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Hou H, Pan Y, Wang Y, Ma Y, Niu X, Sun S, Hou G, Tao W, Gao F. Development and first-in-human study of PSMA-targeted PET tracers with improved pharmacokinetic properties. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06726-6. [PMID: 38683349 DOI: 10.1007/s00259-024-06726-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE A series of new 68Ga-labeled tracers based on [68Ga]Ga-PSMA-617 were developed to augment the tumor-to-kidney ratio and reduce the activity accumulation in bladder, ultimately minimize radiation toxicity to the urinary system. METHODS We introduced quinoline group, phenylalanine and decanoic acid into different tracers to enhance their lipophilicity, strategically limiting their metabolic pathway through the urinary system. Their binding affinity onto LNCaP cells was determined through in vitro saturation assays and competition binding assays. In vivo metabolic study, PET imaging and biodistribution experiment were performed in LNCaP tumor-bearing B-NSG male mice. The most promising tracer was selected for first-in-human study. RESULTS Four radiotracers were synthesized with radiochemical purity (RCP) > 95% and molar activity in a range of 20.0-25.5 GBq/μmol. The binding affinities (Ki) of TWS01, TWS02 to PSMA were in the low nanomolar range (< 10 nM), while TWS03 and TWS04 exhibited binding affinities with Ki > 20 nM (59.42 nM for TWS03 and 37.14 nM for TWS04). All radiotracers exhibited high stability in vivo except [68Ga]Ga-TWS03. Micro PET/CT imaging and biodistribution analysis revealed that [68Ga]Ga-TWS02 enabled clear tumor visualization in PET images at 1.5 h post-injection, with higher tumor-to-kidney ratio (T/K, 0.93) and tumor-to-muscle ratio (T/M, 107.62) compared with [68Ga]Ga-PSMA-617 (T/K: 0.39, T/M: 15.01) and [68Ga]Ga-PSMA-11 (T/K: 0.15, T/M: 24.00). In first-in-human study, [68Ga]Ga-TWS02 effectively detected PCa-associated lesions including primary and metastatic lesions, with lower accumulation in urinary system, suggesting that [68Ga]Ga-TWS02 might be applied in the detection of bladder invasion, with minimized radiation toxicity to the urinary system. CONCLUSION Introduction of quinoline group, phenylalanine and decanoic acid into different tracers can modulate the binding affinity and pharmacokinetics of PSMA in vivo. [68Ga]Ga-TWS02 showed high binding affinity to PSMA, excellent pharmacokinetic properties and clear imaging of PCa-associated lesions, making it a promising radiotracer for the clinical diagnosis of PCa. Moreover, TWS02 with a chelator DOTA could also label 177Lu and 225Ac, which could be used for PCa treatment without significant side effects. TRIAL REGISTRATION The clinical evaluation of this study was registered On October 30, 2021 at https://www.chictr.org.cn/ (No: ChiCTR2100052545).
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Affiliation(s)
- Haodong Hou
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Yuan Pan
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Yanzhi Wang
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Yuze Ma
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012, Shandong, China
| | - Xiaobing Niu
- Department of Urology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223300, Jiangsu, China
| | - Suan Sun
- Department of Pathology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223300, Jiangsu, China
| | - Guihua Hou
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012, Shandong, China.
| | - Weijing Tao
- Department of Nuclear Medicine, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai'an, 223300, Jiangsu, China.
| | - Feng Gao
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012, Shandong, China.
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Shi J, Li D, Chen M, Fu Y, Peng S, Zhang Q, Liang J, Lu Q, Lu J, Ai S, Wang F, Qiu X, Guo H. The Value of 68Ga-PSMA PET/MRI for Classifying Patients with PI-RADS 3 Lesions on Multiparametric MRI: A Prospective Single-Center Study. J Nucl Med 2024; 65:555-559. [PMID: 38485278 DOI: 10.2967/jnumed.123.266742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/23/2024] [Indexed: 04/04/2024] Open
Abstract
Prostate Imaging Reporting and Data System (PI-RADS) category 3 lesions remain a diagnostic challenge for detecting clinically significant prostate cancer (csPCa). This article evaluates the added value of 68Ga-labeled prostate-specific membrane antigen-11 (68Ga-PSMA) PET/MRI in classifying PI-RADS 3 lesions to avoid unnecessary biopsies. Methods: Sixty biopsy-naïve men with PI-RADS 3 lesions on multiparametric MRI were prospectively enrolled between February 2020 and October 2022. In all, 56 participants underwent 68Ga-PSMA PET/MRI and prostate systematic biopsy. 68Ga-PSMA PET/MRI was independently evaluated and reported by the 5-level PRIMARY score developed within the PRIMARY trial. Receiver-operating-characteristic curve analysis was used to estimate the diagnostic performance. Results: csPCa was detected in 8 of 56 patients (14.3%). The proportion of patients with csPCa and a PRIMARY score of 1, 2, 3, 4, and 5 was 0% (0/12), 0% (0/13), 6.3% (1/16), 38.5% (5/13), and 100% (2/2), respectively. The estimated area under the curve of the PRIMARY score was 0.91 (95% CI, 0.817-0.999). For a PRIMARY score of 4-5 versus a PRIMARY score of 1-3, the sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 83.3%, 46.7%, and 97.5%, respectively. With a PRIMARY score of at least 4 to make a biopsy decision in men with PI-RADS 3 lesions, 40 of 48 patients (83.3%) could avoid unnecessary biopsies, at the expense of missing 1 of 8 (12.5%) csPCa cases. Conclusion: 68Ga-PSMA PET/MRI has great potential to classify patients with PI-RADS 3 lesions and help avoid unnecessary biopsies.
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Affiliation(s)
- Jingyan Shi
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Danyan Li
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Mengxia Chen
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yao Fu
- Department of Pathology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China; and
| | - Shan Peng
- Department of Pathology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China; and
| | - Qing Zhang
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jing Liang
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qun Lu
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jiaming Lu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shuyue Ai
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xuefeng Qiu
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China;
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China;
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Kroenke M, Schweiger L, Horn T, Haller B, Schwamborn K, Wurzer A, Maurer T, Wester HJ, Eiber M, Rauscher I. Validation of 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET Imaging Results with Histopathology from Salvage Surgery in Patients with Biochemical Recurrence of Prostate Cancer. J Nucl Med 2022; 63:1809-1814. [PMID: 35393348 PMCID: PMC9730917 DOI: 10.2967/jnumed.121.263707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/28/2022] [Indexed: 01/11/2023] Open
Abstract
18F-rhPSMA-7, and its single diastereoisomer form, 18F-rhPSMA-7.3, are prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals. Here, we investigated their accuracy for the assessment of lymph node (LN) metastases validated by histopathology. Methods: Data from 58 patients with biochemical recurrence of prostate cancer after radical prostatectomy receiving salvage surgery after PET imaging with 18F-rhPSMA-7 or 18F-rhPSMA-7.3 were retrospectively reviewed. Two nuclear medicine physicians reviewed all PET scans and morphologic imaging in consensus. Readers were masked from the results of histopathology. PET and morphologic imaging were correlated with histopathology from resected LNs. Results: In 75 of 150 resected regions in 54 of 58 patients, tumor lesions were present in histopathology. The template-based specificity of PET (18F-rhPSMA-7 and 18F-rhPSMA-7.3 combined) and morphologic imaging was 93.3% and 100%, respectively. However, 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET detected metastases in 61 of 75 histopathologically proven metastatic LN fields (81.3%) whereas morphologic imaging was positive in only 9 of 75 (12.0%). The positive predictive value was 92.4% for 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET and 100% for morphologic imaging. 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET performance was significantly superior to morphologic imaging (difference in the areas under the receiver-operating-characteristic curves, 0.222; 95% CI, 0.147-0.298; P < 0.001). The mean size of PET-positive and histologically confirmed LN metastases was 6.3 ± 3.1 mm (range, 2-15 mm) compared with a mean size of 9.8 ± 2.5 mm (range, 7-15 mm) on morphologic imaging. Conclusion: 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET offer a high positive predictive value comparable to that reported for 68Ga-PSMA-11 and represent a valuable tool for guiding salvage lymphadenectomy.
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Affiliation(s)
- Markus Kroenke
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Department of Radiology and Nuclear Medicine, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Lilit Schweiger
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kristina Schwamborn
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Wurzer
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Chair of Radiopharmacy, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Tobias Maurer
- Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Jürgen Wester
- Chair of Radiopharmacy, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
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Regmi SK, Sathianathen N, Stout TE, Konety BR. MRI/PET Imaging in elevated PSA and localized prostate cancer: a narrative review. Transl Androl Urol 2021; 10:3117-3129. [PMID: 34430415 PMCID: PMC8350235 DOI: 10.21037/tau-21-374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To review the recent milestones in MRI and PET based imaging and evaluate their evolving role in the setting of elevated PSA as well as localized prostate cancer. Background The importance of multiparametric MRI (mpMRI) and PET based imaging for the diagnosis and staging of prostate cancer cannot be understated. Accurate staging has become another significant milestone with the use of PET scans, particularly with prostate specific radiotracers like 68-Gallium Prostate Specific Membrane Antigen (68Ga-PSMA). Integrated PET/MRI systems are commercially available and can be modulated to evaluate the unique needs of localized as well as recurrent prostate cancer. Methods A literature search was performed using PubMed and Google Scholar using the MeSH compliant and other keywords that included prostate cancer, PSA, mpMRI, PET CT, PET/MRI. Conclusions mpMRI has now established itself as the gold-standard of local prostate imaging and has been incorporated into international guidelines as part of the diagnostic work-up of prostate cancer. PSMA PET/CT has shown superiority over conventional imaging even in staging of localized prostate cancer based on recent randomized control data. Imaging parameters from PET/MRI have been shown to be associated with malignancy, Gleason score and tumour volume. As mpMRI and PSMA PET/CT become more ubiquitous and established; we can anticipate more high-quality data, cost optimization and increasing availability of PET/MRI to be ready for primetime in localized prostate cancer.
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Affiliation(s)
- Subodh K Regmi
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas E Stout
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Wang H, Amiel T, Würnschimmel C, Langbein T, Steiger K, Rauscher I, Horn T, Maurer T, Weber W, Wester HJ, Knorr K, Eiber M. PSMA-ligand uptake can serve as a novel biomarker in primary prostate cancer to predict outcome after radical prostatectomy. EJNMMI Res 2021; 11:76. [PMID: 34417907 PMCID: PMC8380207 DOI: 10.1186/s13550-021-00818-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background The prostate-specific membrane antigen (PSMA) is a relevant target in prostate cancer, and immunohistochemistry studies showed associations with outcome. PSMA-ligand positron emission tomography (PET) is increasingly used for primary prostate cancer staging, and the molecular imaging TNM classification (miTNM) standardizes its reporting. We aimed to investigate the potential of PET-imaging to serve as a noninvasive imaging biomarker to predict disease outcome in primary prostate cancer after radical prostatectomy (RP). Methods In this retrospective analysis, 186 primary prostate cancer patients treated with RP who had undergone a 68Ga-PSMA-11 PET up to three months prior to the surgery were included. Maximum standardized uptake value (SUVmax), SUVmean, tumor volume (TV) and total lesion (TL) were collected from PET-imaging. Moreover, clinicopathological information, including age, serum prostate-specific antigen (PSA) level, and pathological characteristics, was assessed for disease outcome prediction. A stage group system for PET-imaging findings based on the miTNM framework was developed. Results At a median follow-up after RP of 38 months (interquartile range (IQR) 22–53), biochemical recurrence (BCR) was observed in 58 patients during the follow-up period. A significant association between a positive surgical margin and miN status (miN1 vs. miN0, odds ratio (OR): 5.428, p = 0.004) was detected. miT status (miT ≥ 3a vs. miT < 3, OR: 2.696, p = 0.003) was identified as an independent predictor for Gleason score (GS) ≥ 8. Multivariate Cox regression analysis indicated that PSA level (hazard ratio (HR): 1.024, p = 0.014), advanced GS (GS ≥ 8 vs. GS < 8, HR: 3.253, p < 0.001) and miT status (miT ≥ 3a vs. miT < 3, HR: 1.941, p = 0.035) were independent predictors for BCR. For stage I disease as determined by PET-imaging, a shorter BCR-free survival was observed in the patients with higher SUVmax (IA vs. IB stage, log-rank, p = 0.022). Conclusion Preoperative miTNM classification from 68Ga-PSMA-11 PET correlates with postoperative GS, surgical margin status and time to BCR. The association between miTNM staging and outcome proposes 68Ga-PSMA-11 PET as a novel non-invasive imaging biomarker and potentially serves for ancillary pre-treatment stratification. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00818-2.
