Improving Diagnosis of Primary Prostate Cancer With Combined 68Ga–Prostate-Specific Membrane Antigen–HBED-CC Simultaneous PET and Multiparametric MRI and Clinical Parameters

Jena, Amarnath; Taneja, Rajesh; Taneja, Sangeeta; Singh, Amresh Kumar; Kumar, V. Ravi; Agarwal, Anshuman; Subramanian, N

doi:10.2214/ajr.18.19585

Cited by 30 publications

(22 citation statements)

References 31 publications

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“…We found higher SUV max and SUV mean values and lower ADC values in patients with LN metastasis, which may be due to the presence of more aggressive tumor with higher Gleason scores, that were documented to have both higher PSMA uptake and lower ADC values in the literature (26,27,34). Concomitant usage of SUV and ADC parameters by using the ratio of SUV/ADC further increased the sensitivity and specificity of PET/MRI imaging in predicting LN metastasis.…”

Section: Discussionmentioning

confidence: 53%

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Correlation of SUVmax and Apparent Diffusion Coefficient Values Detected by Ga-68 PSMA PET/MRI in Primary Prostate Lesions and Their Significance in Lymph Node Metastasis: Preliminary Results of an On-going Study

Uslu-Beşli¹,

Bakir²,

Asa³

et al. 2019

Mirt

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Objectives:Gallium-68 (Ga-68) prostate specific membrane antigen (PSMA) positron emission tomography (PET) has been shown to be more accurate than multiparametric prostate magnetic resonance imaging (MRI) in detection of primary prostate lesions. Using hybrid PET/MRI we aim to detect the correlation between SUVmax and apparent diffusion coefficient (ADC) in primary prostate lesions and to assess their prognostic value in detection of lymph node (LN) metastasis.Methods:Twenty-six patients, who were diagnosed as having prostate cancer with biopsy and underwent Ga-68 PSMA PET/MRI together with biparametric prostate MRI (bpMRI) were included. SUVmax, SUVmean and ADC were recorded for index lesions drawing a region of interest (ROI) of 1 cm2 around the pixel with the highest SUVmax (ROI-1) and another ROI following borders of prostate tumor detected by bpMRI (ROI-2). Presence of LN metastasis was recorded according to PSMA PET/MRI.Results:SUVmax was inversely correlated with ADC (ROI-1: p=0.010; ROI-2: p=0.017 for b=800). SUVmax and SUVmeans were both higher in patients with LN metastasis and ADC was lower in patients with LN metastasis for ROI-1. SUVmax cut-off value of 19.8 for ROI-1 and 20.9 for ROI-2 had sensitivity and specificity of 77.8% and 76.5%, respectively for detection of LN metastasis, whereas ADC (b=800) cut-off value of 0.92x10-3 mm2/s had sensitivity and specificity of 87.5% and 76.5%, respectively. SUVmax/ADC (b=800) ratio increased the sensitivity and specificity to 100% and 82.4%, respectively.Conclusion:SUV and ADC values are inversely correlated in primary prostate lesions and the combined use of both values increases the diagnostic accuracy of hybrid PET/MRI in the detection of primary prostate lesions.

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Section: Discussionmentioning

confidence: 53%

“…Ga-68 PSMA uptake was shown to be correlated with tumor Gleason score, serum PSA levels, PI-RADS category and DRE findings (25). ADC value obtained by mpMRI was also found to be correlated with Gleason scores (26,27), serum PSA levels (28), molecular markers (29) and was introduced to be a promising tool to monitor therapy response (30,31).…”

Section: Discussionmentioning

confidence: 99%

Correlation of SUVmax and Apparent Diffusion Coefficient Values Detected by Ga-68 PSMA PET/MRI in Primary Prostate Lesions and Their Significance in Lymph Node Metastasis: Preliminary Results of an On-going Study

Uslu-Beşli¹,

Bakir²,

Asa³

et al. 2019

Mirt

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“…PSMA-11 targets the prostate-specific membrane antigen (PSMA), which is overexpressed in most prostate cancer cells [1]. Several studies have shown that the combination of 68 Ga-PSMA-11 PET with anatomical information from magnetic resonance (MR) imaging provides superior detection and diagnostic accuracy of prostate cancers in comparison to other imaging techniques [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Kinetic modeling of 68Ga-PSMA-11 and validation of simplified methods for quantification in primary prostate cancer patients

