1
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Beutler BD, Whang G, Tchelepi H. PET/CT Ultrasound Fusion for Percutaneous Biopsy: A Retrospective Single-Center Study and Review of the Literature. Clin Nucl Med 2022; 47:692-698. [PMID: 35452012 DOI: 10.1097/rlu.0000000000004220] [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: 11/26/2022]
Abstract
PURPOSE The aim of this study was to assess the diagnostic yield and complication rate of 18 F-FDG PET/CT ultrasound (US) fusion for percutaneous biopsy of FDG-avid lesions among patients with known or suspected malignancy. PATIENTS AND METHODS We describe the clinical, imaging, and histopathologic features of 36 patients who underwent percutaneous biopsy using real-time PET/CT US fusion. In addition, we review the literature on PET/CT US fusion. Using Medline, the following MeSH terms were searched and relevant citations assessed: "fusion imaging," "PET/CT fusion," "PET/CT-guided biopsy," "PET/US fusion," "ultrasound fusion," and "ultrasound fusion-guided biopsy." RESULTS A total of 36 patients (15 men, 21 women) with known or suspected malignancy and prior PET/CT imaging underwent percutaneous biopsy of FDG-avid lesions using PET/CT US fusion between October 2014 and July 2020. Coregistration was achieved using General Electric LOGIQ E9 software. Adequate tissue for analysis was obtained in all 36 patients. Histologic evaluation revealed malignancy in 14 patients (38.9%) and nonneoplastic tissue in 22 patients (61.1%). No intraprocedural or postprocedural complications were recorded. CONCLUSIONS Fusion of PET/CT and US for percutaneous biopsy of FDG-avid lesions can be used to achieve excellent diagnostic yield with a low risk of complications.
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Affiliation(s)
- Bryce David Beutler
- From the University of Southern California, Keck School of Medicine, Los Angeles, CA
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2
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Galgano SJ, West JT, Rais-Bahrami S. Role of molecular imaging in the detection of localized prostate cancer. Ther Adv Urol 2022; 14:17562872221105018. [PMID: 35755177 PMCID: PMC9218890 DOI: 10.1177/17562872221105018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Molecular imaging of prostate cancer continues to grow, with recent inclusion of several positron emission tomography (PET) radiotracers into the recent National Comprehensive Cancer Network guidelines and the US Food and Drug Administration approval of prostate-specific membrane antigen (PSMA)-targeted radiotracers. While much of the work for many of these radiotracers is focused on systemic staging and restaging in both newly diagnosed high-risk prostate cancer and biochemically recurrent disease patients, the potential role of molecular imaging for the detection of localized prostate cancer has not yet been fully established. The primary aim of this article will be to present the potential role for molecular imaging in the detection of localized prostate cancer and discuss potential advantages and disadvantages to utilization of both PET/computed tomography (CT) and PET/magnetic resonance imaging (MRI) for this clinical indication of use.
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Affiliation(s)
- Samuel J Galgano
- Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, JT J779, Birmingham, AL 35294, USA
| | - Janelle T West
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Manafi-Farid R, Ranjbar S, Jamshidi Araghi Z, Pilz J, Schweighofer-Zwink G, Pirich C, Beheshti M. Molecular Imaging in Primary Staging of Prostate Cancer Patients: Current Aspects and Future Trends. Cancers (Basel) 2021; 13:5360. [PMID: 34771523 PMCID: PMC8582501 DOI: 10.3390/cancers13215360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
Accurate primary staging is the cornerstone in all malignancies. Different morphological imaging modalities are employed in the evaluation of prostate cancer (PCa). Regardless of all developments in imaging, invasive histopathologic evaluation is still the standard method for the detection and staging of the primary PCa. Magnetic resonance imaging (MRI) and computed tomography (CT) play crucial roles; however, functional imaging provides additional valuable information, and it is gaining ever-growing acceptance in the management of PCa. Targeted imaging with different radiotracers has remarkably evolved in the past two decades. [111In]In-capromab pendetide scintigraphy was a new approach in the management of PCa. Afterwards, positron emission tomography (PET) tracers such as [11C/18F]choline and [11C]acetate were developed. Nevertheless, none found a role in the primary staging. By introduction of the highly sensitive small molecule prostate-specific membrane antigen (PSMA) PET/CT, as well as recent developments in MRI and hybrid PET/MRI systems, non-invasive staging of PCa is being contemplated. Several studies investigated the role of these sophisticated modalities in the primary staging of PCa, showing promising results. Here, we recapitulate the role of targeted functional imaging. We briefly mention the most popular radiotracers, their diagnostic accuracy in the primary staging of PCa, and impact on patient management.
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Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran 1411713135, Iran;
| | - Shaghayegh Ranjbar
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Zahra Jamshidi Araghi
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Julia Pilz
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Gregor Schweighofer-Zwink
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Christian Pirich
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Mohsen Beheshti
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
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4
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Regmi SK, Sathianathen N, Stout TE, Konety BR. MRI/PET Imaging in elevated PSA and localized prostate cancer: a narrative review. Transl Androl Urol 2021; 10:3117-3129. [PMID: 34430415 PMCID: PMC8350235 DOI: 10.21037/tau-21-374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To review the recent milestones in MRI and PET based imaging and evaluate their evolving role in the setting of elevated PSA as well as localized prostate cancer. Background The importance of multiparametric MRI (mpMRI) and PET based imaging for the diagnosis and staging of prostate cancer cannot be understated. Accurate staging has become another significant milestone with the use of PET scans, particularly with prostate specific radiotracers like 68-Gallium Prostate Specific Membrane Antigen (68Ga-PSMA). Integrated PET/MRI systems are commercially available and can be modulated to evaluate the unique needs of localized as well as recurrent prostate cancer. Methods A literature search was performed using PubMed and Google Scholar using the MeSH compliant and other keywords that included prostate cancer, PSA, mpMRI, PET CT, PET/MRI. Conclusions mpMRI has now established itself as the gold-standard of local prostate imaging and has been incorporated into international guidelines as part of the diagnostic work-up of prostate cancer. PSMA PET/CT has shown superiority over conventional imaging even in staging of localized prostate cancer based on recent randomized control data. Imaging parameters from PET/MRI have been shown to be associated with malignancy, Gleason score and tumour volume. As mpMRI and PSMA PET/CT become more ubiquitous and established; we can anticipate more high-quality data, cost optimization and increasing availability of PET/MRI to be ready for primetime in localized prostate cancer.