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Affiliation(s)
- Hui Wang
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Thomas Amiel
- Department of Urology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Würnschimmel
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Thomas Langbein
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thomas Horn
- Department of Urology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hans-Juergen Wester
- Pharmaceutical Radiochemistry, Technical University of Munich, Walther-Meißner-Str. 3, 85748, Garching, Germany
| | - Karina Knorr
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Zhao J, Kader A, Mangarova DB, Brangsch J, Brenner W, Hamm B, Makowski MR. Dynamic Contrast-Enhanced MRI of Prostate Lesions of Simultaneous [ 68Ga]Ga-PSMA-11 PET/MRI: Comparison between Intraprostatic Lesions and Correlation between Perfusion Parameters. Cancers (Basel) 2021; 13:1404. [PMID: 33808685 PMCID: PMC8003484 DOI: 10.3390/cancers13061404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
We aimed to retrospectively compare the perfusion parameters measured from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of prostate benign lesions and malignant lesions to determine the relationship between perfusion parameters. DCE-MRI was performed in patients with PCa who underwent simultaneous [68Ga]Ga-prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET)/MRI. Six perfusion parameters (arrival time (AT), time to peak (TTP), wash-in slope (W-in), wash-out slope (W-out), peak enhancement intensity (PEI), and initial area under the 60-s curve (iAUC)), and a semi-quantitative parameter, standardized uptake values maximum (SUVmax) were calculated by placing regions of interest in the largest area of the lesions. The DCE-MRI parameters between prostate benign and malignant lesions were compared. The DCE-MRI parameters in both the benign and malignant lesions subgroup with SUVmax ≤ 3.0 and SUVmax > 3.0 were compared. The correlation of DCE-MRI parameters was investigated. Malignant lesions demonstrated significantly shorter TTP and higher SUVmax than did benign lesions. In the benign and malignant lesions subgroup, perfusion parameters of lesions with SUVmax ≤ 3.0 show no significant difference to those with SUVmax > 3.0. DCE-MRI perfusion parameters show a close correlation with each other. DCE-MRI parameters reflect the perfusion characteristics of intraprostatic lesions with malignant lesions, demonstrating significantly shorter TTP. There is a moderate to strong correlation between DCE-MRI parameters. Semi-quantitative analysis reflects that malignant lesions show a significantly higher SUVmax than benign lesions.
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Affiliation(s)
- Jing Zhao
- Institute of Radiology and Nuclear Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (A.K.); (D.B.M.); (J.B.); (B.H.); (M.R.M.)
| | - Avan Kader
- Institute of Radiology and Nuclear Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (A.K.); (D.B.M.); (J.B.); (B.H.); (M.R.M.)
- Department of Biology, Chemistry and Pharmacy, Institute of Biology, Freie Universität Berlin, Königin-Luise-Str. 1-3, 14195 Berlin, Germany
| | - Dilyana B. Mangarova
- Institute of Radiology and Nuclear Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (A.K.); (D.B.M.); (J.B.); (B.H.); (M.R.M.)
- Department of Veterinary Medicine, Institute of Veterinary Pathology, Freie Universität Berlin, Robert-von-Ostertag-Str. 15, Building 12, 14163 Berlin, Germany
| | - Julia Brangsch
- Institute of Radiology and Nuclear Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (A.K.); (D.B.M.); (J.B.); (B.H.); (M.R.M.)
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Bernd Hamm
- Institute of Radiology and Nuclear Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (A.K.); (D.B.M.); (J.B.); (B.H.); (M.R.M.)
| | - Marcus R. Makowski
- Institute of Radiology and Nuclear Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (A.K.); (D.B.M.); (J.B.); (B.H.); (M.R.M.)
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
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Liu Y, Yu H, Liu J, Zhang X, Lin M, Schmidt H, Gao J, Xu B. A Pilot Study of 18F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions. Front Oncol 2021; 11:612157. [PMID: 33747927 PMCID: PMC7973269 DOI: 10.3389/fonc.2021.612157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the feasibility and diagnostic performance of prostate-specific membrane antigen (PSMA) based 18F-DCFPyL PET/CT-ultrasound (PET/CT-US) or PET/MRI-ultrasound (PET/MRI-US) fusion targeted biopsy for intra-prostatic PET-positive lesions. Methods From April 2018 to November 2019, we prospectively enrolled 55 candidates to perform PET/CT-US or PET/MRI-US fusion targeted biopsies for solitary PET-positive prostate lesions (two to four cores/lesion). The positive rates of prostate cancer based on patients and biopsy cores were calculated respectively. With reference to the pathological results of biopsy cores, the MR signal characteristics in the area of the PET-positive lesion were analyzed for the patients who underwent PET/MRI. Results A total of 178 biopsy cores were taken on the 55 patients. One hundred forty-six biopsy cores (82.0%, 146/178) from 51 (92.7%, 51/55) patients were positive for prostate cancer; 47 (85.5%, 47/55) were clinically significant prostate cancer. It is noteworthy that nine patients underwent both 18F-DCFPyL PET/CT and PET/MRI examinations; the seven patients with prostate cancer showed abnormal MR signal in the area of the PET-positive lesion while the other two patients with prostatic hyperplasia and prostatitis showed normal MR signal in the area of the PET-positive lesion. Conclusion This study indicated that 18F-DCFPyL PET/CT-US or PET/MRI-US fusion targeted prostate biopsies may be valuable for prostate cancer diagnosis and have a high detection rate of clinically significant prostate cancer for PET-positive lesions. PET/MR can rule out some false PET-positive lesions, which may potentially reduce unnecessary prostate biopsies.
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Affiliation(s)
- Yachao Liu
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongkai Yu
- Department of Urology Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaojun Zhang
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mu Lin
- Magnetic Resonance Collaboration, Diagnostic Imaging, Siemens Healthineers Ltd., Shanghai, China
| | - Holger Schmidt
- Magnetic Resonance Education, Customer Services, Siemens Healthcare GmbH, Erlangen, Germany
| | - Jiangping Gao
- Department of Urology Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
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8
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Kroenke M, Mirzoyan L, Horn T, Peeken JC, Wurzer A, Wester HJ, Makowski M, Weber WA, Eiber M, Rauscher I. Matched-Pair Comparison of 68Ga-PSMA-11 and 18F-rhPSMA-7 PET/CT in Patients with Primary and Biochemical Recurrence of Prostate Cancer: Frequency of Non-Tumor-Related Uptake and Tumor Positivity. J Nucl Med 2020; 62:1082-1088. [PMID: 33277394 DOI: 10.2967/jnumed.120.251447] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
Radiohybrid prostate-specific membrane antigen (rhPSMA) ligands are a new class of prostate cancer theranostic agents. 18F-rhPSMA-7 offers the advantages of 18F labeling and low urinary excretion compared with 68Ga-PSMA-11. Here, we compare the frequency of non-tumor-related uptake and tumor positivity with 68Ga-PSMA-11 and 18F-rhPSMA-7 in patients with primary or recurrent prostate cancer. Methods: This retrospective matched-pair comparison matched 160 18F-rhPSMA-7 with 160 68Ga-PSMA-11 PET/CT studies for primary staging (n = 33) and biochemical recurrence (n = 127) according to clinical characteristics. Two nuclear medicine physicians reviewed all scans, first identifying all PET-positive lesions and then differentiating lesions suggestive of prostate cancer from those that were benign, on the basis of known pitfalls and ancillary information from CT. For each region, the SUVmax of the lesion with the highest PSMA ligand uptake was noted. Tumor positivity rates were determined, and SUVmax was compared separately for each tracer. Results: 18F-rhPSMA-7 and 68Ga-PSMA-11 PET revealed 566 and 289 PSMA ligand-positive lesions, respectively. Of these, 379 and 100 lesions, equaling 67.0% and 34.6%, respectively, of all PSMA-positive lesions, were considered benign. The distribution of their etiology was similar (42%, 24%, and 25% with 18F-rhPSMA-7 vs. 32%, 24%, and 38% with 68Ga-PSMA-11 for ganglia, bone, and unspecific lymph nodes, respectively). All primary tumors were positive with both agents (n = 33 each), whereas slightly more metastatic lesions were observed with 68Ga-PSMA-11 in both disease stages (113 for 18F-rhPSMA-7 and 124 for 68Ga-PSMA-11). The SUVmax of 18F-rhPSMA-7 and 68Ga-PSMA-11 did not differ (P > 0.05) in local recurrence or primary prostate cancer; however, the tumor-to-bladder ratio was significantly higher with 18F-rhPSMA-7 (4.9 ± 5.3 vs. 2.2 ± 3.7, P = 0.02, for local recurrence; 9.8 ± 9.7 vs. 2.3 ± 2.6, P < 0.001, for primary prostate cancer). Conclusion: The tumor positivity rate was consistently high for 68Ga-PSMA-11 and 18F-rhPSMA-7. Both tracers revealed a considerable number of areas of uptake that were reliably identified as benign by trained physicians making use of corresponding morphologic imaging and known PSMA pitfalls. These were more frequent with 18F-rhPSMA-7. However, the matched-pair comparison could have introduced a source of bias. Adequate reader training can allow physicians to differentiate benign uptake from disease and be able to benefit from the logistical and clinical advantages of 18F-rhPSMA-7.