et al. 2020

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Background: The positron emission tomography (PET) ligand 68 Ga-Glu-urea-Lys(Ahx)-HBED-CC (68 Ga-PSMA-11) targets the prostate-specific membrane antigen (PSMA), upregulated in prostate cancer cells. Although 68 Ga-PSMA-11 PET is widely used in research and clinical practice, full kinetic modeling has not yet been reported nor have simplified methods for quantification been validated. The aims of our study were to quantify 68 Ga-PSMA-11 uptake in primary prostate cancer patients using compartmental modeling with arterial blood sampling and to validate the use of standardized uptake values (SUV) and image-derived blood for quantification. Results: Fifteen patients with histologically proven primary prostate cancer underwent a 60-min dynamic 68 Ga-PSMA-11 PET scan of the pelvis with axial T1 Dixon, T2, and diffusion-weighted magnetic resonance (MR) images acquired simultaneously. Time-activity curves were derived from volumes of interest in lesions, normal prostate, and muscle, and mean SUV calculated. In total, 18 positive lesions were identified on both PET and MR. Arterial blood activity was measured by automatic arterial blood sampling and manual blood samples were collected for plasmato-blood ratio correction and for metabolite analysis. The analysis showed that 68 Ga-PSMA-11 was stable in vivo. Based on the Akaike information criterion, 68 Ga-PSMA-11 kinetics were best described by an irreversible two-tissue compartment model. The rate constants K 1 and k 3 and the net influx rate constants K i were all significantly higher in lesions compared to normal tissue (p < 0.05). K i derived using image-derived blood from an MR-guided method showed excellent agreement with K i derived using arterial blood sampling (intraclass correlation coefficient = 0.99). SUV correlated significantly with K i with the strongest correlation of scan time-window 30-45 min (rho 0.95, p < 0.001). Both K i and SUV correlated significantly with serum prostate specific antigen (PSA) level and PSA density. Conclusions: 68 Ga-PSMA-11 kinetics can be described by an irreversible two-tissue compartment model. An MR-guided method for image-derived blood provides a non-invasive alternative to blood sampling for kinetic modeling studies. SUV showed strong correlation with K i and can be used in routine clinical settings to quantify 68 Ga-PSMA-11 uptake.

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“…These findings were consistent with other studies. [ 27 – 30 ] SUV max /ADC may be used as a predictive parameter for PCa, to help distinguish benign from malignant prostatic lesions.…”

Section: Discussionmentioning

confidence: 99%

68Ga-PSMA-11 PET/CT combining ADC value of MRI in the diagnosis of naive prostate cancer

Wang¹,

Yu²,

Zang³

et al. 2020

Medicine

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68 Ga-PSMA-11 positron emission computed tomography /computed tomography (PET/CT) is more sensitive than magnetic resonance imaging (MRI) in detecting prostate cancer (PCa). We evaluated the value of 68 Ga-PSMA-11 PET/CT with MRI in treatment-naive PCa. This retrospective study was approved by the hospital ethics committee. The MRI and 68 Ga-PSMA-11 PET/CT imaging data of 63 cases of highly suspected PCa were enrolled in this study. The SUV max and apparent diffusion coefficient (ADC), and their ratio, were assessed as diagnostic markers to distinguish PCa from benign disease. There were 107 prostate lesions detected in 63 cases. Forty cases with 64 malignant primary lesions were confirmed PCa, whereas 23 cases had 43 benign lesions. PSMA-avid lesions correlated with hypointense signal on ADC maps and hyperintense signal on diffusion-weighted imaging. The ADC of PCa was lower than that of benign lesions, and SUV max and SUV max /ADC of PCa was higher than that of benign lesions ( P < .01). ADC had significant negative correlation with Gleason score (GS) and SUV max , SUV max , and SUV max /ADC positively correlated with GS. From ROC analysis, we established cutoff values of ADC, SUV max , and SUV max /ADC at 1.02 × 10 −3 mm 2 /s, 11.72, and 12.35, respectively, to differentiate PCa from benign lesions. The sensitivity, specificity, and AUC were 90.6%, 58.1%, and 0.816 for ADC, 67.2%, 97.7%, and 0.905 for SUV max , and 81.2%, 88.4%, and 0.929 for SUV max /ADC, respectively. 68 Ga-PSMA-11 PET/CT combined with MRI offers higher diagnostic efficacy in the detection of PCa than either modality alone.

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Improving Diagnosis of Primary Prostate Cancer With Combined ⁶⁸Ga–Prostate-Specific Membrane Antigen–HBED-CC Simultaneous PET and Multiparametric MRI and Clinical Parameters

Cited by 30 publications

References 31 publications

Correlation of SUV<sub>max</sub> and Apparent Diffusion Coefficient Values Detected by Ga-68 PSMA PET/MRI in Primary Prostate Lesions and Their Significance in Lymph Node Metastasis: Preliminary Results of an On-going Study

Correlation of SUV<sub>max</sub> and Apparent Diffusion Coefficient Values Detected by Ga-68 PSMA PET/MRI in Primary Prostate Lesions and Their Significance in Lymph Node Metastasis: Preliminary Results of an On-going Study

Kinetic modeling of 68Ga-PSMA-11 and validation of simplified methods for quantification in primary prostate cancer patients

68Ga-PSMA-11 PET/CT combining ADC value of MRI in the diagnosis of naive prostate cancer

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