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Affiliation(s)
- Subodh K Regmi
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas E Stout
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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5
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Garcia J, Compte A, Galan C, Cozar M, Buxeda M, Mourelo S, Piñeiro T, Soler M, Valls E, Bassa P, Santabarbara J. 18F-choline PET/MR in the initial staging of prostate cancer. Impact on the therapeutic approach. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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6
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18F-choline PET/MRI on initial staging of prostate cancer. Impact on therapy approach. Rev Esp Med Nucl Imagen Mol 2021; 40:72-81. [PMID: 33579662 DOI: 10.1016/j.remn.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022]
Abstract
AIM Evaluate the therapy impact of initial staging in patients diagnosed with prostate cancer by 18 F-choline PET/MRI hybrid technique. MATERIAL A prospective study which included 31 patients diagnosed with prostate cancer; Gleason > 7; mean PSA 13.6 ng/mL (range 6.3-20.6). PET/MRI studies were acquired simultaneously with hybrid equipment (SIGNA.3T, GE) following intravenous injection of 185 ± 18.5MBq of 18F-choline: - Early/prostate imaging: PET emission + multiparametric MR: DIXON-T1-T2-diffusion-gadolinium. - Late/whole-body imaging: PET emission + MR: DIXON-T1-T2-diffusion-STIR sequences. Images were visually evaluated. SUV & ADC & textures were also calculated. Treatment selection was based upon Oncology Committee consensus decision. RESULTS Procedure was well tolerated in all patients, and no artifacts were reported. MRI was superior in T staging in eight patients (25.8%) (Likert: 2-3), whereas PET increased MRI sensitivity in three patients (9.7%) (PIRADS: 3). PROSTATE LESION LOCATION Peripheral 91.4%, transitional 8.6%. SUVmax threshold: 2.95: sensitivity 92.9%, specificity 66.7%. No correlation SUV vs. ADC. Better distinction between stage T2 vs. T3 using the DiscrLin model with NG = 16 (AUC 0.7767 ± 0.3386). PET was superior to T2 in textures analysis (0.588 vs. 0.412). Seventeen patients (54.8%) were staged ≥ T3, with surgical treatment being contraindicated. Fifteen patients (48.4%) presented with extra-prostatic disease: 8/31 oligometastatic and 7/31 multiple metastasis. Therapy approach following PET/MRI was: radical treatment in 24/31 patients (77.4%), 14 radical prostatectomy and 10 MRI-guided radiotherapy; systemic treatment in 7/31 patients (22.6%). CONCLUSION 18F-choline PET/MRI had a complementary role for the T staging, with a high detection rate for NM infiltration. PET/MRI findings allowed patients to be directed either to prostatectomy or MRI-guided radiotherapy, and thus avoiding radicaltreatment in 22.6% of patients.
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7
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Prostate Cancer: Prostate-specific Membrane Antigen Positron-emission Tomography/Computed Tomography or Positron-emission Tomography/Magnetic Resonance Imaging for Staging. Top Magn Reson Imaging 2020; 29:59-66. [PMID: 32015295 DOI: 10.1097/rmr.0000000000000229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Positron-emission tomography (PET) with prostate-specific membrane antigen (PSMA) has been increasingly used to image prostate cancer in the last decade. In the staging setting several studies have already been published suggesting PSMA PET can be a valuable tool. They, however, did not translate into recommendations by guidelines. Both PSMA PET/computed tomography (CT) and PET/magnetic resonance imaging have been investigated in the staging setting, showing higher detection rate of prostate cancer lesions over the conventional imaging work-up and some studies already showed an impact on disease management. The aim of this review is to provide an overview of the existing published data regarding PSMA PET for staging prostate cancer, with emphasis on PET/magnetic resonance imaging. Despite the fact that PSMA is a relatively new tool and not officially recommended for staging yet, there are >50 original studies in the literature assessing PSMA PET performance in the staging setting of prostate cancer, and some meta-analyses.
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8
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Lebastchi AH, Gupta N, DiBianco JM, Piert M, Davenport MS, Ahdoot MA, Gurram S, Bloom JB, Gomella PT, Mehralivand S, Turkbey B, Pinto PA, George AK. Comparison of cross-sectional imaging techniques for the detection of prostate cancer lymph node metastasis: a critical review. Transl Androl Urol 2020; 9:1415-1427. [PMID: 32676426 PMCID: PMC7354341 DOI: 10.21037/tau.2020.03.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Conventional staging for prostate cancer (PCa) is performed for men diagnosed with unfavorable-intermediate or higher risk disease. Computed tomography (CT) of the abdomen and pelvis and whole body bone scan remains the standard of care for the detection of visceral, nodal, and bone metastasis. The implementation of the 2012 United States Preventive Services Task Force recommendation against routine prostate specific antigen (PSA) screening resulted in a rise of metastatic PCa at the time of diagnosis, emphasizing the importance of effective imaging modalities for evaluating metastatic disease. CT plays a major role in clinical staging at the time of PCa diagnosis, but multi-parametric magnetic resonance imaging (MRI) is now integrated into many prostate biopsy protocols for the detection of primary PCa, and may be a surrogate for CT for nodal staging. Current guidelines incorporate both CT and MRI as appropriate cross-sectional imaging modalities for the identification of nodal metastasis in indicated patients. There is an ongoing debate about the utility of traditional cross-sectional imaging modalities as well as advanced imaging modalities in detection of both organ-confined PCa detection and nodal involvement.
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Affiliation(s)
- Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nikhil Gupta
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - John M DiBianco
- Department of Urology, George Washington University Medical School, Washington D.C., USA
| | - Morand Piert
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael A Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Patrick T Gomella
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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9
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Nikas JB, Mitanis NT, Nikas EG. Whole Exome and Transcriptome RNA-Sequencing Model for the Diagnosis of Prostate Cancer. ACS OMEGA 2020; 5:481-486. [PMID: 31956794 PMCID: PMC6964263 DOI: 10.1021/acsomega.9b02995] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/18/2019] [Indexed: 06/02/2023]
Abstract
In our previous study, we developed a genome-wide DNA methylation model for the diagnosis of prostate cancer, and we pointed out that a considerable average error is associated with the current method for the diagnosis of prostate cancer, which is predicated on pathological assessment of biopsied tissue. In this study, we utilized whole exome and transcriptome RNA-sequencing (RNA-seq) data that were derived from 468 tumor samples and 51 normal samples of prostatic tissue, and we analyzed over 20,000 genes per sample. We were able to develop a mathematical model that classified tumor tissue versus normal tissue with a high accuracy. The overall sensitivity was 97.01%, and the overall specificity was 94.12%. The input variables to the model were the mRNA expression values of the following nine genes: ANGPT1, MED21, AOX1, PLP2, HPN, HPN-AS1, EPHA10, NKX2-3, and LRFN1. The model was validated with unknown samples, with a 10-fold cross-validation, and a leave-one-out cross-validation. We present here a genomic model, based on a whole exome and transcriptome RNA-seq analysis of biopsied prostatic tissue, that could be utilized in the diagnosis of prostate cancer.
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Affiliation(s)
- Jason B. Nikas
- Research
& Development, Genomix Inc., Minneapolis, Minnesota 55364, United States
| | - Nikos T. Mitanis
- Department
of Mathematics, University of the Aegean, Samos 83200, Greece
| | - Emily G. Nikas
- School
of Mathematics, University of Minnesota, Minneapolis, Minnesota 55455, United States
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10
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Nikas JB, Nikas EG. Genome-Wide DNA Methylation Model for the Diagnosis of Prostate Cancer. ACS OMEGA 2019; 4:14895-14901. [PMID: 31552329 PMCID: PMC6751714 DOI: 10.1021/acsomega.9b01613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/22/2019] [Indexed: 06/02/2023]
Abstract
Prostate cancer is the most prevalent and the second most lethal malignancy among males in the United States of America. Its diagnosis is almost entirely predicated upon histopathological analysis of the biopsied tissue, and it is associated with a substantial average error. Using genome-wide DNA methylation data derived from 469 prostatic tumor tissue samples and 50 normal prostatic tissue samples and interrogating over 485 000 CpG sites per sample (spanning across gene promoters, CpG islands, shores, shelves, gene bodies, and intergenic and other areas), we were able to develop a mathematical model that classified with a high accuracy (overall sensitivity = 95.31% and overall specificity = 94.00%) tumor tissue versus normal tissue. The methylation β values of five CpG sites, corresponding to the genes LINC01091, RPS15, SNORA10, and two unknown DNA areas in chromosome 1, provided the input to the model. The model was validated with unknown samples, as well as with a sixfold cross-validation and a leave-one-out cross-validation. This study presents a novel genomic model based on genome-wide DNA methylation analysis of biopsied prostatic tissue that could aid in the diagnosis of prostate cancer and help advance the transition to genomic medicine.