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Affiliation(s)
- Markus Kroenke
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lilit Mirzoyan
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Neuherberg, Germany; and
| | - Alexander Wurzer
- Pharmaceutical Radiochemistry, School of Medicine, Technical University of Munich. Munich, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, School of Medicine, Technical University of Munich. Munich, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;
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9
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Kroenke M, Wurzer A, Schwamborn K, Ulbrich L, Jooß L, Maurer T, Horn T, Rauscher I, Haller B, Herz M, Wester HJ, Weber WA, Eiber M. Histologically Confirmed Diagnostic Efficacy of 18F-rhPSMA-7 PET for N-Staging of Patients with Primary High-Risk Prostate Cancer. J Nucl Med 2019; 61:710-715. [PMID: 31836681 DOI: 10.2967/jnumed.119.234906] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/03/2019] [Indexed: 01/06/2023] Open
Abstract
18F-rhPSMA-7 (radiohybrid prostate-specific membrane antigen [PSMA]) is a novel ligand for PET imaging. Here, we present data from a retrospective analysis using PET/CT and PET/MRI examinations to investigate the efficacy of 18F-rhPSMA-7 PET for primary N-staging of patients with prostate cancer (PC) compared with morphologic imaging (CT or MRI) and validated by histopathology. Methods: Data from 58 patients with high-risk PC (according to the D'Amico criteria) who were staged with 18F-rhPSMA-7 PET/CT or PET/MRI at our institution between July 2017 and June 2018 were reviewed. The patients had a median prescan prostate-specific antigen value of 12.2 ng/mL (range, 1.2-81.6 ng/mL). The median injected activity of 18F-rhPSMA-7 was 327 MBq (range, 132-410 MBq), with a median uptake time of 79.5 min (range, 60-153 min). All patients underwent subsequent radical prostatectomy and extended pelvic lymph node dissection. The presence of lymph node metastases was determined by an experienced reader independently for both the PET and the morphologic datasets using a template-based analysis on a 5-point scale. Patient-level and template-based results were both compared with histopathologic findings. Results: Lymph node metastases were present in 18 patients (31.0%) and were located in 52 of 375 templates (13.9%). Receiver-operating-characteristic analyses showed 18F-rhPSMA-7 PET to perform significantly better than morphologic imaging on both patient-based and template-based analyses (areas under curve, 0.858 vs. 0.649 [P = 0.012] and 0.765 vs. 0.589 [P < 0.001], respectively). On patient-based analyses, the sensitivity, specificity, and accuracy of 18F-rhPSMA-7 PET were 72.2%, 92.5%, and 86.2%, respectively, and those of morphologic imaging were 50.0%, 72.5%, and 65.5%, respectively. On template-based analyses, the sensitivity, specificity, and accuracy of 18F-rhPSMA-7 PET were 53.8%, 96.9%, and 90.9%, respectively, and those of morphologic imaging were 9.6%, 95.0%, and 83.2%, respectively. Conclusion: 18F-rhPSMA-7 PET is superior to morphologic imaging for N-staging of high-risk primary PC. The efficacy of 18F-rhPSMA-7 is similar to published data for 68Ga-PSMA-11.
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Affiliation(s)
- Markus Kroenke
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Kristina Schwamborn
- Institute of Pathology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lena Ulbrich
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lena Jooß
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; and
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Herz
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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10
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Zhu J, Li H, Xiong Z, Shen M, Conti PS, Shi X, Chen K. Polyethyleneimine-Coated Manganese Oxide Nanoparticles for Targeted Tumor PET/MR Imaging. ACS APPLIED MATERIALS & INTERFACES 2018; 10:34954-34964. [PMID: 30234287 PMCID: PMC7469916 DOI: 10.1021/acsami.8b12355] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A Mn3O4 nanoparticle (NP)-based dual-modality probe has been developed for tumor positron emission tomography (PET)/magnetic resonance (MR) imaging. The dual-modality imaging probe was constructed by modifying multifunctional polyethyleneimine (PEI)-coated Mn3O4 NPs with folic acid (FA), followed with the radiolabeling with 64Cu. The formed imaging probe was utilized for PET/MR imaging of human cervical cancer mouse xenografts, which overexpress folate receptor (FR). The PEI-coated Mn3O4 NPs were synthesized using a solvothermal approach via decomposition of acetylacetone manganese. Multifunctional groups, including fluorescein isothiocyanate (FI), PEGylated FA, and NOTA chelator, were then sequentially loaded onto the surface of the amine groups of the Mn3O4 NPs. The remaining PEI amines were neutralized by the acetylation reaction. The resulting NOTA-FA-FI-PEG-PEI-Ac-Mn3O4 NPs were fully characterized and evaluated in vitro and successfully radiolabeled with 64Cu for tumor PET/MR imaging in small animals. In vivo blocking experiments were performed to determine the FR binding specificity of NPs. PET imaging results demonstrated that 64Cu-labeled Mn3O4 NPs display good tracer uptake in the FR-expressing HeLa tumors (tumor-to-muscle (T/M) ratio: 5.35 ± 0.31 at 18 h postinjection (pi)) and substantially reduced tracer uptake in the FR-blocked HeLa tumors (T/M ratio: 2.78 ± 0.68 at 18 h pi). The ex vivo data, including PET imaging and biodistribution, further confirmed the tumor binding specificity of the 64Cu-labeled Mn3O4 NPs. Moreover, the FR-targeted Mn3O4 NPs exhibited efficient T1-weighted MR imaging (MRI), leading to the precise tumor MRI at 18 h pi. PET/MR imaging with the 64Cu-NOTA-FA-FI-PEG-PEI-Ac-Mn3O4 NPs may offer a new quantitative approach to precisely measure the FR in tumors. The strategy of incorporating PEI nanotechnology into the construction of new biomaterials may be applied for the construction of novel nanoplatforms for cancer diagnosis and therapy.
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Affiliation(s)
- Jingyi Zhu
- Molecular Imaging Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, China
| | - Hongsheng Li
- Molecular Imaging Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Zhijuan Xiong
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Mingwu Shen
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Peter S. Conti
- Molecular Imaging Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Xiangyang Shi
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, China
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
- Corresponding Authors:. Tel: +86-21-67792656. Fax: +86-21-67792306 804 (X.S.)., . Tel: +1-323-442-3858. Fax: +1-323-442-3253 (K.C.)
| | - Kai Chen
- Molecular Imaging Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
- Corresponding Authors:. Tel: +86-21-67792656. Fax: +86-21-67792306 804 (X.S.)., . Tel: +1-323-442-3858. Fax: +1-323-442-3253 (K.C.)
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11
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Riola-Parada C, Carreras-Delgado J, Pérez-Dueñas V, Garcerant-Tafur M, García-Cañamaque L. 18F-choline PET/MR in suspected recurrence of prostate cancer. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Shandiz MS, Rad HS, Ghafarian P, Yaghoubi K, Ay MR. Capturing Bone Signal in MRI of Pelvis, as a Large FOV Region, Using TWIST Sequence and Generating a 5-Class Attenuation Map for Prostate PET/MRI Imaging. Mol Imaging 2018; 17:1536012118789314. [PMID: 30064303 PMCID: PMC6071149 DOI: 10.1177/1536012118789314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: Prostate imaging is a major application of hybrid positron emission tomography/magnetic
resonance imaging (PET/MRI). Currently, MRI-based attenuation correction (MRAC) for
whole-body PET/MRI in which the bony structures are ignored is the main obstacle to
successful implementation of the hybrid modality in the clinical work flow. Ultrashort
echo time sequence captures bone signal but needs specific hardware–software and is
challenging in large field of view (FOV) regions, such as pelvis. The main aims of the
work are (1) to capture a part of the bone signal in pelvis using short echo time (STE)
imaging based on time-resolved angiography with interleaved stochastic trajectories
(TWIST) sequence and (2) to consider the bone in pelvis attenuation map (µ-map) to MRAC
for PET/MRI systems. Procedures: Time-resolved angiography with interleaved stochastic trajectories, which is routinely
used for MR angiography with high temporal and spatial resolution, was employed for
fast/STE MR imaging. Data acquisition was performed in a TE of 0.88 milliseconds (STE)
and 4.86 milliseconds (long echo time [LTE]) in pelvis region. Region of interest
(ROI)-based analysis was used for comparing the signal-to-noise ratio (SNR) of cortical
bone in STE and LTE images. A hybrid segmentation protocol, which is comprised of image
subtraction, a Fuzzy-based segmentation, and a dedicated morphologic operation, was used
for generating a 5-class µ-map consisting of cortical bone, air cavity, fat, soft
tissue, and background (µ-mapMR-5c). A MR-based 4-class µ-map
(µ-mapMR-4c) that considered soft tissue rather than bone was generated. As
such, a bilinear (µ-mapCT-ref), 5 (µ-mapCT-5c), and 4 class µ-map
(µ-mapCT-4c) based on computed tomography (CT) images were generated.
Finally, simulated PET data were corrected using µ-mapMR-5c (PET-MRAC5c),
µ-mapMR-4c (PET-MRAC4c), µ-mapCT-5c (PET-CTAC5c), and
µ-mapCT-ref (PET-CTAC). Results: The ratio of SNRbone to SNRair cavity in LTE images was 0.8, this
factor was increased to 4.4 in STE images. The Dice, Sensitivity, and Accuracy metrics
for bone segmentation in proposed method were 72.4% ± 5.5%, 69.6% ± 7.5%, and 96.5% ±
3.5%, respectively, where the segmented CT served as reference. The mean relative error
in bone regions in the simulated PET images were −13.98% ± 15%, −35.59% ± 15.41%, and
1.81% ± 12.2%, respectively, in PET-MRAC5c, PET-MRAC4c, and PET-CTAC5c where PET-CTAC
served as the reference. Despite poor correlation in the joint histogram of
µ-mapMR-4c versus µ-mapCT-5c (R2 > 0.78) and
PET-MRAC4c versus PET-CTAC5c (R2 = 0.83), high correlations were observed in
µ-mapMR-5c versus µ-mapCT-5c (R2 > 0.94) and
PET-MRAC5c versus PET-CTAC5c (R2 > 0.96). Conclusions: According to the SNRSTE, pelvic bone, the cortical bone can be separate from
air cavity in STE imaging based on TWIST sequence. The proposed method generated an
MRI-based µ-map containing bone and air cavity that led to more accurate tracer uptake
estimation than MRAC4c. Uptake estimation in hybrid PET/MRI can be improved by employing
the proposed method.
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Affiliation(s)
- Mehdi Shirin Shandiz
- 1 Department of Medical Physics, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamid Saligheh Rad
- 2 Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.,3 Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Ghafarian
- 4 Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.,5 PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khadijeh Yaghoubi
- 1 Department of Medical Physics, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Reza Ay
- 2 Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.,3 Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
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13
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Kuo HT, Pan J, Zhang Z, Lau J, Merkens H, Zhang C, Colpo N, Lin KS, Bénard F. Effects of Linker Modification on Tumor-to-Kidney Contrast of 68Ga-Labeled PSMA-Targeted Imaging Probes. Mol Pharm 2018; 15:3502-3511. [DOI: 10.1021/acs.molpharmaceut.8b00499] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Hsiou-Ting Kuo
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Jinhe Pan
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Zhengxing Zhang
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Joseph Lau
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Helen Merkens
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Chengcheng Zhang
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Nadine Colpo
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Kuo-Shyan Lin
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - François Bénard
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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14
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Riola-Parada C, Carreras-Delgado JL, Pérez-Dueñas V, Garcerant-Tafur M, García-Cañamaque L. 18F-choline PET/MRI in suspected recurrence of prostate carcinoma. Rev Esp Med Nucl Imagen Mol 2018; 37:296-301. [PMID: 29793842 DOI: 10.1016/j.remn.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the usefulness of simultaneous 18F-choline PET/MRI in the suspicion of prostate cancer recurrence and to relate 18F-choline PET/MRI detection rate with analytical and pathological variables. MATERIAL AND METHODS 27 patients with prostate cancer who received local therapy as primary treatment underwent a 18F-choline PET/MRI due to suspicion of recurrence (persistently rising serum PSA level). 18F-choline PET/MRI findings were validated by anatomopathological analysis, other imaging tests or by biochemical response to oncological treatment. RESULTS 18F-choline PET/MRI detected disease in 15 of 27 patients (detection rate 55.56%). 4 (15%) presented exclusively local recurrence, 5 (18%) lymph node metastases and 7 (26%) bone metastases. Mean PSA (PSAmed) at study time was 2.94ng/mL (range 0.18-10ng/mL). PSAmed in patients with positive PET/MRI was 3.70ng/mL (range 0.24-10ng/mL), higher than in patients with negative PET/MRI, PSAmed 1.97ng/mL (range 0.18-4.38ng/mL), although without statistically significant differences. Gleason score at diagnosis in patients with a positive study was 7.33 (range 6-9) and in patients with a negative study was 7 (range 6-9), without statistically significant differences. CONCLUSION 18F-choline PET/MRI detection rate was considerable despite the relatively low PSA values in our sample. The influence of Gleason score and PSA level on 18F-choline PET/MRI detection rate was not statistically significant.
