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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) 18F-choline PET/MR in the initial staging of prostate cancer. Impact on the ther...
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Vol. 40. Issue 2.
Pages 72-81 (March - April 2021)
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Vol. 40. Issue 2.
Pages 72-81 (March - April 2021)
Original Article
18F-choline PET/MR in the initial staging of prostate cancer. Impact on the therapeutic approach
La PET/RM con 18F-colina en el diagnóstico inicial del cáncer de próstata. Impacto en la estrategia terapéutica
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J.R. Garcia
Corresponding author
jrgarcia@cetir.es

Corresponding author.
, A. Compte, C. Galan, M. Cozar, M. Buxeda, S. Mourelo, T. Piñeiro, M. Soler, E. Valls, P. Bassa, J.M. Santabarbara
Unidad PET/RM, CETIR Viladomat, Grupo Biomédico ASCIRES, Barcelona, Spain
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Abstract
Aim

Evaluate the therapy impact of initial staging in patients diagnosed with prostate cancer by 18F-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 ± 18.5 MBq 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 artefacts were reported. MRI was superior in T staging in 8 patients (25.8%) (Likert: 2–3), whereas PET increased MRI sensitivity in 3 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. Radiomics: Better distinctiion between stage T2 vs T3 using the DiscrLin model with NG = 16 (AUC 0,7767 ± 0,3386). 68 variables, more frequently PET than T2 (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 radical treatment in 22.6% of patients.

Keywords:
PET/MRI
18F-Choline
Prostate cancer
Estadification
Resumen
Objetivo

Evaluar el impacto terapéutico de la estadificación inicial de pacientes con cáncer de próstata mediante la exploración integrada 18F-Colina PET/RM.

Material

Estudio prospectivo de 31 pacientes diagnosticados de cáncer de próstata: Gleason >7; PSA: 13,6 ng/mL (6,3–20,6). Adquisición simultánea en cámara PET/RM tras la administración de 185 ± 18,5 MBq de 18F-Colina:

- Fase precoz/prostática (1-bed): emisión PET + RM multiparamétrica: DIXON-T1-T2- difusión-Gadolinio.

- Fase tardía/cuerpo completo: emisión PET + RM: DIXON-T1-T2-difusión-STIR. Interpretación visual y cálculo de SUV & ADC & Texturas. Selección del tratamiento en comité oncológico.

Resultados

Todos los pacientes toleraron la exploración, sin artefactos. En 8 pacientes (25,8%) la RM fue superior en la estadificación T (Likert:2–3), mientras que la PET aumento la sensibilidad de la RM en 3 pacientes (9,7%) (PIRADS:3).

Localización T

Zona periférica 91,4%, transicional 8,6%. Umbral SUVmax 2,95: sensibilidad 92,9%, especificidad 66,7%. Sin correlación SUV vs ADC. Mejor distinción estadio T2 vs T3 mediante el modelo DiscrLin con NG = 16 (AUC 0,7767 ± 0,3386). 68 variables, con mayor frecuencia PET que T2 (0.588 vs 0.412) En 17 pacientes (54,8%) la estadificación T fue ≥ T3, contraindicando la opción quirúrgica. En 15 pacientes (48,4%) presentaron enfermedad extra-prostática: oligometástasis (8/31), multimetástasis (7/31). La decisión terapéutica tras PET/RM fue: 77,4% tratamiento radical (24/31), prostatectomía en 14 y radioterapia radioguiada en 10; 22,6% tratamiento sistémico (7/31).

Conclusión

La 18F-Colina PET/RM muestra un carácter complementario en la estadificación T, con elevada tasa de detección de la infiltración NM. Los hallazgos de la exploración permiten la selección de los candidatos a prostatectomía o radioterapia radioguiada, evitando una terapia radical en un 22,6% de los pacientes.

Palabras clave:
PET/RM
18F-Colina
Cáncer de próstata
Estadificación

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