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Affiliation(s)
- Jason B. Nikas
- Research &
Development, Genomix Incorporation, Minneapolis, Minnesota 55364, United States
| | - Emily G. Nikas
- School
of Mathematics, University of Minnesota, Minneapolis, Minnesota 55455, United States
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11
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Davenport MS, Montgomery JS, Kunju LP, Siddiqui J, Shankar PR, Rajendiran T, Shao X, Lee E, Denton B, Barnett C, Piert M. 18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 1. Improved Risk Stratification for MRI-Guided Transrectal Prostate Biopsies. J Nucl Med 2019; 61:337-343. [PMID: 31420496 DOI: 10.2967/jnumed.119.225789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/24/2019] [Indexed: 01/21/2023] Open
Abstract
A prospective single-arm clinical trial was conducted to determine whether 18F-choline PET/mpMRI can improve the specificity of multiparametric MRI (mpMRI) of the prostate for Gleason ≥ 3+4 prostate cancer. Methods: Before targeted and systematic prostate biopsy, mpMRI and 18F-choline PET/CT were performed on 56 evaluable subjects with 90 Likert score 3-5 mpMRI target lesions, using a 18F-choline target-to-background ratio of greater than 1.58 to indicate a positive 18F-choline result. Prostate biopsies were performed after registration of real-time transrectal ultrasound with T2-weighted MRI. A mixed-effects logistic regression was applied to measure the performance of mpMRI (based on prospective Likert and retrospective Prostate Imaging Reporting and Data System, version 2 [PI-RADS], scores) compared with 18F-choline PET/mpMRI to detect Gleason ≥ 3+4 cancer. Results: The per-lesion accuracy of systematic plus targeted biopsy for mpMRI alone was 67.8% (area under receiver-operating-characteristic curve [AUC], 0.73) for Likert 4-5 and 70.0% (AUC, 0.76) for PI-RADS 3-5. Several PET/MRI models incorporating 18F-choline with mpMRI data were investigated. The most promising model selected all high-risk disease on mpMRI (Likert 5 or PI-RADS 5) plus low- and intermediate-risk disease (Likert 4 or PI-RADS 3-4), with an elevated 18F-choline target-to-background ratio greater than 1.58 as positive for significant cancer. Using this approach, the accuracy on a per-lesion basis significantly improved to 88.9% for Likert (AUC, 0.90; P < 0.001) and 91.1% for PI-RADS (AUC, 0.92; P < 0.001). On a per-patient basis, the accuracy improved to 92.9% for Likert (AUC, 0.93; P < 0.001) and to 91.1% for PI-RADS (AUC, 0.91; P = 0.009). Conclusion: 18F-choline PET/mpMRI improved the identification of Gleason ≥ 3+4 prostate cancer compared with mpMRI, with the principal effect being improved risk stratification of intermediate-risk mpMRI lesions.
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Affiliation(s)
- Matthew S Davenport
- Radiology Department, University of Michigan, Ann Arbor, Michigan.,Urology Department, University of Michigan, Ann Arbor, Michigan
| | | | | | - Javed Siddiqui
- Pathology Department, University of Michigan, Ann Arbor, Michigan
| | - Prasad R Shankar
- Radiology Department, University of Michigan, Ann Arbor, Michigan
| | | | - Xia Shao
- Radiology Department, University of Michigan, Ann Arbor, Michigan
| | - Eunjee Lee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.,Department of Information and Statistics, Chungnam National University, Daejeon, South Korea
| | - Brian Denton
- RTI Health Solutions, Research Triangle Park, North Carolina; and
| | - Christine Barnett
- RTI Health Solutions, Research Triangle Park, North Carolina; and.,Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Morand Piert
- Radiology Department, University of Michigan, Ann Arbor, Michigan
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12
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Barnett CL, Davenport MS, Montgomery JS, Kunju LP, Denton BT, Piert M. 18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 2. Cost-Effectiveness Analysis. J Nucl Med 2019; 60:1705-1712. [PMID: 31350321 DOI: 10.2967/jnumed.119.225771] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/30/2019] [Indexed: 01/29/2023] Open
Abstract
The objective of this study was to evaluate the cost-effectiveness of 18F-choline PET/multiparametric MRI (mpMRI) versus mpMRI alone for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 in men with elevated prostate-specific antigen levels. Methods: A Markov model of prostate cancer onset and progression was used to estimate the health and economic consequences of 18F-choline PET/mpMRI for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 in men with elevated prostate-specific antigen levels. Multiple simultaneous hybrid 18F-choline PET/mpMRI strategies were evaluated using Likert or Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) scoring; the first was biopsy for Likert 5 mpMRI lesions or Likert 3-4 lesions with 18F-choline target-to-background ratios of greater than or equal to 1.58, and the second was biopsy for PI-RADSv2 5 mpMRI lesions or PI-RADSv2 3-4 mpMRI lesions with 18F-choline target-to-background ratios of greater than or equal to 1.58. These strategies were compared with universal standard biopsy, mpMRI alone with biopsy only for PI-RADSv2 3-5 lesions, and mpMRI alone with biopsy only for Likert 4-5 lesions. For each mpMRI strategy, either no biopsy or standard biopsy could be performed after negative mpMRI results were obtained. Deaths averted, quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratios were estimated for each strategy. Results: When the results of 18F-choline PET/mpMRI were negative, performing a standard biopsy was more expensive and had lower QALYs than performing no biopsy. The best screening strategy among those considered in this study performed hybrid 18F-choline PET/mpMRI with Likert scoring on men with elevated PSA, performed combined biopsy (targeted biopsy and standard 12-core biopsy) for men with positive imaging results, and no biopsy for men with negative imaging results ($22,706/QALY gained relative to mpMRI alone); this strategy reduced the number of biopsies by 35% in comparison to mpMRI alone. When the same policies were compared using PI-RADSv2 instead of Likert scoring, hybrid 18F-choline PET/mpMRI cost $46,867/QALY gained relative to mpMRI alone. In a threshold analysis, the best strategy among those considered remained cost-effective when the sensitivity and specificity of PET/mpMRI and combined biopsy (targeted biopsy and standard 12-core biopsy) were simultaneously reduced by 20 percentage points. Conclusion: 18F-choline PET/mpMRI for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 is cost-effective and can reduce the number of unneeded biopsies in comparison to mpMRI alone.
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Affiliation(s)
- Christine L Barnett
- RTI Health Solutions, Research Triangle Park, North Carolina.,Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, Ann Arbor, Michigan.,Department of Urology, University of Michigan, Ann Arbor, Michigan; and
| | | | | | - Brian T Denton
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan.,Department of Urology, University of Michigan, Ann Arbor, Michigan; and
| | - Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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13
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Feasibility and Initial Results: Fluciclovine Positron Emission Tomography/Ultrasound Fusion Targeted Biopsy of Recurrent Prostate Cancer. J Urol 2019; 202:413-421. [PMID: 30817240 DOI: 10.1097/ju.0000000000000200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We assessed the feasibility and cancer detection rate of fluciclovine (18F) positron emission tomography-ultrasound fusion targeted biopsy vs standard template biopsy in the same patient with biochemical failure after nonsurgical therapy for prostate cancer. MATERIALS AND METHODS A total of 21 patients with a mean ± SD prostate specific antigen of 7.4 ± 6.8 ng/ml and biochemical failure after nonoperative prostate cancer treatment underwent fluciclovine (18F) positron emission tomography-computerized tomography (mean 364.1 ± 37.7 MBq) and planning transrectal prostate ultrasound with 3-dimensional image reconstruction. Focal prostatic activity on positron emission tomography was delineated and co-registered with planning ultrasound. During the subsequent biopsy session computer generated 12-core template biopsies were performed and then fluciclovine defined targets were revealed and biopsied. Histological analysis of template and targeted cores were completed. RESULTS Template biopsy was positive for malignancy in 6 of 21 patients (28.6%), including 10 of 124 regions and 11 of 246 cores, vs targeted biopsy in 10 of 21 (47.6%), including 17 of 50 regions and 40 of 125 cores. Five of 21 patients had positive findings on targeted biopsy only and 1 of 21 had positive findings on template biopsy only. An additional case was upgraded from Grade Group 2 to 3 on targeted biopsy. Extraprostatic disease was detected in 8 of 21 men (38.1%) with histological confirmation in all 3 who underwent lesion biopsy. CONCLUSIONS Fluciclovine positron emission tomography real-time ultrasound fusion guidance for biopsy is feasible in patients with biochemical failure after nonsurgical therapy for prostate cancer. It identifies more recurrent prostate cancer using fewer cores compared with template biopsy in the same patient. Further study is required to determine in what manner targeted biopsy may augment template biopsy of recurrent prostate cancer.