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Affiliation(s)
- C Riola-Parada
- Servicio de Medicina Nuclear, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España.
| | - J L Carreras-Delgado
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - V Pérez-Dueñas
- Servicio de Radiología, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España
| | - M Garcerant-Tafur
- Servicio de Medicina Nuclear, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España
| | - L García-Cañamaque
- Servicio de Medicina Nuclear, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España
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15
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Knorr K, Eiber M, Maurer T, Wester HJ, Scheidhauer K. [PET-CT and PET-MRI of the prostate : From 18F-FDG to 68Ga-PSMA]. Radiologe 2018; 57:631-636. [PMID: 28688023 DOI: 10.1007/s00117-017-0276-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CLINICAL/METHODICAL ISSUE In the last few years nuclear medical diagnostics have experienced a unprecedented renaissance in the diagnostics of prostate cancer, due to the availability of hybrid imaging with positron emission tomography computed tomography (PET/CT), PET magnetic resonance imaging (PET/MRI) and single photon emission computed tomography (SPECT) CT as well as the development of prostate-specific radiopharmaceuticals. METHODICAL INNOVATIONS The use of fluorodeoxyglucose (FDG), which has been successfully implemented for many years in PET diagnostics, is only helpful in dedifferentiated tumors due to the biological characteristics of prostate cancer. New specific radiopharmaceuticals, such as choline-derivatives, which are incorporated into the prostate cancer cell and built into the cell membrane as well as the recently developed highly specific ligands for prostate-specific membrane antigen (PSMA) are revolutionizing prostate cancer imaging and (re-) staging. PRACTICAL RECOMMENDATIONS The 68 Ga-labeled PSMA ligands for PET-CT and PET-MRI are highly specific tracers for primary diagnostics and detection of metastases of prostate carcinoma. In risk patients, which includes patients with intermediate and high-risk tumors, they have largely replaced choline-based PET-CT, especially in the case of very low PSA values <0.5 ng/ml in the diagnostics of recurrence. The use in the primary diagnostics as PET-MRI, also in combination with multiparametric MRI (mpMRI), is promising with respect to early diagnostics and image fusion-assisted biopsy as well as surgery and irradiation planning.
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Affiliation(s)
- K Knorr
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - M Eiber
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - T Maurer
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - H-J Wester
- Pharmazeutische Radiochemie, Technische Universität München, Garching, Deutschland
| | - K Scheidhauer
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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16
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Schiller K, Devecka M, Maurer T, Eiber M, Gschwend J, Schwaiger M, Combs SE, Habl G. Impact of 68Ga-PSMA-PET imaging on target volume definition and guidelines in radiation oncology - a patterns of failure analysis in patients with primary diagnosis of prostate cancer. Radiat Oncol 2018; 13:36. [PMID: 29490670 PMCID: PMC5831712 DOI: 10.1186/s13014-018-0977-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/15/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND 68Ga-PSMA-PET-imaging has proven to be a highly sensitive and specific diagnostic element for patients with prostate cancer (PC). Does the standard clinical target volume (CTV) cover the majority of 68Ga-PSMA-PET detected lymph nodes (LNs) in a primary setting? METHODS 25 out of 159 patients with primary PC who underwent 68Ga-PSMA-PET-imaging were analyzed in the process of this study. These 25 high-risk patients had a total of 126 LNs with positive 68Ga-PSMA-ligand uptake. A standard CTV according to the 'Radiation Therapy Oncology Group' consensus was delineated and LNs were judged whether they were in- or outside of this target volume. With a Pearson correlation we additionally evaluated whether the Gleason score, the prostate-specific antigen (PSA) value or the risk according to the Roach formula correlate with a higher chance of LNs being outside of the CTV in uncommon LN locations. RESULTS 81 (64.3%) of 126 LNs were covered by the CTV with a complete coverage of all positive LNs inside the respective radiation volume in 11 of 25 patients (44%). LNs that were not covered by the CTV included (para-aortic,) common-iliac, pre-sacral, obturatoric, para-rectal, para-vesical and pre-acetabular locations. In a statistical analysis neither the Gleason score, nor the PSA value, nor the calculated risk with the Roach formula correlated with LNs being inside or outside of the CTV in this patient group. CONCLUSION 68Ga-PSMA-PET-imaging proves to be a valuable asset for patients and physicians for primary diagnosis and treatment planning. In our study, trusting the RTOG consensus for CTV delineation would have led to up to 35.7% of all LNs not to be included in the clinical radiation volume, which might have resulted in insufficient radiation dose coverage.
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Affiliation(s)
- K. Schiller
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - M. Devecka
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - T. Maurer
- Department of Urology, Technical University Munich (TUM), Munich, Germany
| | - M. Eiber
- Department of Nuclear Medicine, Technical University Munich (TUM), Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Site Munich, Heidelberg, Germany
| | - J. Gschwend
- Department of Urology, Technical University Munich (TUM), Munich, Germany
| | - M. Schwaiger
- Department of Nuclear Medicine, Technical University Munich (TUM), Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Site Munich, Heidelberg, Germany
| | - S. E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum, Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Site Munich, Heidelberg, Germany
| | - G. Habl
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum, Munich, Germany
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Li R, Ravizzini GC, Gorin MA, Maurer T, Eiber M, Cooperberg MR, Alemozzaffar M, Tollefson MK, Delacroix SE, Chapin BF. The use of PET/CT in prostate cancer. Prostate Cancer Prostatic Dis 2017; 21:4-21. [PMID: 29230009 DOI: 10.1038/s41391-017-0007-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/28/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Positron emission tomography/computed tomography (PET/CT) has recently emerged as a promising diagnostic imaging platform for prostate cancer. Several radiolabelled tracers have demonstrated efficacy for cancer detection in various clinical settings. In this review, we aim to illustrate the diverse use of PET/CT with different tracers for the detection of prostate cancer. METHODS We searched MEDLINE using the terms 'prostate cancer', 'PET', 'PET/CT' and 'PET/MR'). The current review was limited to 18F-NaF PET/CT, choline-based PET/CT, fluciclovine PET/CT and PSMA-targeted PET/CT, as these modalities have been the most widely adopted. RESULTS NaF PET/CT has shown efficacy in detecting bone metastases with high sensitivity, but relatively low specificity. Currently, choline PET/CT has been the most extensively studied modality. Although having superior specificity, choline PET/CT suffers from low sensitivity, especially at low PSA levels. Nevertheless, choline PET/CT was found to significantly improve upon conventional imaging modalities (CIM) in the detection of metastatic lesions at biochemical recurrence (BCR). Newer methods using fluciclovine and PSMA-targeted radiotracers have preliminarily demonstrated great promise in primary and recurrent staging of prostate cancer. However, their superior efficacy awaits confirmation in larger series. CONCLUSIONS PET/CT has emerged as a promising staging modality for both primary and recurrent prostate cancer. Newer tracers have increased detection accuracies for small, incipient metastatic foci. The clinical implications of these occult PET/CT detected disease foci require organized evaluation. Efforts should be aimed at defining their natural history as well as responsiveness and impact of metastasis-directed therapy.
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Affiliation(s)
- Roger Li
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA.
| | - Gregory C Ravizzini
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tobias Maurer
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | | | | | | | - Scott E Delacroix
- Department of Urology, Louisiana State University, New Orleans, LA, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
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Kaittanis C, Andreou C, Hieronymus H, Mao N, Foss CA, Eiber M, Weirich G, Panchal P, Gopalan A, Zurita J, Achilefu S, Chiosis G, Ponomarev V, Schwaiger M, Carver BS, Pomper MG, Grimm J. Prostate-specific membrane antigen cleavage of vitamin B9 stimulates oncogenic signaling through metabotropic glutamate receptors. J Exp Med 2017; 215:159-175. [PMID: 29141866 PMCID: PMC5748857 DOI: 10.1084/jem.20171052] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/17/2017] [Accepted: 10/04/2017] [Indexed: 12/14/2022] Open
Abstract
Kaittanis et al. show that the processing of glutamated folates by prostate-specific membrane antigen induces the activation of metabotropic glutamate receptors and initiation of PI3K–Akt signaling in prostate cancer. Prostate-specific membrane antigen (PSMA) or folate hydrolase 1 (FOLH1) is highly expressed on prostate cancer. Its expression correlates inversely with survival and increases with tumor grade. However, the biological role of PSMA has not been explored, and its role in prostate cancer remained elusive. Filling this gap, we demonstrate that in prostate cancer, PSMA initiates signaling upstream of PI3K through G protein–coupled receptors, specifically via the metabotropic glutamate receptor (mGluR). PSMA’s carboxypeptidase activity releases glutamate from vitamin B9 and other glutamated substrates, which activate mGluR I. Activated mGluR I subsequently induces activation of phosphoinositide 3-kinase (PI3K) through phosphorylation of p110β independent of PTEN loss. The p110β isoform of PI3K plays a particularly important role in the pathogenesis of prostate cancer, but the origin of its activation was so far unknown. PSMA expression correlated with PI3K–Akt signaling in cells, animal models, and patients. We interrogated the activity of the PSMA–PI3K axis through positron emission tomography and magnetic resonance imaging. Inhibition of PSMA in preclinical models inhibited PI3K signaling and promoted tumor regression. Our data present a novel oncogenic signaling role of PSMA that can be exploited for therapy and interrogated with imaging.
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Affiliation(s)
- Charalambos Kaittanis
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY.,Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Chrysafis Andreou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Haley Hieronymus
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ninghui Mao
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine A Foss
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Gregor Weirich
- Department of Pathology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Palak Panchal
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anuradha Gopalan
- Genitourinary Division, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juan Zurita
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Achilefu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Gabriela Chiosis
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vladimir Ponomarev
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Brett S Carver
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Jan Grimm
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY .,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Pharmacology, Weill Cornell Medical College, New York, NY.,Department of Radiology, Weill Cornell Medical College, New York, NY
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19
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Patterns of failure after radical prostatectomy in prostate cancer - implications for radiation therapy planning after 68Ga-PSMA-PET imaging. Eur J Nucl Med Mol Imaging 2017. [PMID: 28646463 DOI: 10.1007/s00259-017-3746-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). 68Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases. OBJECTIVE In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not. METHODS AND MATERIALS Thirty-one out of 83 patients (37%) with high-risk PC were the subject of our study. Information from 68Ga-PSMA-PET imaging was used to individualize treatment plans to include suspicious lesions as well as possibly boost sites with tracer uptake in LN or the prostate bed. For evaluation, 68Ga-PSMA-PET-positive LN were contoured in a patient dataset with a standard lymph drainage (RTOG consensus on CTV definition of pelvic lymph nodes) radiation field depicting color-coded nodes that would have been infield or outfield of that standard lymph drainage field and thereby visualizing typical patterns of failure of a "blind" radiation therapy after RPE and LAE. RESULTS Compared to negative conventional imaging (CT/MRI), lesions suspicious for PC were detected in 27/31 cases (87.1%) by 68Ga-PSMA-PET imaging, which resulted in changes to the radiation concept. There were 16/31 patients (51.6%) that received a simultaneous integrated boost (SIB) to a subarea of the prostate bed (in only three cases this dose escalation would have been planned without the additional knowledge of 68Ga-PSMA-PET imaging) and 18/31 (58.1%) to uncommon (namely presacral, paravesical, pararectal, preacetabular and obturatoric) LN sites. Furthermore, 14 patients (45.2%) had a changed TNM staging result by means of 68Ga-PSMA-PET imaging. CONCLUSION Compared to conventional CT or MRI staging, 68Ga-PSMA-PET imaging detects more PC lesions and, thus, significantly influences radiation planning in recurrent prostate cancer patients enabling individually tailored treatment.
