Simultaneous whole-body PET/MRI with integrated multiparametric MRI for primary staging of high-risk prostate cancer
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ORIGINAL ARTICLE
Simultaneous whole‑body PET/MRI with integrated multiparametric MRI for primary staging of high‑risk prostate cancer Sascha Kaufmann1 · Stephan Kruck2 · Sergios Gatidis1 · Tobias Hepp1 · Wolfgang M. Thaiss1 · Jörg Hennenlotter2 · Johannes Schwenck3 · Marcus Scharpf4 · Konstantin Nikolaou1 · Arnulf Stenzl2 · Gerald Reischl5 · Christian la Fougère3,6,7 · Jens Bedke2,7 Received: 22 October 2019 / Accepted: 21 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Whole-body positron emission tomography/magnetic resonance imaging (wbPET/MRI) is a promising diagnostic tool of recurrent prostate cancer (PC), but its role in primary staging of high-risk PC (hrPC) is not well defined. Thus, the aim was to compare the diagnostic accuracy for T-staging of PET-blinded reading (PBR) and PET/MRI. Methods In this prospective study, hrPC patients scheduled to radical prostatectomy (RPx) with extended lymphadenectomy (eLND) were staged with wbPET/MRI and either 68Ga-PSMA-11 or 11C-choline including simultaneous multiparametric MRI (mpMRI). Images were assessed in two sessions, first as PBR (mpMRI and wbMRI) and second as wbPET/MRI. Prostate Imaging Reporting and Data System criteria (PIRADS v2) were used for T-staging. Results were correlated with the exact anatomical localization and extension as defined by histopathology. Diagnostic accuracy of cTNM stage according to PBR was compared to pathological pTNM stage as reference standard. Results Thirty-four patients underwent wbPET/MRI of 68Ga-PSMA-11 (n = 17) or 11C-choline (n = 17). Twenty-four patients meeting the inclusion criteria of localized disease ± nodal disease based on imaging results underwent RPx and eLND, whereas ten patients were excluded from analysis due to metastatic disease. T-stage was best defined by mpMRI with underestimation of tumor lesion size by PET for both tracers. N-stage yielded a per patient sensitivity/specificity comparable to PBR. Conclusion MpMRI is the primary modality for T-staging in hrPC as PET underestimated T-stage in direct comparison to final pathology. In this selected study, cohort MRI shows no inferiority compared to wbPET/MRI considering N-staging. Keywords Prostate cancer · PET · PSMA · MRI · Choline
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-019-03066-1) contains supplementary material, which is available to authorized users. * Wolfgang M. Thaiss [email protected]‑tuebingen.de 1
Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe‑Seyler‑Str. 3, 72076 Tübingen, Germany
2
Department of Urology, University Hospital Tuebingen, Hoppe‑Seyler‑Str. 3, 72076 Tübingen, Germany
3
Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Otfried‑Müller‑Straße 14, 72076 Tübingen, Germany
Prostate cancer (PC) represents the most common non-cutaneous cancer in men in North America and Europe and is a leading cause of ca
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