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14
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Abiodun-Ojo OA, Akintayo AA, Akin-Akintayo OO, Tade FI, Nieh PT, Master VA, Alemozaffar M, Osunkoya AO, Goodman MM, Fei B, Schuster DM. 18F-Fluciclovine Parameters on Targeted Prostate Biopsy Associated with True Positivity in Recurrent Prostate Cancer. J Nucl Med 2019; 60:1531-1536. [PMID: 30954940 DOI: 10.2967/jnumed.119.227033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022] Open
Abstract
We evaluated 18F-fluciclovine uptake parameters that correlate with true positivity for local recurrence in non-prostatectomy-treated patients. Methods: Twenty-one patients (prostate-specific antigen level, 7.4 ± 6.8 ng/mL) with biochemical recurrence after nonprostatectomy local therapy (radiotherapy and cryotherapy) underwent dual-time-point 18F-fluciclovine (364.1 ± 37.7 MBq) PET/CT from pelvis to diaphragm. Prostatic uptake over background was delineated and coregistered to a prostate-biopsy-planning ultrasound. Transrectal biopsies of 18F-fluciclovine-defined targets were completed using a 3-dimensional visualization and navigation platform. Histologic analyses of lesions were completed. Lesion characteristics including SUVmax, target-to-background ratio (TBR), uptake pattern, and subjective reader's suspicion level were compared between true-positive (malignant) and false-positive (benign) lesions. Univariate analysis was used to determine the association between PET and histologic findings. Receiver-operating-characteristic curves were plotted to determine discriminatory cutoffs for TBR. Statistical significance was set at a P value of less than 0.05. Results: Fifty lesions were identified in 21 patients on PET. Seventeen of 50 (34.0%) targeted lesions in 10 of 21 patients were positive for malignancy. True-positive lesions had a significantly higher SUVmax (6.62 ± 1.70 vs. 4.92 ± 1.27), marrow TBR (2.57 ± 0.81 vs. 1.69 ± 0.51), and blood-pool TBR (4.10 ± 1.17 vs. 2.99 ± 1.01) than false-positive lesions at the early time point (P < 0.01) and remained significant at the delayed time point, except for blood-pool TBR. Focal uptake (odds ratio, 12.07; 95% confidence interval, 2.98-48.80; P < 0.01) and subjective highest suspicion level (odds ratio, 10.91; 95% confidence interval, 1.19-99.69; P = 0.03) correlated with true positivity. Using the receiver-operating-characteristic curve, optimal cutoffs for marrow TBR were 1.9 (area under the curve, 0.82) and 1.8 (area under the curve, 0.85) at early and delayed imaging, respectively. With these cutoffs, 15 of 17 malignant lesions were identified at both time points; however, fewer false-positive lesions were detected at the delayed time point (5/33) than at the early time point (11/33). Conclusion: True positivity of 18F-fluciclovine-targeted prostate biopsy in non-prostatectomy-treated patients correlates with focal uptake, TBR (blood pool and marrow), and subjective highest suspicion level. A marrow TBR of 1.9 at the early time point and 1.8 at the delayed time point had optimal discriminating capabilities. Despite the relatively low intraprostate positive predictive value (34.0%) with 18F-fluciclovine, application of these parameters to interpretative criteria may improve true positivity in the treated prostate.
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Affiliation(s)
- Olayinka A Abiodun-Ojo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Akinyemi A Akintayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Oladunni O Akin-Akintayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Funmilayo I Tade
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Peter T Nieh
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Adeboye O Osunkoya
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mark M Goodman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Emory University Center for Systems Imaging, Atlanta, Georgia
| | - Baowei Fei
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Bioengineering, Erick Josson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, Texas; and.,Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David M Schuster
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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15
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Li M, Huang Z, Yu H, Wang Y, Zhang Y, Song B. Comparison of PET/MRI with multiparametric MRI in diagnosis of primary prostate cancer: A meta-analysis. Eur J Radiol 2019; 113:225-231. [PMID: 30927951 DOI: 10.1016/j.ejrad.2019.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This meta-analysis aimed to compare the diagnostic performance of positron emission tomography (PET)/MRI using various radiotracers with multiparametric (mp) MRI for detection of primary prostate cancer (PCa). METHODS A systematic literature search up to January 2019 was performed to identify studies that evaluated the diagnostic value of PET/MRI and mpMRI for detection of PCa in the same patient cohorts and had sufficient data to construct 2 × 2 contingency tables for true-positive (TP), false-positive (FP), false-negative (FN), and true-negative (TN) results. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and pooled sensitivity (SEN) and specificity (SPE) were calculated. Summary receiver operating characteristic (ROC) curves and area under the curves (AUCs) were used to compare the performances of PET/MRI and mpMRI. RESULTS We identified 9 eligible studies that included a total of 353 patients. PET/MRI had a SEN of 0.783 (95% CI, 0.758-0.807) and a SPE of 0.899 (95% CI, 0.879-0.917), and mpMRI had a SEN of 0.603 (95% CI, 0.574-0.631) and a SPE of 0.887 (95% CI, 0.866-0.906). PET/MRI had a higher AUC than mpMRI (0.9311, 95% CI, 0.8990-0.9632 vs. 0.8403, 95% CI, 0.7864-0.8942; P = 0.0036). There was no notable publication bias, but there was medium heterogeneity in outcomes. The meta-regression analysis showed the major potential cause of heterogeneity was the use of region-based rather than lesion-based analysis. CONCLUSION PET/MRI has very good diagnostic performance and outperforms mpMRI for the diagnosis of primary PCa.
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Affiliation(s)
- Mou Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zixing Huang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Haopeng Yu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yi Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yongchang Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
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16
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Gennaro KH, Porter KK, Gordetsky JB, Galgano SJ, Rais-Bahrami S. Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification. Diagnostics (Basel) 2018; 8:diagnostics8040080. [PMID: 30513602 PMCID: PMC6316045 DOI: 10.3390/diagnostics8040080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.