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Habl G, Sauter K, Schiller K, Dewes S, Maurer T, Eiber M, Combs SE. 68 Ga-PSMA-PET for radiation treatment planning in prostate cancer recurrences after surgery: Individualized medicine or new standard in salvage treatment. Prostate 2017; 77:920-927. [PMID: 28317152 DOI: 10.1002/pros.23347] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/28/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND 68 Ga-PSMA-PET imaging is a novel promising diagnostic tool to locate early biochemical failure after radical prostatectomy (RP) in prostate cancer (PC) patients. Exact knowledge of the relapse location may result in changes of the therapy concept aside from changes to the TNM stage. To gain data for this approach, we evaluated PC patients receiving 68 Ga-PSMA-PET imaging before salvage radiotherapy (RT). METHODS AND MATERIALS In this study, 100 patients with biochemical failure after RP± prior RT who underwent 68 Ga-PSMA PET/CT or PET/MRI were evaluated undergoing salvage RT in our department. We analyzed TNM staging changes due to 68 Ga-PSMA-PET imaging and its influence on RT planning and treatment. RESULTS Uptake indicative for tumor recurrence in 68 Ga-PSMA-PET was found in 76% of the patients with biochemical recurrent PC. Median PSA level was 1.0 ng/mL (range 0.12-14.7 ng/mL). Of these, 80% showed no morphological correlate in the corresponding CT or MRI. A 43% of all patients experienced a change in TNM stage due to 68 Ga-PSMA-PET imaging. Patients had changes from Tx to rcT+ (28%), 12% from pN0 to rcN1, 1% from pN0/cM0 to rcM1a, and 8% from cM0 to rcM1b. Due to the additional knowledge of 68 Ga-PSMA-PET imaging, initial planned RT planning was adapted in 59% of all cases. An additional simultaneous integrated boost (SIB) to the prostate bed or lymph nodes was given to 32% and 63%, respectively. Ten patients received stereotactic body RT (SBRT) to single bone metastases. CONCLUSION 68 Ga-PSMA-PET imaging showed a high clinical impact on staging and RT management in patients with biochemically recurrent PC, even at low serum PSA levels. With 43% changes in staging and 59% in radiotherapy planning 68 Ga-PSMA-PET could lead to an indispensable tool in guiding radiation treatment in recurrent PC.
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Affiliation(s)
- Gregor Habl
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Zentrum für Stereotaxie und personalisierte Hochpräzisionsstrahlentherapie (StereotakTUM), Technische Universität München (TUM), Munich, Germany
| | - Katharina Sauter
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Kilian Schiller
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Sabrina Dewes
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Tobias Maurer
- Department of Urology, Technical University Munich (TUM), Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich (TUM), Munich, Germany
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
- Zentrum für Stereotaxie und personalisierte Hochpräzisionsstrahlentherapie (StereotakTUM), Technische Universität München (TUM), Munich, Germany
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21
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18 F-Choline Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging for the Detection of Early Local Recurrence of Prostate Cancer Initially Treated by Radiation Therapy: Comparison With Systematic 3-Dimensional Transperineal Mapping Biopsy. Int J Radiat Oncol Biol Phys 2017; 97:986-994. [DOI: 10.1016/j.ijrobp.2016.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 11/23/2022]
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22
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Amouroux G, Zhang Z, Pan J, Jenni S, Zhang C, Hundal-Jabal N, Colpo N, Zeisler J, Lin KS, Bénard F. Synthesis and evaluation of a 68Ga-labeled bradykinin B1 receptor agonist for imaging with positron emission tomography. Bioorg Med Chem 2017; 25:690-696. [PMID: 27908753 DOI: 10.1016/j.bmc.2016.11.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/31/2022]
Abstract
A novel 68Ga-labeled bradykinin B1 receptor (B1R) agonist, 68Ga-Z01115, was synthesized and evaluated for imaging with positron emission tomography (PET). Z01115 exhibited good binding affinity (Ki=25.4±5.1nM) to hB1R. 68Ga-Z01115 was prepared in 74±5 decay-corrected radiochemical yield with >99% radiochemical purity and 155±89GBq/µmol (4.2±2.4Ci/μmol) specific activity. 68Ga-Z01115 was stable in vitro in mouse plasma (93% remaining intact after 60min incubation), and relatively stable in vivo (51±5% remaining intact at 5min post-injection). PET imaging and biodistribution studies in mice showed that 68Ga-Z01115 cleared rapidly from nontarget tissues/organs, and generated high target-to-nontarget contrast images. The uptake of 68Ga-Z01115 in B1R-positive (B1R+) tumor was 5.65±0.59%ID/g at 1h post-injection. Average contrast ratios of B1R+ tumor-to-B1R- tumor, -to-blood and -to-muscle were 24.3, 24.4 and 82.9, respectively. Uptake of 68Ga-Z01115 in B1R+ tumors was reduced by ∼90% with co-injection of cold standard, confirming it was mediated by B1R. Our data suggest that 68Ga-Z01115 is a promising tracer for imaging the expression of B1R that is overexpressed in a variety of cancers.
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Affiliation(s)
- Guillaume Amouroux
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Zhengxing Zhang
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Jinhe Pan
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Silvia Jenni
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Chengcheng Zhang
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Navjit Hundal-Jabal
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Nadine Colpo
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Jutta Zeisler
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Kuo-Shyan Lin
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada; Department of Radiology, University of British Columbia, 3350-950 West 10th Avenue, Vancouver, British Columbia V5Z 4E3, Canada.
| | - François Bénard
- Department of Molecular Oncology, BC Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada; Department of Radiology, University of British Columbia, 3350-950 West 10th Avenue, Vancouver, British Columbia V5Z 4E3, Canada.
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James N, Graham J, Maurer T, Eiber M, Gschwend JE. Diagnosis and Treatment of Prostate Cancer: What Americans Can Learn From International Oncologists. Am Soc Clin Oncol Educ Book 2017; 37:344-357. [PMID: 28561698 DOI: 10.1200/edbk_175496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The three main sections in this article illustrate a number of facets of European health care. The first section looks at the influence of NICE on treatment of metastatic castration-resistant prostate cancer. The second section explores the impact of molecular imaging on diagnosis and treatment, in particular the development and clinical implementation of 68Ga PET imaging in prostate cancer. The final section of the session looks at the STAMPEDE trial and how running a trial on this scale has impacted care of prostate cancer in the United Kingdom and also at the uptake of docetaxel chemotherapy in hormone-sensitive advanced disease.
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Affiliation(s)
- Nicholas James
- From the Institute of Cancer and Genomic Sciences, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Urology, Technical University of Munich, Munich, Germany; Department of Nuclear Medicine, Technical University of Munich, Munich, Germany; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - John Graham
- From the Institute of Cancer and Genomic Sciences, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Urology, Technical University of Munich, Munich, Germany; Department of Nuclear Medicine, Technical University of Munich, Munich, Germany; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Tobias Maurer
- From the Institute of Cancer and Genomic Sciences, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Urology, Technical University of Munich, Munich, Germany; Department of Nuclear Medicine, Technical University of Munich, Munich, Germany; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Matthias Eiber
- From the Institute of Cancer and Genomic Sciences, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Urology, Technical University of Munich, Munich, Germany; Department of Nuclear Medicine, Technical University of Munich, Munich, Germany; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jürgen E Gschwend
- From the Institute of Cancer and Genomic Sciences, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Urology, Technical University of Munich, Munich, Germany; Department of Nuclear Medicine, Technical University of Munich, Munich, Germany; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA
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Eiber M, Weirich G, Holzapfel K, Souvatzoglou M, Haller B, Rauscher I, Beer AJ, Wester HJ, Gschwend J, Schwaiger M, Maurer T. Simultaneous 68Ga-PSMA HBED-CC PET/MRI Improves the Localization of Primary Prostate Cancer. Eur Urol 2016; 70:829-836. [PMID: 26795686 DOI: 10.1016/j.eururo.2015.12.053] [Citation(s) in RCA: 391] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ligands of the prostate-specific membrane antigen (PSMA) show promising results in positron emission tomography (PET) imaging of prostate cancer (PCa). OBJECTIVE To compare the diagnostic performance of simultaneous gallium 68 (68Ga)-PSMA HBED-CC PET/magnetic resonance imaging (MRI) for localization of primary PCa with multiparametric magnetic resonance imaging (mpMRI) and PET alone. DESIGN, SETTING, AND PARTICIPANTS We performed 68Ga-PSMA HBED-CC PET/MRI in 66 men with biopsy-proven PCa. INTERVENTION PET, mpMRI, and combined 68Ga-PSMA HBED-CC PET/MRI were independently evaluated using Prostate Imaging Reporting and Data System criteria or a 5-point Likert scale. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The prostate was divided into sextants for histopathology and coregistered with imaging. Diagnostic performance for localization of malignancy was calculated based on receiver operating characteristics analysis for each modality. Regional quantitative PET tracer uptake was recorded; uptake ratio was defined as the ratio of malignant to nonmalignant prostate tissue. RESULTS AND LIMITATIONS A total of 53 of 66 patients were eligible for analysis. mpMRI, PET, and PET/MRI detected cancer in 66% (35 of 53), 92% (49 of 53), and 98% (52 of 53) of the patients, respectively. Overall, 202 of 318 sextants (63.5%) contained cancer at pathologic examination. Simultaneous PET/MRI statistically outperformed mpMRI (area under the curve [AUC]: 0.88 vs 0.73; p<0.001) and PET imaging (AUC: 0.88 vs 0.83; p=0.002) for localization of PCa. Compared with mpMRI, PET imaging was more accurate (AUC: 0.83 vs 0.73; p=0.003). PET provided a high uptake ratio between malignant versus nonmalignant tissue (5.02 [range: 0.89-29.8]), but no significant correlation was observed between quantitative PET parameters and Gleason score or prostate-specific antigen value. CONCLUSIONS Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves diagnostic accuracy for PCa localization both compared with mpMRI and with PET imaging alone. Further prospective studies are warranted to evaluate its potential (eg, for biopsy guidance). PATIENT SUMMARY We examined gallium 68 (68Ga)-prostate-specific membrane antigen (PSMA) HBED-CC positron emission tomography/magnetic resonance imaging (PET/MRI) for primary prostate cancer (PCa) and compared it with multiparametric MRI and PET alone. Our results indicate a higher diagnostic accuracy for 68Ga-PSMA HBED-CC PET/MRI that may help localize PCa.
