Correlation between Intraprostatic PSMA Uptake and MRI PI-RADS of [68Ga]Ga-PSMA-11 PET/MRI in Patients with Prostate Cancer: Comparison of PI-RADS Version 2.0 and PI-RADS Version 2.1

Abstract

Purpose: We aimed to evaluate the correlation between PSMA uptake and magnetic resonance imaging (MRI) PI-RADS of simultaneous [68Ga]Ga-PSMA-11 PET/MRI regarding PI-RADS version 2.0 and 2.1 respectively and compared the difference between these two versions. Materials and Methods: We retrospectively analyzed a total of forty-six patients with biopsy-proven prostate cancer who underwent simultaneous [68Ga]Ga-PSMA-11 PET/MRI. We classified the lesions regarding PI-RADS version 2.0 and 2.1, peripheral zone (PZ), and transitional zone (TZ), respectively. Based on regions of interest (ROI), standardized uptake values maximum (SUVmax), and corresponding lesion-to-background ratios (LBR) of SUVmax of each category, PI-RADS score 1 to 5, were measured. A comparison between PI-RADS version 2.0 and PI-RADS version 2.1 was performed. Results: A total of 215 focal prostate lesions were analyzed, including two subgroups, 125 TZ and 90 PZ. Data are reported as median and interquartile range (IQR). Regarding PI-RADS version 2.1, TZ SUVmax of each category were 1.5 (0.5, 1.9), 1.9 (0.8, 2.3), 3.3 (2.1, 4.6), 4.2 (3.1, 5.7), 7.3 (5.2, 9.7). PZ SUVmax of each category were 1.0 (0.8, 1.6), 2.5 (1.5, 3.2), 3.3 (1.9, 4.5), 4.3 (3.0, 5.4), 7.4 (5.0, 9.3). Regarding the inter-reader agreement of the overall PI-RADS assessment category, the kappa value was 0.723 for version 2.0 and 0.853 for version 2.1. Conclusion: Revisions of PI-RADS version 2.1 results in variations in lesions classification. Lesions with the PI-RADS category of 3, 4, and 5 present relatively higher intraprostatic PSMA uptake, while lesions with the PI-RADS category of 1 and 2 present relatively lower and similar uptake. Version 2.1 has higher inter-reader reproducibility than version 2.0.

Dynamic Contrast-Enhanced MRI of Prostate Lesions of Simultaneous [68Ga]Ga-PSMA-11 PET/MRI: Comparison between Intraprostatic Lesions and Correlation between Perfusion Parameters

“…Initial results suggest that [ 68 Ga]Ga-PSMA-11 PET/MRI is a beneficial imaging method for detecting suspicious focal prostate cancer lesions [ 17 , 18 ] and monitoring recurrence [ 19 ]. Combining MRI and positron emission tomography (PET) improves diagnostic accuracy [ 20 , 21 ]. Compared with the current standard imaging like CT, MRI, and bone scintigraphy, PSMA-PET imaging shows a higher specificity and sensitivity and is suitable for patients with primary middle-risk or high-risk prostate cancer [ 22 ].…”

Visualization and Quantification of the Extracellular Matrix in Prostate Cancer Using an Elastin Specific Molecular Probe

“…It is overexpressed in epithelial cells of prostate cancer. PSMA can be detected in primary, secondary, and metastatic prostate cancer, which makes it a good marker [ 41 ]. Pu et al demonstrated that the targeted MRI contrast agent has good Gd 3+ binding affinity, metal selectivity, and relaxivity, and strong PSMA targeting ability [ 40 ].…”

Incorporating PSMA-Targeting Theranostics Into Personalized Prostate Cancer Treatment: a Multidisciplinary Perspective

“…Beyond favorable imaging profiles ( 20 ), these agents have been demonstrated in multiple retrospective and prospective studies to be superior compared to standard cross-sectional imaging, (CT/MRI) ( 21 , 22 ) nuclear medicine assays (bone scintigraphy) ( 23 , 24 ), 18 F-fluciclovine ( 25 – 29 ), 11 C-choline PET/CT ( 30 , 31 ), and other modalities ( 32 , 33 ) for characterizing disease burden across the spectrum of the disease ( Figure 1 ). Applications include the localized disease setting for both intraprostatic localization and staging ( 34 – 36 ), detection of lesions during biochemical recurrence ( 22 , 37 ), and for stratification and treatment monitoring in metastatic disease ( 38 ). Furthermore, PSMA-targeted imaging has shown synergy with other modalities such as multiparametric prostate MRI ( 39 , 40 ) and FDG-PET for improved characterization of disease burden ( 41 ) and image guidance for bone biopsies ( 42 ).…”