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Affiliation(s)
- Kyle H Gennaro
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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17
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Grubmüller B, Baltzer P, Hartenbach S, D'Andrea D, Helbich TH, Haug AR, Goldner GM, Wadsak W, Pfaff S, Mitterhauser M, Balber T, Berroteran-Infante N, Grahovac M, Babich J, Seitz C, Kramer G, Susani M, Mazal P, Kenner L, Shariat SF, Hacker M, Hartenbach M. PSMA Ligand PET/MRI for Primary Prostate Cancer: Staging Performance and Clinical Impact. Clin Cancer Res 2018; 24:6300-6307. [PMID: 30139879 DOI: 10.1158/1078-0432.ccr-18-0768] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/11/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Primary staging of prostate cancer relies on modalities, which are limited. We evaluate simultaneous [68Ga]Ga-PSMA-11 PET (PSMA-PET)/MRI as a new diagnostic method for primary tumor-node-metastasis staging compared with histology and its impact on therapeutic decisions. EXPERIMENTAL DESIGN We investigated 122 patients with PSMA-PET/MRI prior to planned radical prostatectomy (RP). Primary endpoint was the accuracy of PSMA-PET/MRI in tumor staging as compared with staging-relevant histology. In addition, a multidisciplinary team reassessed the initial therapeutic approach to evaluate its impact on the therapeutic management. RESULTS PSMA-PET/MRI correctly identified prostate cancer in 119 of 122 patients (97.5%). Eighty-one patients were treated with RP and pelvic lymphadenectomy. The accuracy for T staging was 82.5% [95% confidence interval (CI), 73-90; P < 0.001], for T2 stage was 85% (95% CI, 71-94; P < 0.001), for T3a stage was 79% (95% CI, 43-85; P < 0.001), for T3b stage was 94% (95% CI, 73-100; P < 0.001), and for N1 stage was 93% (95% CI, 84-98; P < 0.001). PSMA-PET/MRI changed the therapeutic strategy in 28.7% of the patients with either the onset of systemic therapy/radiotherapy (n = 16) or active surveillance (n = 19). CONCLUSIONS PSMA-PET/MRI can provide an accurate staging of newly diagnosed prostate cancer. In addition, treatment strategies were changed in almost a third of the patients due to the information of this hybrid imaging technique.
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Affiliation(s)
| | - Pascal Baltzer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gregor M Goldner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Sarah Pfaff
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria
| | - Theresa Balber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Neydher Berroteran-Infante
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marko Grahovac
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - John Babich
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Medical College of Cornell University, New York, New York
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Martin Susani
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Peter Mazal
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Lukas Kenner
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Experimental and Laboratory Animal Pathology, Medical University of Vienna, Vienna, Austria.,Institute of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, University of Texas Southwestern, Dallas, Texas.,Department of Urology and Division of Medical Oncology, Weill Medical College of Cornell University, New York, New York
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria.
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18
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68Ga-PSMA-PET: added value and future applications in comparison to the current use of choline-PET and mpMRI in the workup of prostate cancer. Radiol Med 2018; 123:952-965. [PMID: 30116970 DOI: 10.1007/s11547-018-0929-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/07/2018] [Indexed: 12/24/2022]
Abstract
Positron emission tomography (PET) has been commonly and successfully used, in combination with computed tomography (CT) and more recently magnetic resonance (MRI), in the workup of intermediate or high-risk prostate cancer (PCa). Nowadays, new specific receptor targeted PET tracers in prostate cancer imaging have been introduced; one of the most used is 68Ga-PSMA, that evaluates the expression of prostate-specific membrane antigen (PSMA). This tracer has been rapidly taken into account for its better sensitivity and specificity compared to lipid metabolism tracers, such as 11C/18F labelled fluorocholine. Besides, in the era of theranostics, this tracer is having a useful application not only for imaging but also for therapeutic purposes. The aim of this review article is, in the first part, to give an overview of the main indications and future development of 68Ga-PSMA imaging, using PET/CT or PET/MRI, according to the clinical course of the disease and in view of the current use of multiparametric MRI (mpMRI) and choline PET in the management of PCa. In the second part, a brief overview of the promising 18F-labelled PSMA tracers and the current use of PSMA radionuclide therapy will be provided.
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19
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Palard-Novello X, Blin AL, Le Jeune F, Garin E, Salaün PY, Devillers A, Gambarota G, Querellou S, Bourguet P, Saint-Jalmes H. Optimization of temporal sampling for 18F-choline uptake quantification in prostate cancer assessment. EJNMMI Res 2018; 8:49. [PMID: 29904817 PMCID: PMC6002329 DOI: 10.1186/s13550-018-0410-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/06/2018] [Indexed: 01/12/2023] Open
Abstract
Background Suboptimal temporal sampling of time-activity curves (TAC) from dynamic 18F-fluoromethylcholine (FCH) PET images may introduce bias in quantification of FCH uptake in prostate cancer assessment. We sought to define an optimal temporal sampling protocol for dynamic FCH PET imaging. Seven different time samplings were tested: 5 × 60″, 10 × 30″, 15 × 15″–1 × 75″, 6 × 10″–8 × 30″, 12 × 5″–8 × 30″; 10 × 5″–4 × 10″–3 × 20″–5 × 30″, and 8 × 3″–8 × 12″–6 × 30″. First, the irreversible and reversible one-tissue compartment model with blood volume parameter (VB) (respectively, 1T1K+VB and 1T2k+VB, with K1 = transfer coefficient from the arterial blood to the tissue compartment and k2 = transfer coefficient from the tissue compartment to the arterial blood) were compared for 37 lesions from 32 patients who underwent FCH PET imaging for initial or recurrence assessment of prostate cancer, and the model was selected using the Akaike information criterion. To determine the optimal time sampling, K1 values extracted from 1000 noisy-simulated TAC using Monte Carlo method from the seven different time samplings were compared to a target K1 value which is the average of the K1 values extracted from the 37 lesions using an imaging-derived input function for each patient. K1 values extracted with the optimal time sampling for each tumoral lesion were compared to K1 values extracted from each of the other time samplings for the 37 lesions. Results The 1T2k + VB model was selected. The target K1 value as the objective was 0.506 mL/ccm/min (range 0.216–1.246). Results showed a significant difference between K1 values from the simulated TAC with the seven different time samplings analyzed. The closest K1 value from the simulated TAC to the target K1 value was obtained by the 12 × 5″–8 × 30″ time sampling. Concerning the clinical validation, K1 values extracted from the optimal time sampling (12 × 5″–8 × 30″) were significantly different with K1 values extracted from the other time samplings, except for the comparison with K1 values extracted from the 10 × 5″–4 × 10″–3 × 20″–5 × 30″ time sampling. Conclusions A two-phase framing of dynamic PET reconstruction with frame durations of 5 s (blood phase) and 30 s (tissue phase) could be used to sample the TAC for uptake quantification in prostate cancer assessment.
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Affiliation(s)
- Xavier Palard-Novello
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France. .,Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.