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Affiliation(s)
- Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
| | - Gregor Weirich
- Department of Pathology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Konstantin Holzapfel
- Institute of Radiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Michael Souvatzoglou
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technische Universität München, Garching, Germany
| | - Juergen Gschwend
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
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26
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Shandiz MS, Rad HS, Ghafarian P, Karam MB, Akbarzadeh A, Ay MR. MR-guided attenuation map for prostate PET-MRI: an intensity and morphologic-based segmentation approach for generating a five-class attenuation map in pelvic region. Ann Nucl Med 2016; 31:29-39. [PMID: 27680021 DOI: 10.1007/s12149-016-1128-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Prostate imaging is one of the major application of hybrid PET/MRI systems. Inaccurate attenuation maps (µ-maps) derived by direct segmentation (SEG) in which the cortical bone is ignored and the volume of the air in cavities is underestimated is the main challenge of commercial PET/MRI systems for the quantitative analysis of the pelvic region. The present study considered the cortical bone and air cavity along with soft tissue, fat, and background air in the µ-map of the pelvic region using a method based on SEG. The proposed method uses a dedicated imaging technique that increases the contrast between regions and a hybrid segmentation method to classify MR images based on intensity and morphologic characteristics of tissues, such as symmetry and similarity of bony structures. PROCEDURES Ten healthy volunteers underwent MRI and ultra-low dose CT imaging. The dedicated MR imaging technique uses the short echo time (STE) based on the conventional sequencing implemented on a clinical 1.5T MRI scanner. The generation of a µ-map comprises the following steps: (1) bias field correction; (2) hybrid segmentation (HSEG), including segmenting images into clusters of cortical bone-air, soft tissue, and fat using spatial fuzzy c-means (SFCM), and separation of cortical bone and internal air cavities using morphologic characteristics; (3) the active contour approach for the separation of background air; and (4) the generation of a five-class μ-map for cortical bone, internal air cavity, soft tissue, fat tissue, and background air. Validation was done by comparison with segmented CT images. RESULTS The Dice and sensitivity metrics of cortical bone structures and internal air cavities were 72 ± 11 and 66 ± 13 and 73 ± 10 and 68 ± 20 %, respectively. High correlation was observed between CT and HSEG-based µ-maps (R 2 > 0.99) and the corresponding sinograms (R 2 > 0.98). CONCLUSIONS Currently, pelvis µ-maps provided by the current PET/MRI systems and the ultra-short echo time and atlas-based methods tend to be inaccurate. The proposed method acceptably generated a five-class μ-map using only one image.
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Affiliation(s)
- M Shirin Shandiz
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - H Saligheh Rad
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - P Ghafarian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Bakhshayesh Karam
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Akbarzadeh
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ay
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran.
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Intrapatient Comparison of 111In-PSMA I&T SPECT/CT and Hybrid 68Ga-HBED-CC PSMA PET in Patients With Early Recurrent Prostate Cancer. Clin Nucl Med 2016; 41:e397-402. [DOI: 10.1097/rlu.0000000000001273] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lee MS, Cho JY, Kim SY, Cheon GJ, Moon MH, Oh S, Lee J, Lee S, Woo S, Kim SH. Diagnostic value of integrated PET/MRI for detection and localization of prostate cancer: Comparative study of multiparametric MRI and PET/CT. J Magn Reson Imaging 2016; 45:597-609. [PMID: 27586519 DOI: 10.1002/jmri.25384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/23/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) compared with conventional multiparametric MRI and PET/computed tomography (CT) for the detailed and accurate segmental detection/localization of prostate cancer. MATERIALS AND METHODS Thirty-one patients who underwent integrated PET/MRI using 18 F-choline and 18 F-FDG with an integrated PET/MRI scanner followed by radical prostatectomy were included. The prostate was divided into six segments (sextants) according to anatomical landmarks. Three radiologists noted the presence and location of cancer in each sextant on four different image interpretation modalities in consensus (1, multiparametric MRI; 2, integrated 18 F-FDG PET/MRI; 3, integrated 18 F-choline PET/MRI; and 4, combined interpretation of 1 and 18 F-FDG PET/CT). Sensitivity, specificity, accuracy, positive and negative predictive values, likelihood ratios, and diagnostic performance based on the DOR (diagnostic odds ratio) and NNM (number needed to misdiagnose) were evaluated for each interpretation modality, using the pathologic result as the reference standard. Detection rates of seminal vesicle invasion and extracapsular invasion were also evaluated. RESULTS Integrated 18 F-choline PET/MRI showed significantly higher sensitivity than did multiparametric MRI alone in high Gleason score patients (77.0% and 66.2%, P = 0.011), low Gleason score patients (66.7% and 47.4%, P = 0.007), and total patients (72.5% and 58.0%, P = 0.008) groups. Integrated 18 F-choline PET/MRI and 18 F-FDG PET/MRI showed similar sensitivity and specificity to combined interpretation of multiparametric MRI and 18 F-FDG PET/CT (for sensitivity, 58.0%, 63.4%, 72.5%, and 68.7%, respectively, and for specificity, 87.3%, 80.0%, 81.8%, 72.7%, respectively, in total patient group). However, integrated 18 F-choline PET/MRI showed the best diagnostic performance (as DOR, 11.875 in total patients, 27.941 in high Gleason score patients, 5.714 in low Gleason score groups) among the imaging modalities, regardless of Gleason score. Integrated 18 F-choline PET/MRI showed higher sensitivity and diagnostic performance than did integrated 18 F-FDG PET/MRI (as DOR, 6.917 in total patients, 15.143 in high Gleason score patients, 3.175 in low Gleason score groups) in all three patient groups. CONCLUSION Integrated PET/MRI carried out using a dedicated integrated PET/MRI scanner provides better sensitivity, accuracy, and diagnostic value for detection/localization of prostate cancer compared to multiparametric MRI. Generally, integrated 18 F-choline PET/MRI shows better sensitivity, accuracy, and diagnostic performance than does integrated 18 F-FDG PET/MRI as well as combined interpretation of multiparametric MRI with 18 F-FDG PET/CT. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:597-609.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sungmin Woo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Pyka T, Okamoto S, Dahlbender M, Tauber R, Retz M, Heck M, Tamaki N, Schwaiger M, Maurer T, Eiber M. Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43:2114-2121. [PMID: 27290607 DOI: 10.1007/s00259-016-3435-0] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/02/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of our study was to compare the diagnostic performance of 68Ga-PSMA PET and 99mTc bone scintigraphy (BS) for the detection of bone metastases in prostate cancer (PC) patients. METHODS One hundred twenty-six patients who received planar BS and PSMA PET within three months and without change of therapy were extracted from our database. Bone lesions were categorized into benign, metastatic, or equivocal by two experienced observers. A best valuable comparator (BVC) was defined based on BS, PET, additional imaging, and follow-up data. The cohort was further divided into clinical subgroups (primary staging, biochemical recurrence, and metastatic castration-resistant prostate cancer [mCRPC]). Additionally, subgroups of patients with less than 30 days delay between the two imaging procedures and with additional single-photon emission computed tomography (SPECT) were analyzed. RESULTS A total of 75 of 126 patients were diagnosed with bone metastases. Sensitivities and specificities regarding overall bone involvement were 98.7-100 % and 88.2-100 % for PET, and 86.7-89.3 % and 60.8-96.1 % (p < 0.001) for BS, with ranges representing results for 'optimistic' or 'pessimistic' classification of equivocal lesions. Out of 1115 examined bone regions, 410 showed metastases. Region-based analysis revealed a sensitivity and specificity of 98.8-99.0 % and 98.9-100 % for PET, and 82.4-86.6 % and 91.6-97.9 % (p < 0.001) for BS, respectively. PSMA PET also performed better in all subgroups, except patient-based analysis in mCRPC. CONCLUSION Ga-PSMA PET outperforms planar BS for the detection of affected bone regions as well as determination of overall bone involvement in PC patients. Our results indicate that BS in patients who have received PSMA PET for staging only rarely offers additional information; however, prospective studies, including a standardized integrated x-ray computed tomography (SPECT/CT) protocol, should be performed in order to confirm the presented results.
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Affiliation(s)
- Thomas Pyka
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Shozo Okamoto
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Robert Tauber
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Margitta Retz
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Matthias Heck
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany
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Rauscher I, Maurer T, Beer AJ, Graner FP, Haller B, Weirich G, Doherty A, Gschwend JE, Schwaiger M, Eiber M. Value of 68Ga-PSMA HBED-CC PET for the Assessment of Lymph Node Metastases in Prostate Cancer Patients with Biochemical Recurrence: Comparison with Histopathology After Salvage Lymphadenectomy. J Nucl Med 2016; 57:1713-1719. [PMID: 27261524 DOI: 10.2967/jnumed.116.173492] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/27/2016] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to evaluate the accuracy of Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] PET compared with morphologic imaging for the assessment of lymph node metastases (LNM) in patients with recurrent prostate cancer. METHODS Forty-eight patients (median age, 71 y; interquartile range, 66-74 y) with biochemical recurrence (median prostate-specific antigen level, 1.31 ng/mL; interquartile range, 0.75-2.55 ng/mL) who underwent 68Ga-prostate-specific membrane antigen (PSMA) HBED-CC PET/CT or PET/MR and salvage lymphadenectomy were retrospectively included. Institutional review board approval and written informed consent were obtained from all patients for the purpose of anonymized evaluation and publication of their data. Standardized predefined lymph node (LN) template fields (n = 10) were evaluated in 68Ga-PSMA HBED-CC PET and morphologic imaging for the presence of LNM using a 5-point-scale. Additionally, SUVmean/max and size of suspicious lesions were determined. Specificity of 68Ga-PSMA HBED-CC PET imaging for PET-positive LNs was defined by comparison to histopathology. The diagnostic accuracy of 68Ga-PSMA HBED-CC PET compared with morphologic imaging alone was assessed, and areas under the receiver-operating-characteristic curves are presented. RESULTS LNM were found histologically in 68 of 179 resected anatomic LN fields (38.0%). The specificity of 68Ga-PSMA HBED-CC PET and morphologic imaging was 97.3% and 99.1%, respectively. However, 68Ga-PSMA HBED-CC PET detected LNM in 53 of 68 histopathologically proven metastatic LN fields (77.9%) whereas morphologic imaging was positive in only 18 of 67 (26.9%). 68Ga-PSMA HBED-CC PET imaging performed significantly superior to morphologic imaging for detection of LNM (difference in the areas under the receiver-operating-characteristic curves, 0.139; 95% confidence interval, 0.063-0.214; P < 0.001). In 68Ga-PSMA HBED-CC PET, the mean size of PET-positive LN measured by CT or MRI was 8.3 ± 4.3 mm (range, 4-25 mm), and LNs, which were suspicious only in CT or MRI, presented with a mean size of 13.0 ± 4.9 mm (range, 8-25 mm). CONCLUSION 68Ga-PSMA HBED-CC PET imaging is a promising method for early detection of LNM in patients with biochemical recurrent prostate cancer. It is more accurate than morphologic imaging and thus might represent a valuable tool for guiding salvage lymphadenectomy.
