 0.910, 0.873 and 0.944, respectively. The best cut-offs for differentiating pCR from non-pCR were a 54.9% increase in the ADC and a 63.9% decrease in the SUV. DWI showed 100% (7/7) sensitivity and 70.4% (19/27) specificity and PET/CT showed 100% sensitivity and 77.8% (21/27) specificity. When DWI and PET/CT were combined, there was a trend towards improved specificity compared with DWI. CONCLUSIONS DWI and FDG PET/CT show similar diagnostic accuracy for predicting pCR to neoadjuvant chemotherapy in breast cancer patients. The combined use of DWI and FDG PET/CT has the potential to improve specificity in predicting pCR.
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Affiliation(s)
- Sang Hee Park
- Department of Radiology, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, South Korea
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Complete PSA Remission without Adjuvant Therapy after Secondary Lymph Node Surgery in Selected Patients with Biochemical Relapse after Radical Prostatectomy and Pelvic Lymph Node Dissection. Adv Urol 2011; 2012:609612. [PMID: 21754926 PMCID: PMC3130459 DOI: 10.1155/2012/609612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 04/27/2011] [Accepted: 05/03/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction. To evaluate whether secondary resection of lymph node (LN) metastases (LNMs) can result in PSA remission, we analysed the PSA outcome after resection of LNM detected on PET/CT in patients with biochemical failure. Materials and Methods. 11 patients with PSA relapse (mean 3.02 ng/mL, range 0.5-9.55 ng/mL) after radical prostatectomy without adjuvant therapy were included. Suspicious LN (1-3) detected on choline PET/CT and nearby LN were openly dissected (09/04-02/11). The PSA development was examined. Histological and PET/CT findings were compared. Results. 9 of 10 patients with histologically confirmed LNM showed a PSA response. 4 of 9 patients with single LNM had a complete permanent PSA remission (mean followup 31.8, range 1-48 months). Of metastasis-suspicious LNs (14) 12 could be histologically confirmed. The additionally removed 25 LNs were all correctly negative. Conclusions. The complete PSA remissions after secondary resection of single LNM argue for a feasible therapeutic benefit without adjuvant therapy. For this purpose the choline PET/CT is in spite of its limitations currently the most reliable routinely available diagnostic tool.
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Value of a Dixon-based MR/PET attenuation correction sequence for the localization and evaluation of PET-positive lesions. Eur J Nucl Med Mol Imaging 2011; 38:1691-701. [PMID: 21688050 DOI: 10.1007/s00259-011-1842-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 05/02/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE In this study, the potential contribution of Dixon-based MR imaging with a rapid low-resolution breath-hold sequence, which is a technique used for MR-based attenuation correction (AC) for MR/positron emission tomography (PET), was evaluated for anatomical correlation of PET-positive lesions on a 3T clinical scanner compared to low-dose CT. This technique is also used in a recently installed fully integrated whole-body MR/PET system. METHODS Thirty-five patients routinely scheduled for oncological staging underwent (18)F-fluorodeoxyglucose (FDG) PET/CT and a 2-point Dixon 3-D volumetric interpolated breath-hold examination (VIBE) T1-weighted MR sequence on the same day. Two PET data sets reconstructed using attenuation maps from low-dose CT (PET(AC_CT)) or simulated MR-based segmentation (PET(AC_MR)) were evaluated for focal PET-positive lesions. The certainty for the correlation with anatomical structures was judged in the low-dose CT and Dixon-based MRI on a 4-point scale (0-3). In addition, the standardized uptake values (SUVs) for PET(AC_CT) and PET(AC_MR) were compared. RESULTS Statistically, no significant difference could be found concerning anatomical localization for all 81 PET-positive lesions in low-dose CT compared to Dixon-based MR (mean 2.51 ± 0.85 and 2.37 ± 0.87, respectively; p = 0.1909). CT tended to be superior for small lymph nodes, bone metastases and pulmonary nodules, while Dixon-based MR proved advantageous for soft tissue pathologies like head/neck tumours and liver metastases. For the PET(AC_CT)- and PET(AC_MR)-based SUVs (mean 6.36 ± 4.47 and 6.31 ± 4.52, respectively) a nearly complete concordance with a highly significant correlation was found (r = 0.9975, p < 0.0001). CONCLUSION Dixon-based MR imaging for MR AC allows for anatomical allocation of PET-positive lesions similar to low-dose CT in conventional PET/CT. Thus, this approach appears to be useful for future MR/PET for body regions not fully covered by diagnostic MRI due to potential time constraints.
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Budiharto T, Joniau S, Lerut E, Van den Bergh L, Mottaghy F, Deroose CM, Oyen R, Ameye F, Bogaerts K, Haustermans K, Van Poppel H. Prospective evaluation of 11C-choline positron emission tomography/computed tomography and diffusion-weighted magnetic resonance imaging for the nodal staging of prostate cancer with a high risk of lymph node metastases. Eur Urol 2011; 60:125-30. [PMID: 21292388 DOI: 10.1016/j.eururo.2011.01.015] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 01/08/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for lymph node (LN) staging of prostate cancer (PCa) are largely inadequate. OBJECTIVE Our aim was to assess prospectively the sensitivity, specificity, and positive and negative predictive values for the LN staging by (11)C-choline positron emission tomography (PET)-CT and MR diffusion-weighted imaging (DWI) of the pelvis before retropubic radical prostatectomy (RRP) with extended pelvic LN dissection (PLND). DESIGN, SETTING, AND PARTICIPANTS From February 2008 to August 2009, 36 patients with histologically proven PCa and no pelvic LN involvement on contrast-enhanced CT with a risk ≥ 10% but ≤ 35% at LN metastasis according to the Partin tables were enrolled in this study. INTERVENTION Patients preoperatively underwent (11)C-choline PET-CT and DWI. Subsequently all patients underwent a wide RRP and an extended PLND. MEASUREMENTS Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for LN status of (11)C-choline PET-CT and DWI were calculated with the final histopathology of the LNs as comparator. RESULTS AND LIMITATIONS Seventeen patients (47%) had a pN1 stage, and 38 positive LNs were identified. On a LN region-based analysis, sensitivity, specificity, PPV, NPV, and the number of correctly recognised cases at (11)C-choline PET-CT were 9.4%, 99.7%, 75.0%, 91.0%, and 7.9%, respectively, and at DWI these numbers were 18.8%, 97.6%, 46.2%, 91.7%, and 15.8%, respectively. Twelve LN regions containing macrometastases, of which 2 had capsular penetration, were not detected by (11)C-choline PET-CT; 11 LNs, of which 2 had capsular penetration, were not detected by DWI. This is a small study with 36 patients, but we intend to recruit more patients. CONCLUSIONS From this prospective histopathology-based evaluation of (11)C-choline PET-CT and DWI for LN staging in high-risk PCa patients, it is concluded that these techniques cannot be recommended at present to detect occult LN metastases before initial treatment.
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Affiliation(s)
- Tom Budiharto
- Department of Radiation Oncology, UH Leuven, Leuvens Kanker Instituut, Leuven, Belgium.
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