| | - Anne-Lise Blin
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France
| | - Florence Le Jeune
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.,Univ Rennes-EA 4712, Rennes, France
| | - Etienne Garin
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.,UMR 124, Univ Rennes, Inserm, Rennes, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale-EA 3878, Brest, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | | | - Solène Querellou
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale-EA 3878, Brest, France
| | - Patrick Bourguet
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | - Hervé Saint-Jalmes
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France.,Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
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20
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Muehlematter UJ, Nagel HW, Becker A, Mueller J, Vokinger KN, de Galiza Barbosa F, Ter Voert EEGT, Veit-Haibach P, Burger IA. Impact of time-of-flight PET on quantification accuracy and lesion detection in simultaneous 18F-choline PET/MRI for prostate cancer. EJNMMI Res 2018; 8:41. [PMID: 29855728 PMCID: PMC5981153 DOI: 10.1186/s13550-018-0390-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/18/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accurate attenuation correction (AC) is an inherent problem of positron emission tomography magnetic resonance imaging (PET/MRI) systems. Simulation studies showed that time-of-flight (TOF) detectors can reduce PET quantification errors in MRI-based AC. However, its impact on lesion detection in a clinical setting with 18F-choline has not yet been evaluated. Therefore, we compared TOF and non-TOF 18F-choline PET for absolute and relative difference in standard uptake values (SUV) and investigated the detection rate of metastases in prostate cancer patients. RESULTS Non-TOF SUV was significantly lower compared to TOF in all osseous structures, except the skull, in primary lesions of the prostate, and in pelvic nodal and osseous metastasis. Concerning lymph node metastases, both experienced readers detected 16/19 (84%) on TOF PET, whereas on non-TOF PET readers 1 and 2 detected 11 (58%), and 14 (73%), respectively. With TOF PET readers 1 and 2 detected 14/15 (93%) and 11/15 (73%) bone metastases, respectively, whereas detection rate with non-TOF PET was 73% (11/15) for reader 1 and 53% (8/15) for reader 2. The interreader agreement was good for osseous metastasis detection on TOF (kappa 0.636, 95% confidence interval [CI] 0.453-0.810) and moderate on non-TOF (kappa = 0.600, CI 0.438-0.780). CONCLUSION TOF reconstruction for 18F-choline PET/MRI shows higher SUV measurements compared to non-TOF reconstructions in physiological osseous structures as well as pelvic malignancies. Our results suggest that addition of TOF information has a positive impact on lesion detection rate for lymph node and bone metastasis in prostate cancer patients.
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Affiliation(s)
- Urs J Muehlematter
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Hannes W Nagel
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Anton Becker
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Julian Mueller
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Edwin E G T Ter Voert
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Patrick Veit-Haibach
- Department Joint Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Irene A Burger
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
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21
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Multiparametric magnetic resonance imaging versus Partin tables and the Memorial Sloan-Kettering cancer center nomogram in risk stratification of patients with prostate cancer referred to external beam radiation therapy. Radiol Med 2018; 123:778-787. [DOI: 10.1007/s11547-018-0903-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/02/2018] [Indexed: 12/30/2022]
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22
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Elschot M, Selnæs KM, Johansen H, Krüger-Stokke B, Bertilsson H, Bathen TF. The Effect of Including Bone in Dixon-Based Attenuation Correction for 18F-Fluciclovine PET/MRI of Prostate Cancer. J Nucl Med 2018; 59:1913-1917. [PMID: 29728516 DOI: 10.2967/jnumed.118.208868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/24/2018] [Indexed: 01/04/2023] Open
Abstract
The objective of this study was to evaluate the effect of including bone in Dixon-based attenuation correction for 18F-fluciclovine PET/MRI of primary and recurrent prostate cancer. Methods: 18F-fluciclovine PET data from 2 PET/MRI studies-one for staging of high-risk prostate cancer (28 patients) and one for diagnosis of recurrent prostate cancer (81 patients)-were reconstructed with a 4-compartment (reference) and 5-compartment attenuation map. In the latter, continuous linear attenuation coefficients for bone were included by coregistration with an atlas. The SUVmax and mean 50% isocontour SUV (SUViso) of primary, locally recurrent, and metastatic lesions were compared between the 2 reconstruction methods using linear mixed-effects models. In addition, mean SUVs were obtained from bone marrow in the third lumbar vertebra (L3) to investigate the effect of including bone attenuation on lesion-to-bone marrow SUV ratios (SUVRmax and SUVRiso; recurrence study only). The 5-compartment attenuation maps were visually compared with the in-phase Dixon MR images for evaluation of bone registration errors near the lesions. P values of less than 0.05 were considered significant. Results: Sixty-two lesions from 39 patients were evaluated. Bone registration errors were found near 19 (31%) of these lesions. In the remaining 8 primary prostate tumors, 7 locally recurrent lesions, and 28 lymph node metastases without bone registration errors, use of the 5-compartment attenuation map was associated with small but significant increases in SUVmax (2.5%; 95% confidence interval [CI], 2.0%-3.0%; P < 0.001) and SUViso (2.5%; 95% CI, 1.9%-3.0%; P < 0.001), but not SUVRmax (0.2%; 95% CI, -0.5%-0.9%; P = 0.604) and SUVRiso (0.2%; 95% CI -0.6%-1.0%; P = 0.581), in comparison to the 4-compartment attenuation map. Conclusion: The investigated method for atlas-based inclusion of bone in 18F-fluciclovine PET/MRI attenuation correction has only a small effect on the SUVs of soft-tissue prostate cancer lesions, and no effect on their lesion-to-bone marrow SUVRs when using signal from L3 as a reference. The attenuation maps should always be checked for registration artifacts for lesions in or close to the bones.
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Affiliation(s)
- Mattijs Elschot
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kirsten M Selnæs
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Trondheim, Norway
| | - Håkon Johansen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Brage Krüger-Stokke
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology, St. Olavs Hospital, Trondheim, Norway
| | - Helena Bertilsson
- Department of Urology, St. Olavs Hospital, Trondheim, Norway; and.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Trondheim, Norway
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23
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18F-Choline PET/MR Can Detect and Delineate Local Recurrence After High-Intensity Focused Ultrasound Therapy of Prostate Cancer. Clin Nucl Med 2018; 43:e111-e112. [DOI: 10.1097/rlu.0000000000001987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Piert M, Shankar PR, Montgomery J, Kunju LP, Rogers V, Siddiqui J, Rajendiran T, Hearn J, George A, Shao X, Davenport MS. Accuracy of tumor segmentation from multi-parametric prostate MRI and 18F-choline PET/CT for focal prostate cancer therapy applications. EJNMMI Res 2018; 8:23. [PMID: 29589155 PMCID: PMC5869349 DOI: 10.1186/s13550-018-0377-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/15/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The study aims to assess the accuracy of multi-parametric prostate MRI (mpMRI) and 18F-choline PET/CT in tumor segmentation for clinically significant prostate cancer. 18F-choline PET/CT and 3 T mpMRI were performed in 10 prospective subjects prior to prostatectomy. All subjects had a single biopsy-confirmed focus of Gleason ≥ 3+4 cancer. Two radiologists (readers 1 and 2) determined tumor boundaries based on in vivo mpMRI sequences, with clinical and pathologic data available. 18F-choline PET data were co-registered to T2-weighted 3D sequences and a semi-automatic segmentation routine was used to define tumor volumes. Registration of whole-mount surgical pathology to in vivo imaging was conducted utilizing two ex vivo prostate specimen MRIs, followed by gross sectioning of the specimens within a custom-made 3D-printed plastic mold. Overlap and similarity coefficients of manual segmentations (seg1, seg2) and 18F-choline-based segmented lesions (seg3) were compared to the pathologic reference standard. RESULTS All segmentation methods greatly underestimated the true tumor volumes. Human readers (seg1, seg2) and the PET-based segmentation (seg3) underestimated an average of 79, 80, and 58% of the tumor volumes, respectively. Combining segmentation volumes (union of seg1, seg2, seg3 = seg4) decreased the mean underestimated tumor volume to 42% of the true tumor volume. When using the combined segmentation with 5 mm contour expansion, the mean underestimated tumor volume was significantly reduced to 0.03 ± 0.05 mL (2.04 ± 2.84%). Substantial safety margins up to 11-15 mm were needed to include all tumors when the initial segmentation boundaries were drawn by human readers or the semi-automated 18F-choline segmentation tool. Combining MR-based human segmentations with the metabolic information based on 18F-choline PET reduced the necessary safety margin to a maximum of 9 mm to cover all tumors entirely. CONCLUSIONS To improve the outcome of focal therapies for significant prostate cancer, it is imperative to recognize the full extent of the underestimation of tumor volumes by mpMRI. Combining metabolic information from 18F-choline with MRI-based segmentation can improve tumor coverage. However, this approach requires confirmation in further clinical studies.