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Affiliation(s)
- Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Frank-Philipp Graner
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Gregor Weirich
- Department of Pathology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; and
| | - Alan Doherty
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Jürgen E Gschwend
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Update on advances in molecular PET in urological oncology. Jpn J Radiol 2016; 34:470-85. [PMID: 27222021 DOI: 10.1007/s11604-016-0553-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/07/2016] [Indexed: 12/28/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) with 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for the combined metabolic and anatomic evaluation of many cancers. In urological oncology, however, the use of (18)F-FDG has been limited by a generally low tumor uptake, and physiological excretion of FDG through the urinary system. (18)F-FDG PET/CT is useful when applied to specific indications in selected patients with urological malignancy. New radiotracers and positron emission tomography/magnetic resonance imaging (PET/MRI) are expected to further improve the performance of PET in uro-oncology.
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Pfob CH, Ziegler S, Graner FP, Köhner M, Schachoff S, Blechert B, Wester HJ, Scheidhauer K, Schwaiger M, Maurer T, Eiber M. Biodistribution and radiation dosimetry of (68)Ga-PSMA HBED CC-a PSMA specific probe for PET imaging of prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43:1962-70. [PMID: 27207281 DOI: 10.1007/s00259-016-3424-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 05/11/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Positron emission tomography (PET) agents targeting the prostate-specific membrane antigen (PSMA) are currently under broad clinical and scientific investigation. (68)Ga-PSMA HBED-CC constitutes the first (68)Ga-labelled PSMA-inhibitor and has evolved as a promising agent for imaging PSMA expression in vivo. The aim of this study was to evaluate the whole-body distribution and radiation dosimetry of this new probe. METHODS Five patients with a history or high suspicion of prostate cancer were injected intravenously with a mean of 139.8 ± 13.7 MBq of (68)Ga-PSMA HBED-CC (range 120-158 MBq). Four static skull to mid-thigh scans using a whole-body fully integrated PET/MR-system were performed 10 min, 60 min, 130 min, and 175 min after the tracer injection. Time-dependent changes of the injected activity per organ were determined. Mean organ-absorbed doses and effective doses (ED) were calculated using OLINDA/EXM. RESULTS Injection of a standard activity of 150 MBq (68)Ga-PSMA HBED-CC resulted in a median effective dose of 2.37 mSv (Range 1.08E-02 - 2.46E-02 mSv/MBq). The urinary bladder wall (median absorbed dose 1.64E-01 mGv/MBq; range 8.76E-02 - 2.91E-01 mGv/MBq) was the critical organ, followed by the kidneys (median absorbed dose 1.21E-01 mGv/MBq; range 7.16E-02 - 1.75E-01), spleen (median absorbed dose 4.13E-02 mGv/MBq; range 1.57E-02 - 7.32E-02 mGv/MBq) and liver (median absorbed dose 2.07E-02 mGv/MBq; range 1.80E-02 - 2.57E-02 mGv/MBq). No drug-related pharmacological effects occurred. CONCLUSION The use of (68)Ga-PSMA HBED-CC results in a relatively low radiation exposure, delivering organ doses that are comparable to those of other (68)Ga-labelled PSMA-inhibitors used for PET-imaging. Total effective dose is lower than for other PET-agents used for prostate cancer imaging (e.g. (11)C- and (18)F-Choline).
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Affiliation(s)
- Christian H Pfob
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Sibylle Ziegler
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
| | - Frank Philipp Graner
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
| | - Markus Köhner
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
| | - Sylvia Schachoff
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
| | - Birgit Blechert
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
| | - Hans-Jürgen Wester
- Chair of Pharmaceutical Radiochemistry, Department Chemie, Technische Universität München, Walther-Meissner-Str. 3, 85748, Garching, Germany
| | - Klemens Scheidhauer
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar; Ismaningerstrasse 22, 81675, Munich, Germany
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Bojorquez JZ, Bricq S, Brunotte F, Walker PM, Lalande A. A novel alternative to classify tissues from T 1 and T 2 relaxation times for prostate MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:777-88. [PMID: 27160300 DOI: 10.1007/s10334-016-0562-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To segment and classify the different attenuation regions from MRI at the pelvis level using the T 1 and T 2 relaxation times and anatomical knowledge as a first step towards the creation of PET/MR attenuation maps. MATERIALS AND METHODS Relaxation times were calculated by fitting the pixel-wise intensities of acquired T 1- and T 2-weighted images from eight men with inversion-recovery and multi-echo multi-slice spin-echo sequences. A decision binary tree based on relaxation times was implemented to segment and classify fat, muscle, prostate, and air (within the body). Connected component analysis and an anatomical knowledge-based procedure were implemented to localize the background and bone. RESULTS Relaxation times at 3 T are reported for fat (T 1 = 385 ms, T 2 = 121 ms), muscle (T 1 = 1295 ms, T 2 = 40 ms), and prostate (T 1 = 1700 ms, T 2 = 80 ms). The relaxation times allowed the segmentation-classification of fat, prostate, muscle, and air, and combined with anatomical knowledge, they allowed classification of bone. The good segmentation-classification of prostate [mean Dice similarity score (mDSC) = 0.70] suggests a viable implementation in oncology and that of fat (mDSC = 0.99), muscle (mDSC = 0.99), and bone (mDSCs = 0.78) advocates for its implementation in PET/MR attenuation correction. CONCLUSION Our method allows the segmentation and classification of the attenuation-relevant structures required for the generation of the attenuation map of PET/MR systems in prostate imaging: air, background, bone, fat, muscle, and prostate.
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Affiliation(s)
- Jorge Zavala Bojorquez
- LE2I, UMR 6306, CNRS, Arts et Métiers, Université Bourgogne Franche-Comté, 21000, Dijon, France.
| | - Stéphanie Bricq
- LE2I, UMR 6306, CNRS, Arts et Métiers, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - François Brunotte
- LE2I, UMR 6306, CNRS, Arts et Métiers, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Paul M Walker
- LE2I, UMR 6306, CNRS, Arts et Métiers, Université Bourgogne Franche-Comté, 21000, Dijon, France
| | - Alain Lalande
- LE2I, UMR 6306, CNRS, Arts et Métiers, Université Bourgogne Franche-Comté, 21000, Dijon, France
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Abstract
Currently, the findings of imaging procedures used for detection or staging of prostate cancer depend on morphology of lymph nodes or bone metabolism and do not always meet diagnostic needs. Prostate-specific membrane antigen (PSMA), a transmembrane protein that has considerable overexpression on most prostate cancer cells, has gained increasing interest as a target molecule for imaging. To date, several small compounds for labelling PSMA have been developed and are currently being investigated as imaging probes for PET with the (68)Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC being the most widely studied agent. (68)Ga-PSMA-PET imaging in combination with multiparametric MRI (mpMRI) might provide additional molecular information on cancer localization within the prostate. In patients with primary prostate cancer of intermediate-risk to high-risk, PSMA-based imaging has been reported to improve detection of metastatic disease compared with CT or mpMRI, rendering additional cross-sectional imaging or bone scintigraphy unnecessary. Furthermore, in patients with biochemically recurrent prostate cancer, use of (68)Ga-PSMA-PET imaging has been shown to increase detection of metastatic sites, even at low serum PSA values, compared with conventional imaging or PET examination with different tracers. Thus, although current knowledge is still limited and derived mostly from retrospective series, PSMA-based imaging holds great promise to improve prostate cancer management.
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Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, Wester HJ, Heck M, Kübler H, Beer AJ, Schwaiger M, Eiber M. Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. J Urol 2015; 195:1436-1443. [PMID: 26682756 DOI: 10.1016/j.juro.2015.12.025] [Citation(s) in RCA: 540] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Current standard imaging techniques are insufficient to reliably detect lymph node metastases in prostate cancer. Recently ligands of PSMA (prostate specific membrane antigen) were introduced in PET (positron emission tomography) of prostate cancer. Thus the aims of this retrospective analysis were to 1) investigate the diagnostic efficacy of (68)Ga-PSMA-PET imaging for lymph node staging in patients with prostate cancer scheduled for radical prostatectomy and 2) compare it to morphological imaging (computerized tomography and magnetic resonance tomography) with histopathological evaluation as the standard of reference. MATERIALS AND METHODS A total of 130 patients with intermediate to high risk prostate cancer were staged with (68)Ga-PSMA-PET/magnetic resonance tomography or PET/computerized tomography from December 2012 to November 2014 before radical prostatectomy and template pelvic lymph node dissection. Histopathological findings of resected tissue were statistically correlated with the results of (68)Ga-PSMA-PET and morphological imaging in a patient and template based manner. RESULTS Lymph node metastases were found in 41 of 130 patients (31.5%). On patient based analysis the sensitivity, specificity and accuracy of (68)Ga-PSMA-PET were 65.9%, 98.9% and 88.5%, and those of morphological imaging were 43.9%, 85.4% and 72.3%, respectively. Of 734 dissected lymph node templates 117 (15.9%) showed metastases. On template based analysis the sensitivity, specificity and accuracy of (68)Ga-PSMA-PET were 68.3%, 99.1% and 95.2%, and those of morphological imaging were 27.3%, 97.1% and 87.6%, respectively. On ROC analysis (68)Ga-PSMA-PET performed significantly better than morphological imaging alone on patient and template based analyses (p = 0.002 and <0.001, respectively). CONCLUSIONS In patients with intermediate to high risk prostate cancer preoperative lymph node staging with (68)Ga-PSMA-PET proved to be superior to standard routine imaging. Thus it has the potential to replace current standard imaging for this indication if confirmed by prospective studies.
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Affiliation(s)
- Tobias Maurer
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
| | - Jürgen E Gschwend
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Michael Souvatzoglou
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Gregor Weirich
- Institute of Pathology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Hans-Jürgen Wester
- Department of Pharmaceutical Radiochemistry, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Heck
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Hubert Kübler
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Department of Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
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Pyka T, Weirich G, Einspieler I, Maurer T, Theisen J, Hatzichristodoulou G, Schwamborn K, Schwaiger M, Eiber M. 68Ga-PSMA-HBED-CC PET for Differential Diagnosis of Suggestive Lung Lesions in Patients with Prostate Cancer. J Nucl Med 2015; 57:367-71. [PMID: 26585062 DOI: 10.2967/jnumed.115.164442] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/28/2015] [Indexed: 12/26/2022] Open
Abstract
UNLABELLED In prostate cancer (PC) patients, the differentiation between lung metastases and lesions of different origin, for example, primary lung cancer, is a common clinical question. Herein, we investigated the use of Glu-NH-CO-NH-Lys(Ahx)-HBED-CC ((68)Ga-PSMA-HBED-CC) for this purpose. METHODS PC patients (n = 1,889) undergoing (68)Ga-PSMA PET/CT or PET/MR scans were evaluated retrospectively for suggestive lung lesions. For up to 5 lesions per patient, location, CT diameter, CT morphology, and SUVmax were determined. The standard for classification was either histopathologic evaluation or, in the case of PC metastases, responsivity to antihormone therapy. A comparison of the different classes was executed by Student t test. Prostate-specific antigen and prostate-specific membrane antigen (PSMA) immunohistochemistry were performed if histologic samples were available; (68)Ga-PSMA autoradiography was performed on an exemplary case of PET-positive lung cancer. RESULTS Eighty-nine lesions in 45 patients were identified, of which 76 were classified as PC (39 proven, 37 highly probable), 7 as primary lung cancer, and 2 as activated tuberculosis; 4 lesions remained unclear. The mean SUVmax was 4.4 ± 3.9 for PC metastases and 5.6 ± 1.6 for primary lung cancer (P = 0.408). Additionally, substantial differences in SUVmax intraindividually were detected. The 2 tuberculous lesions showed an SUVmax of 7.8 and 2.5. Using immunohistochemistry, we could demonstrate PSMA expression in the neovasculature of several PSMA PET-positive lung cancers as well as in tuberculous lesions from our histologic database. CONCLUSION Quantitative (SUV) analysis of (68)Ga-PSMA PET was not able to discriminate reliably between pulmonary metastases and primary lung cancer in PC patients. The reason for the unexpectedly high tracer uptake in non-PC lesions is not completely clear. PSMA expression in neovasculature provides a possible explanation for this finding; however, other contributing factors, such as tracer binding to proteins other than PSMA, cannot be excluded at present.
