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Comparison between pelvic PSMA-PET/MR and whole-body PSMA-PET/CT for the initial evaluation of prostate cancer: a proof of concept study

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

Despite the advantages of prostate-specific membrane antigen (PSMA)-PET/MR over PSMA-PET/CT, its relatively long scanning time and suboptimal PET attenuation correction necessitate careful assessment of the most appropriate setting for this type of study. We assessed lesion agreement between PSMA-PET/MR and PSMA-PET/CT in patients undergoing initial evaluation of prostate cancer.

Methods

This was a prospective study of consecutive patients with histological biopsy-proven prostate cancer who underwent pelvic PSMA-PET/MR followed by whole-body PSMA-PET/CT. All conspicuous PSMA-avid foci were counted on PSMA-PET/CT and PSMA-PET/MR with CT or MR correlation. Analysis was performed for intra-prostatic lesions, capsular invasion, seminal vesicle involvement and lymph node and bone involvement. Incidental and significant findings seen on PSMA-PET/CT outside the PSMA-PET/MR field of view were also analysed. Agreements between PSMA-PET/CT and PSMA-PET/MR findings were performed using Cohen’s kappa test.

Results

Image analysis was performed on 140 patients (mean age, 67.3 ± 8.2 years). Agreement between PSMA PET/CT and PSMA-PET/MR was very good for intra-prostatic PSMA-avid foci (K = 0.85) and pelvic lymph nodes (K = 0.98), good for PSMA-avid bone metastases (K = 0.76) and fair for prostatic capsular invasion (K = 0.25) and seminal vesicle involvement (K = 0.31). Twelve patients (8.5%) had incidental findings and two patients (1.4%) had clinically significant findings.

Conclusion

Limited pelvic PSMA-PET/MR has very good agreement with PET/CT regarding PSMA-avid prostatic, regional lymph nodes and bone lesions, and is superior to PET/CT with regard to capsular invasion and seminal vesicle involvement.

Key Points

• Limited pelvic PSMA-PET/MR is superior to whole-body PSMA-PET/CT in detecting extensions of localised disease, mainly due to the high soft tissue resolution of MR.

• Limited pelvic PSMA-PET/MR may be useful for initial evaluation of histological biopsy-proven prostate cancer.

• Further studies are warranted to evaluate limited pelvic PSMA-PET/MR for screening and active surveillance in selected populations.

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Abbreviations

18F:

18-Fluorine

68Ga:

68-Gallium

CI:

Confidence interval

CT:

Computed tomography

FOV:

Field of view

GS:

Gleason score

mp-MRI:

Multi-parametric magnetic resonance imaging

MR:

Magnetic resonance

OSEM:

Ordered subset expectation maximisation

PET:

Positron emission tomography

PI-RADS:

Prostate Imaging-Reporting and Data System

PSMA:

Prostate-specific membrane antigen

SE:

Standard error

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Acknowledgements

The authors acknowledge Zohar Nitsan, Inbal Machcat and Hagai Baruch for their excellent work in patient scanning, Dr. Limor Shaharabani-Gargir for patient management and Dr. Sharon Furman-Assaf for editing.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Liran Domachevsky and Hanna Bernstine contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel

    Liran Domachevsky, Hanna Bernstine, Natalia Goldberg, Meital Nidam & David Groshar

  2. Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel

    Hanna Bernstine & David Groshar

  3. Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA

    Onofrio A. Catalano

Authors
  1. Liran Domachevsky
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  2. Hanna Bernstine
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  3. Natalia Goldberg
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  4. Meital Nidam
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  5. Onofrio A. Catalano
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  6. David Groshar
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Corresponding author

Correspondence to David Groshar.

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Guarantor

The scientific guarantor of this publication is Prof. David Groshar.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Meital Nidam) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Domachevsky, L., Bernstine, H., Goldberg, N. et al. Comparison between pelvic PSMA-PET/MR and whole-body PSMA-PET/CT for the initial evaluation of prostate cancer: a proof of concept study. Eur Radiol 30, 328–336 (2020). https://doi.org/10.1007/s00330-019-06353-y

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  • DOI: https://doi.org/10.1007/s00330-019-06353-y

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