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Affiliation(s)
- Morand Piert
- Radiology Department, University of Michigan, Ann Arbor, MI USA
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Health System, University Hospital B1G505C, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0028 USA
| | | | | | | | - Virginia Rogers
- Radiology Department, University of Michigan, Ann Arbor, MI USA
| | - Javed Siddiqui
- Pathology Department, University of Michigan, Ann Arbor, MI USA
| | | | - Jason Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI USA
| | - Arvin George
- Urology Department, University of Michigan, Ann Arbor, MI USA
| | - Xia Shao
- Radiology Department, University of Michigan, Ann Arbor, MI USA
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25
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Provost J, Garofalakis A, Sourdon J, Bouda D, Berthon B, Viel T, Perez-Liva M, Lussey-Lepoutre C, Favier J, Correia M, Pernot M, Chiche J, Pouysségur J, Tanter M, Tavitian B. Simultaneous positron emission tomography and ultrafast ultrasound for hybrid molecular, anatomical and functional imaging. Nat Biomed Eng 2018; 2:85-94. [PMID: 31015628 DOI: 10.1038/s41551-018-0188-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 12/23/2017] [Indexed: 12/21/2022]
Abstract
Positron emission tomography-computed tomography (PET-CT) is the most sensitive molecular imaging modality, but it does not easily allow for rapid temporal acquisition. Ultrafast ultrasound imaging (UUI)-a recently introduced technology based on ultrasonic holography-leverages frame rates of up to several thousand images per second to quantitatively map, at high resolution, haemodynamic, biomechanical, electrophysiological and structural parameters. Here, we describe a pre-clinical scanner that registers PET-CT and UUI volumes acquired simultaneously and offers multiple combinations for imaging. We demonstrate that PET-CT-UUI allows for simultaneous images of the vasculature and metabolism during tumour growth in mice and rats, as well as for synchronized multi-modal cardiac cine-loops. Combined anatomical, functional and molecular imaging with PET-CT-UUI represents a high-performance and clinically translatable technology for biomedical research.
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Affiliation(s)
- Jean Provost
- Institut Langevin, Ecole Supérieure de Physique et de Chimie Industrielles, Paris Sciences and Letters Research University CNRS UMR 7587 Inserm U979, Inserm Technology Research Accelerator in Biomedical Ultrasound, Paris, France
| | - Anikitos Garofalakis
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Joevin Sourdon
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Damien Bouda
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Béatrice Berthon
- Institut Langevin, Ecole Supérieure de Physique et de Chimie Industrielles, Paris Sciences and Letters Research University CNRS UMR 7587 Inserm U979, Inserm Technology Research Accelerator in Biomedical Ultrasound, Paris, France
| | - Thomas Viel
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mailyn Perez-Liva
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charlotte Lussey-Lepoutre
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France.,Faculté de Médecine, Université Pierre et Marie Curie, Paris, France.,Nuclear Medicine Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Judith Favier
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mafalda Correia
- Institut Langevin, Ecole Supérieure de Physique et de Chimie Industrielles, Paris Sciences and Letters Research University CNRS UMR 7587 Inserm U979, Inserm Technology Research Accelerator in Biomedical Ultrasound, Paris, France
| | - Mathieu Pernot
- Institut Langevin, Ecole Supérieure de Physique et de Chimie Industrielles, Paris Sciences and Letters Research University CNRS UMR 7587 Inserm U979, Inserm Technology Research Accelerator in Biomedical Ultrasound, Paris, France
| | - Johanna Chiche
- Faculté de Médecine, Université de Nice Sophia Antipolis, Nice, France.,Équipe Contrôle Métabolique des Morts Cellulaires, Inserm, U1065, Centre Méditerranéen de Médecine Moléculaire, Nice, France
| | - Jacques Pouysségur
- Institute for Research on Cancer and Aging, Université de Nice Sophia Antipolis, Centre Antoine Lacassagne, Nice, France.,Department of Medical Biology, Centre Scientifique de Monaco, Monaco, Monaco
| | - Mickael Tanter
- Institut Langevin, Ecole Supérieure de Physique et de Chimie Industrielles, Paris Sciences and Letters Research University CNRS UMR 7587 Inserm U979, Inserm Technology Research Accelerator in Biomedical Ultrasound, Paris, France.
| | - Bertrand Tavitian
- Inserm, UMR970, Paris Cardiovascular Research Center, Paris, France. .,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. .,Department of Radiology, Georges Pompidou European Hospital, Paris, France.
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26
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Bailey J, Piert M. Performance of 68Ga-PSMA PET/CT for Prostate Cancer Management at Initial Staging and Time of Biochemical Recurrence. Curr Urol Rep 2017; 18:84. [PMID: 28889366 DOI: 10.1007/s11934-017-0736-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF THE REVIEW Recently introduced Gallium-68 labeled PSMA-ligands such as HBED-CC (68Ga-PSMA) have shown promise for unmet diagnostic needs in prostate cancer. RECENT FINDINGS 68Ga-PSMA has demonstrated improved detection rates and specificity for prostate cancer compared to standard imaging approaches. In the setting of primary disease, 68Ga-PSMA appears to preferentially identify treatment-relevant intermediate and high-risk prostate cancer. There is also a growing evidence that 68Ga-PSMA positron emission tomography (PET) outperforms alternative conventional imaging methods including choline-based radiotracers for the localization of disease sites at biochemical recurrence, particularly at lower prostate-specific antigen (PSA) levels (< 1 ng/mL). However, the majority of published work lacks rigorous verification of imaging results. 68Ga-PSMA offers significant promise for both, primary disease and biochemically recurrent prostate cancer. The evidence base to support 68Ga-PSMA is however still underdeveloped, and more rigorous studies substantiating efficacy are needed.
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Affiliation(s)
- Jason Bailey
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Health System, University Hospital B1G505C, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-0028, USA.
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27
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Wetter A, Grueneisen J, Umutlu L. PET/MR imaging of pelvic malignancies. Eur J Radiol 2017; 94:A44-A51. [DOI: 10.1016/j.ejrad.2017.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 01/03/2023]
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Abstract
Fluorodeoxyglucose PET and PET/computed tomography have gained acceptance in the evaluation of disease. Nontargeted tracers have been used in the diagnosis of certain malignancies but may not be sensitive or specific enough to become standard of care. Newer targeted PET tracers have been developed that target disease-specific biomarkers, and allow accurate and sensitive detection of disease. Combined with the capabilities of MR imaging to evaluate soft tissue, precision imaging with PET/MR imaging can change the diagnosis. This article discusses specific areas in which precision imaging with nontargeted and targeted diagnostic agents can change the diagnosis and treatment.
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Affiliation(s)
- Eugene Huo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Laura Eisenmenger
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA.
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29
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Vāvere AL, Scott PJH. Clinical Applications of Small-molecule PET Radiotracers: Current Progress and Future Outlook. Semin Nucl Med 2017; 47:429-453. [PMID: 28826519 DOI: 10.1053/j.semnuclmed.2017.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radiotracers, or radiopharmaceuticals, are bioactive molecules tagged with a radionuclide used for diagnostic imaging or radiotherapy and, when a positron-emitting radionuclide is chosen, the radiotracers are used for PET imaging. The development of novel PET radiotracers in many ways parallels the development of new pharmaceuticals, and small molecules dominate research and development pipelines in both disciplines. The 4 decades since the introduction of [18F]FDG have seen the development of many small molecule PET radiotracers. Ten have been approved by the US Food and Drug Administration as of 2016, whereas hundreds more are being evaluated clinically. These radiotracers are being used in personalized medicine and to support drug discovery programs where they are greatly improving our understanding of and ability to treat diseases across many areas of medicine including neuroscience, cardiovascular medicine, and oncology.