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Affiliation(s)
- Thomas Pyka
- Department of Nuclear Medicine, Klinikum Rechts der Isar der TU München, Munich, Germany
| | - Gregor Weirich
- Institute of Pathology, Klinikum Rechts der Isar der TU München, Munich, Germany
| | - Ingo Einspieler
- Department of Nuclear Medicine, Klinikum Rechts der Isar der TU München, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar der TU München, Munich, Germany; and
| | - Jörg Theisen
- Department of Surgery, Klinikum Rechts der Isar der TU München, Munich, Germany
| | | | - Kristina Schwamborn
- Institute of Pathology, Klinikum Rechts der Isar der TU München, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar der TU München, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar der TU München, Munich, Germany
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Renard Penna R, Brenot-Rossi I, Salomon L, Soulié M. Imagerie du cancer de la prostate : IRM et imagerie nucléaire. Prog Urol 2015; 25:933-46. [DOI: 10.1016/j.purol.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 10/25/2022]
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Boellaard R, Rausch I, Beyer T, Delso G, Yaqub M, Quick HH, Sattler B. Quality control for quantitative multicenter whole-body PET/MR studies: A NEMA image quality phantom study with three current PET/MR systems. Med Phys 2015; 42:5961-9. [DOI: 10.1118/1.4930962] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
An early and correct diagnosis together with accurate staging of prostate cancer is necessary in order to plan the most appropriate treatment strategy. Morphological imaging modalities such as transrectal ultrasonography (TRUS), CT, and MRI can have some limitations regarding their accuracy for primary diagnosis and staging of prostate cancer; for instance, they have limited specificity in differentiating cancer from benign prostatic conditions and, by using size as the only criterion to characterize lymph node metastases, they might not be accurate enough for tumour characterization. In this scenario, PET-CT with (11)C-labelled or (18)F-labelled choline derivatives provides morphological and functional characterization and could overcome the limitations of the conventional imaging techniques. PET-CT is one of the most investigated molecular imaging modalities for prostate cancer diagnosis and staging. Currently, the main investigations on the role of PET-CT in the diagnosis and staging of prostate cancer have been performed on a retrospective basis and this type of analysis might be one of the main reasons why different results regarding its diagnostic accuracy have been reported.
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Picchio M, Mapelli P, Panebianco V, Castellucci P, Incerti E, Briganti A, Gandaglia G, Kirienko M, Barchetti F, Nanni C, Montorsi F, Gianolli L, Fanti S. Imaging biomarkers in prostate cancer: role of PET/CT and MRI. Eur J Nucl Med Mol Imaging 2015; 42:644-55. [PMID: 25595344 DOI: 10.1007/s00259-014-2982-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/17/2022]
Abstract
Prostate-specific antigen (PSA) is currently the most widely used biomarker of prostate cancer (PCa). PSA suggests the presence of primary tumour and disease relapse after treatment, but it is not able to provide a clear distinction between locoregional and distant disease. Molecular and functional imaging, that are able to provide a detailed and comprehensive overview of PCa extension, are more reliable tools for primary tumour detection and disease extension assessment both in staging and restaging. In the present review we evaluate the role of PET/CT and MRI in the diagnosis, staging and restaging of PCa, and the use of these imaging modalities in prognosis, treatment planning and response assessment. Innovative imaging strategies including new radiotracers and hybrid scanners such as PET/MRI are also discussed.
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Affiliation(s)
- M Picchio
- Nuclear Medicine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy,
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Kohan AA, Paspulati RM, Sherertz T, Mihaloew H, Herrmann K. Positron emission tomography-magnetic resonance imaging in oncologic diseases of the male and female pelvis. Semin Roentgenol 2014; 49:334-44. [PMID: 25498230 DOI: 10.1053/j.ro.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Andres A Kohan
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH
| | - Tracy Sherertz
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH
| | - Hugh Mihaloew
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH
| | - Karin Herrmann
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH.
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Muzic RF, DiFilippo FP. Positron emission tomography-magnetic resonance imaging: technical review. Semin Roentgenol 2014; 49:242-54. [PMID: 25497909 DOI: 10.1053/j.ro.2014.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Raymond F Muzic
- Department of Radiology, University Hospitals Case Medical Center & Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH.
| | - Frank P DiFilippo
- Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
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Prevrhal S, Heinzer S, Wülker C, Renisch S, Ratib O, Börnert P. Fat-constrained 18F-FDG PET reconstruction in hybrid PET/MR imaging. J Nucl Med 2014; 55:1643-9. [PMID: 25168626 DOI: 10.2967/jnumed.114.139758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
UNLABELLED Fusion of information from PET and MR imaging can increase the diagnostic value of both modalities. This work sought to improve (18)F FDG PET image quality by using MR Dixon fat-constrained images to constrain PET image reconstruction to low-fat regions, with the working hypothesis that fatty tissue metabolism is low in glucose consumption. METHODS A novel constrained PET reconstruction algorithm was implemented via a modification of the system matrix in list-mode time-of-flight ordered-subsets expectation maximization reconstruction, similar to the way time-of-flight weighting is incorporated. To demonstrate its use in PET/MR imaging, we modeled a constraint based on fat/water-separating Dixon MR images that shift activity away from regions of fat tissue during PET image reconstruction. PET and MR imaging scans of a modified National Electrical Manufacturers Association/International Electrotechnical Commission body phantom simulating body fat/water composition and in vivo experiments on 2 oncology patients were performed on a commercial time-of-flight PET/MR imaging system. RESULTS Fat-constrained PET reconstruction visibly and quantitatively increased resolution and contrast between high-uptake and fatty-tissue regions without significantly affecting the images in nonfat regions. CONCLUSION The incorporation of MR tissue information, such as fat, in image reconstruction can improve the quality of PET images. The combination of a variety of potential other MR tissue characteristics with PET represents a further justification for merging MR data with PET data in hybrid systems.
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Affiliation(s)
| | | | - Christian Wülker
- Heidelberg University, Mannheim Medical Faculty, Mannheim, Germany; and
| | | | - Osman Ratib
- Department of Medical Imaging, Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Geneva, Geneva, Switzerland
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Maurer T, Eiber M, Krause BJ. [Molecular multimodal hybrid imaging in prostate and bladder cancer]. Urologe A 2014; 53:469-83. [PMID: 24700188 DOI: 10.1007/s00120-014-3440-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Since the introduction of combined radiologic-nuclear imaging procedures like PET/CT and PET/MRI, new and promising diagnostic tools in bladder and prostate cancer imaging are available to physicians. Although PET-based hybrid imaging in bladder cancer is currently utilized only in selected cases, an increase in PET imaging can be observed in prostate cancer due to the development of cancer-specific PET tracers. Especially novel ligands of prostate-specific membrane antigen (PSMA) exhibit great potential to effectively influence future staging of prostate cancer. However, before recommendations for implication in routine staging can be given, evaluation in the context of prospective multicenter clinical trials are mandatory.
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Affiliation(s)
- T Maurer
- Urologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81671, München, Deutschland,
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Buchegger F, Garibotto V, Zilli T, Allainmat L, Jorcano S, Vees H, Rager O, Steiner C, Zaidi H, Seimbille Y, Ratib O, Miralbell R. First imaging results of an intraindividual comparison of (11)C-acetate and (18)F-fluorocholine PET/CT in patients with prostate cancer at early biochemical first or second relapse after prostatectomy or radiotherapy. Eur J Nucl Med Mol Imaging 2013; 41:68-78. [PMID: 24104592 DOI: 10.1007/s00259-013-2540-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE (18)F-Fluorocholine (FCH) and (11)C-acetate (ACE) PET are widely used for detection of recurrent prostate cancer (PC). We present the first results of a comparative, prospective PET/CT study of both tracers evaluated in the same patients presenting with recurrence and low PSA to compare the diagnostic information provided by the two tracers. METHODS The study group comprised 23 patients studied for a rising PSA level after radical prostatectomy (RP, 7 patients, PSA ≤ 3 ng/ml), curative radiotherapy (RT, 7 patients, PSA ≤ 5 ng/ml) or RP and salvage RT (9 patients, PSA ≤ 5 ng/ml). Both FCH and ACE PET/CT scans were performed in a random sequence a median of 4 days (range 0 to 11 days) apart. FCH PET/CT was started at injection (307 ± 16 MBq) with a 10-min dynamic acquisition of the prostate bed, followed by a whole-body PET scan and late (45 min) imaging of the pelvis. ACE PET/CT was performed as a double whole-body PET scan starting 5 and 22 min after injection (994 ± 72 MBq), and a late view (45 min) of the prostate bed. PET/CT scans were blindly reviewed by two independent pairs of two experienced nuclear medicine physicians, discordant subgroup results being discussed to reach a consensus for positive, negative end equivocal results. RESULTS PET results were concordant in 88 out of 92 local, regional and distant findings (Cohen's kappa 0.929). In particular, results were concordant in all patients concerning local status, bone metastases and distant findings. Lymph-node results were concordant in 19 patients and different in 4 patients. On a per-patient basis results were concordant in 22 of 23 patients (14 positive, 5 negative and 3 equivocal). In only one patient was ACE PET/CT positive for nodal metastases while FCH PET/CT was overall negative; interestingly, the ACE-positive and FCH-negative lymph nodes became positive in a second FCH PET/CT scan performed a few months later. CONCLUSION Overall, ACE and FCH PET/CT showed excellent concordance, on both a per-lesion and a per-patient basis, suggesting that both tracers perform equally for recurrent prostate cancer staging.
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Affiliation(s)
- Franz Buchegger
- Nuclear Medicine Division, University Hospital of Geneva, 1211, Geneva 14, Switzerland,
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Kitajima K, Murphy RC, Nathan MA, Sugimura K. Update on positron emission tomography for imaging of prostate cancer. Int J Urol 2013; 21:12-23. [PMID: 23991644 DOI: 10.1111/iju.12250] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/10/2013] [Indexed: 12/11/2022]
Abstract
Prostate cancer is the most common non-cutaneous malignancy among men in the Western world, and continues to be a major health problem. Imaging has recently become more important in the clinical management of prostate cancer patients, including diagnosis, staging, choice of optimal treatment strategy, treatment follow up and restaging. Positron emission tomography, a functional and molecular imaging technique, has opened a new field in clinical oncological imaging. The most common positron emission tomography radiotracer, 18F-fluorodeoxyglucose, has been limited in imaging of prostate cancer. Recently, however, other positron emission tomography tracers, such as 11C-acetate and 11C- or (18) F-choline, have shown promising results. In the present review article, we overview the potential and current use of positron emission tomography or positron emission tomography/computed tomography imaging employing the four most commonly used positron emission tomography radiotracers, 18F-fluorodeoxyglucose, 11C-acetate and 11C- or 18F-choline, for imaging evaluation of prostate cancer.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University School of Medicine, Kobe, Japan
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