¹⁸F-Choline PET/MRI: The Additional Value of PET for MRI-Guided Transrectal Prostate Biopsies

Abstract

We assessed the value of fusion 18F-fluoromethylcholine (18F-choline) PET/MRI for image-guided (targeted) prostate biopsies to detect significant prostate cancer (Gleason ≥ 3 + 4) compared with standard (systematic 12-core) biopsies. Methods Within an ongoing prospective clinical trial, hybrid 18F-choline PET/CT and multiparametric 3T MRI (mpMRI) of the pelvis were performed in 36 subjects with a rising prostate-specific antigen for known (n = 15) or suspected (n = 21) prostate cancer before a prostate biopsy procedure. PET and T2-weighted MR volumes of the prostate were spatially registered using commercially available software. Biopsy targets were selected on the basis of visual appearance on MRI and graded as low, intermediate, or high risk for significant disease. Volumes of interest were defined for MR-identified lesions. 18F-choline uptake measures were obtained from the MR target and a mirrored background volume of interest. The biopsy procedure was performed after registration of real-time transrectal ultrasound with T2-weighted MR and included image-guided cores plus standard cores. Histologic results were determined from standard and targeted biopsy cores as well as prostatectomy specimens (n = 10). Results Fifteen subjects were ultimately identified with Gleason ≥ 3 + 4 prostate cancer, of which targeted biopsy identified significantly more (n = 12) than standard biopsies (n = 5; P = 0.002). A total of 52 lesions were identified by mpMRI (19 low, 18 intermediate, 15 high risk), and mpMRI-assigned risk was a strong predictor of final pathology (area under the curve = 0.81; P < 0.001). When the mean 18F-choline target-to-background ratio was used, the addition of 18F-choline to mpMRI significantly improved the prediction of Gleason ≥ 3 + 4 cancers over mpMRI alone (area under the curve = 0.92; P < 0.001). Conclusion Fusion PET/MRI transrectal ultrasound image registration for targeted prostate biopsies is clinically feasible and accurate. The addition of 18F-choline PET to mpMRI improves the identification of significant prostate cancer.

Androgen Deprivation Therapy (ADT), Metabolic Syndrome and Metastatic Prostate Cancer: In Vivo and In Vitro Assessments of Effects of Metformin

“…Supportive results have also been reported by other small case series using PSMA PET/MRI [383,384]. Piert et al fused 18F-choline PET/MRI with transrectal ultrasound (TRUS) for targeted biopsies to increase percentage involvement of tumor in each core and biopsy positive rate (80% vs 33% positive biopsy on standard biopsy) [385]. Lee et al recently published that 18F-choline and 18F-FDG PET/MRI performed pre-operatively yielded similar results between two tests and also to mpMRI alone [386].…”

The Effect of Including Bone in Dixon-Based Attenuation Correction for 18F-Fluciclovine PET/MRI of Prostate Cancer

“…(4,18,22,23), and detection of disease recurrence after initial treatment with curative intent, e.g. (24)(25)(26)(27).…”

Preclinical Evaluation of 11C-Sarcosine as a Substrate of Proton-Coupled Amino Acid Transporters and First Human Application in Prostate Cancer

“…11 C-choline and 18 F-fluorocholine are widely used PET radiotracers for prostate cancer imaging (9,20), but also 11 C-methionine and 11 C-acetate PET have been successfully tested for this indication (32,33). 11 C-choline is known to be rapidly transported into human cancers, including prostate cancer.…”

“…Anatomic 3-T MRI was performed separately (Ingenia; Philips). PET data were registered with the 3-dimensional T2-weighted MRI using commercial software (MIM Maestro Software) (20,21). The 3-dimensional T2-weighted sequence was then used for targeted transrectal prostate biopsies with a commercial system (UroNav; Invivo).…”