Purpose

Whole-body positron emission tomography/magnetic resonance imaging (wbPET/MRI) is a promising diagnostic tool of recurrent prostate cancer (PC), but its role in primary staging of high-risk PC (hrPC) is not well defined. Thus, the aim was to compare the diagnostic accuracy for T-staging of PET-blinded reading (PBR) and PET/MRI.

Methods

In this prospective study, hrPC patients scheduled to radical prostatectomy (RPx) with extended lymphadenectomy (eLND) were staged with wbPET/MRI and either ⁶⁸Ga-PSMA-11 or ¹¹C-choline including simultaneous multiparametric MRI (mpMRI). Images were assessed in two sessions, first as PBR (mpMRI and wbMRI) and second as wbPET/MRI. Prostate Imaging Reporting and Data System criteria (PIRADS v2) were used for T-staging. Results were correlated with the exact anatomical localization and extension as defined by histopathology. Diagnostic accuracy of cTNM stage according to PBR was compared to pathological pTNM stage as reference standard.

Results

Thirty-four patients underwent wbPET/MRI of ⁶⁸Ga-PSMA-11 (n = 17) or ¹¹C-choline (n = 17). Twenty-four patients meeting the inclusion criteria of localized disease ± nodal disease based on imaging results underwent RPx and eLND, whereas ten patients were excluded from analysis due to metastatic disease. T-stage was best defined by mpMRI with underestimation of tumor lesion size by PET for both tracers. N-stage yielded a per patient sensitivity/specificity comparable to PBR.

Conclusion

MpMRI is the primary modality for T-staging in hrPC as PET underestimated T-stage in direct comparison to final pathology. In this selected study, cohort MRI shows no inferiority compared to wbPET/MRI considering N-staging.

中文翻译：

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同时全身PET / MRI和集成多参数MRI用于高危前列腺癌的主要分期。

目的

全身正电子发射断层扫描/磁共振成像（wbPET / MRI）是复发性前列腺癌（PC）的一种有前途的诊断工具，但其在高危PC（hrPC）的主要分期中的作用尚未明确。因此，目的是比较PET盲读（PBR）和PET / MRI的T分期的诊断准确性。

方法

在这项前瞻性研究中，计划通过根治性前列腺切除术（RPx）和延长的淋巴结清扫术（eLND）的hrPC患者采用wbPET / MRI和⁶⁸ Ga-PSMA-11或¹¹ C-胆碱进行分期，包括同步多参数MRI（mpMRI）。在两个阶段中评估图像，第一阶段为PBR（mpMRI和wbMRI），第二阶段为wbPET / MRI。前列腺成像报告和数据系统标准（PIRADS v2）用于T分期。结果与组织病理学定义的确切解剖定位和扩展相关。将根据PBR对cTNM分期的诊断准确性与作为参考标准的病理性pTNM分期进行了比较。

结果

34例患者接受了⁶⁸ Ga-PSMA-11（n  = 17）或¹¹ C-胆碱（n  = 17）的wbPET / MRI检查。根据影像学结果对符合局部疾病±淋巴结疾病纳入标准的24例患者进行了RPx和eLND，而10例由于转移性疾病而被排除在分析之外。用mpMRI最好地定义了T期，两种示踪剂均低估了PET的肿瘤病变大小。N期产生的每位患者的敏感性/特异性与PBR相当。

结论

MpMRI是hrPC中T分期的主要方式，因为与最终病理学相比，PET低估了T期。在这项选定的研究中，队列MRI与考虑n分期的wbPET / MRI相比没有发现任何劣势。