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Affiliation(s)
- Amy L Vāvere
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI.
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30
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Piert M, Shao X, Raffel D, Davenport MS, Montgomery J, Kunju LP, Hockley BG, Siddiqui J, Scott PJH, Chinnaiyan AM, Rajendiran T. Preclinical Evaluation of 11C-Sarcosine as a Substrate of Proton-Coupled Amino Acid Transporters and First Human Application in Prostate Cancer. J Nucl Med 2017; 58:1216-1223. [PMID: 28302759 DOI: 10.2967/jnumed.116.173179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/14/2017] [Indexed: 12/14/2022] Open
Abstract
Sarcosine is a known substrate of proton-coupled amino acid transporters (PATs), which are overexpressed in selected tissues and solid tumors. Sarcosine, an N-methyl derivative of the amino acid glycine and a metabolic product of choline, plays an important role for prostate cancer aggressiveness and progression. Methods:11C-radiolabeled sarcosine was tested as a new PET imaging probe in comparison with 11C-choline in 2 prostate cancer tumor xenograft models (DU-145 and PC-3). We characterized 11C-sarcosine transport in PC-3 and LNCaP tumor cells and performed 11C-sarcosine PET with CT in the first human subject with localized Gleason 4 + 3 prostate cancer. Target metabolite analyses of sarcosine and its natural precursors, glycine and choline, were performed from independent human prostate tissues. Results: In vitro assays indicated blockage of 11C-sarcosine uptake into PC-3 and LNCaP tumor cells by excess unlabeled (cold) sarcosine. 5-hydroxy-l-tryptophan, but not 2-aminobicyclo-(2,2,1)-heptane-2-carboxylic acid, competitively inhibited 11C-sarcosine tumor cell uptake, confirming PAT-mediated transport. In vivo tumor-to-background ratios (TBRs) obtained from 11C-sarcosine PET were significantly elevated compared with 11C-choline in DU-145 (TBR: 1.92 ± 0.11 for 11C-sarcosine vs. 1.41 ± 0.13 for 11C-choline [n = 10; P < 0.002]) and PC-3 tumors (TBR: 1.89 ± 0.2 for 11C-sarcosine vs. 1.34 ± 0.16 for 11C-choline [n = 7; P < 0.002]). 11C-sarcosine produced high-contrast images in 1 case of localized clinically significant prostate cancer. Target metabolite analyses revealed significant stepwise increases of sarcosine, glycine, and choline tissue levels from benign prostate tissue to localized prostate cancer and subsequently metastatic disease. 11C-sarcosine showed a favorable radiation dosimetry with an effective dose estimate of 0.0045 mSv/MBq, resulting in 2.68 mSv for a human subject (600-MBq dose). Conclusion:11C-sarcosine is a novel radiotracer for PATs and shows initial utility for prostate cancer imaging, with potential benefit over commonly used 11C-choline.
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Affiliation(s)
- Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Xia Shao
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - David Raffel
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Brian G Hockley
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Javed Siddiqui
- Pathology Department, University of Michigan, Ann Arbor, Michigan; and.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Arul M Chinnaiyan
- Pathology Department, University of Michigan, Ann Arbor, Michigan; and.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Thekkelnaycke Rajendiran
- Pathology Department, University of Michigan, Ann Arbor, Michigan; and.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
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31
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Abstract
18F-fluorocholine (FCH) PET/computed tomography (CT) is a valuable imaging modality in prostate cancer disease. Probably, its main role is restaging of patients with biochemical recurrence after radical prostatectomy or external beam radiotherapy. 18F-FCH PET/CT is strengthening its position in the initial staging, biopsy target definition, radiotherapy planning, and therapy monitoring. Gleason score and prostate-specific antigen value, doubling time, and velocity can influence positivity of 18F-FCH PET/CT. The influence of androgen deprivation therapy on choline uptake is not precisely clarified. Collaboration between nuclear medicine physicians, radiologists, urologists, oncologists, and radiotherapists is crucial to help patients with prostate cancer disease.
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Affiliation(s)
- Marina Hodolič
- Nuclear Medicine Research Department, Iason, Graz, Austria; Department of Nuclear Medicine, Palacký University Olomouc, Olomouc, Czech Republic.
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32
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Gorin MA, Rowe SP, Denmeade SR. Clinical Applications of Molecular Imaging in the Management of Prostate Cancer. PET Clin 2017; 12:185-192. [PMID: 28267452 DOI: 10.1016/j.cpet.2016.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
At the heart of selecting an optimal management strategy for men with prostate cancer is accurately determining a given patient's clinical stage and extent of disease. Molecular imaging with PET using properly selected radiotracers offers the opportunity for improved contrast resolution over conventional imaging and thus increased sensativity for detecting sites of disease. In addition, molecular imaging provides the prospect of obtaining functional or biological information regarding a patient's cancer. To date, several PET radiotracers have been developed for prostate cancer imaging. This review summarizes the potential clinical applications of molecular imaging in the management of men with prostate cancer.
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Affiliation(s)
- Michael A Gorin
- Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 118, Baltimore, MD 21287, USA.
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Samuel R Denmeade
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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33
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PET imaging for lymph node dissection in prostate cancer. World J Urol 2016; 35:507-515. [PMID: 27752756 DOI: 10.1007/s00345-016-1954-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/07/2016] [Indexed: 12/15/2022] Open
Abstract
The detection of neoplastic lymph nodal involvement in prostate cancer (PCa) patients has relevant therapeutic and prognostic significance, both in the clinical settings of primary staging and restaging. Lymph nodal dissection (LND) currently represents the gold standard for evaluating the presence of lymph nodal involvement. However, this procedure is invasive, associated with morbidity, and may fail in detecting all potential lymph nodal metastatic regions. Currently the criteria for lymph nodal detection using conventional imaging techniques mainly rely on morphological assessment with unsatisfactory diagnostic accuracy. Positron emission tomography (PET) represents a helpful imaging technique for a proper staging of lymph nodal status. The most investigated PET radiotracer is choline, although many others have been explored as guide for both primary and salvage LND, such as fluorodeoxyglucose, acetate, fluorocyclobutanecarboxylic acid and prostate-specific membrane antigen. In the present review, a comprehensive literature review addressing the role of PET for LND in PCa patients is reported, with the use of the above-mentioned radiotracers.
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34
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Woodrum DA, Gorny KR, Greenwood B, Mynderse LA. MRI-Guided Prostate Biopsy of Native and Recurrent Prostate Cancer. Semin Intervent Radiol 2016; 33:196-205. [PMID: 27582607 DOI: 10.1055/s-0036-1586151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive, curative treatment of the whole gland with either radical prostatectomy or radiation therapy. However, many men are reluctant to take the definitive step due to potential morbidity associated with either therapy. A growing interest in active surveillance or focal therapy has emerged as realistic alternatives for many patients. With each of these management strategies, it is critical to accurately quantify and stage the cancer with improved biopsy targeting and more precise imaging with magnetic resonance imaging (MRI). Furthermore, having dependable prostate imaging allows for targeted biopsies to improve the yield of clinically significant prostate cancer and decrease detection of indolent prostate cancer. MRI-guided targeted biopsy techniques include cognitive MRI/transrectal ultrasound fusion biopsy, in-bore transrectal targeted biopsy using a calibrated guidance device, and in-bore direct MR-guided transperineal biopsy with a software-based transperineal grid template. Herein we present a contemporary review of MRI-guided targeted biopsy techniques for new and recurrent cancerous foci of the prostate.
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35
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