Is There an Additional Value of ¹¹C-Choline PET-CT to T2-weighted MRI Images in the Localization of Intraprostatic Tumor Nodules?

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• 作者：Laura Van den Bergh ; Michel Koole ; Sofie Isebaert ; Steven Joniau ; Christophe M. Deroose ; Raymond Oyen ; Evelyne Lerut ; Tom Budiharto ; Felix Mottaghy ; Guy Bormans ; Hendrik Van Poppel ; Karin Haustermans
• 关键词：Prostate cancer ; 11C-choline PET-CT ; T2-weighted MRI ; Tumor localization ; Intraprostatic boost
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 出版时间：1 August, 2012
• 年：2012
• 卷：83
• 期：5
• 页码：1486-1492
• 全文大小：635 K

文摘

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Purpose

To investigate the additional value of ¹¹C-choline positron emission tomography (PET)-computed tomography (CT) to T2-weighted (T2w) magnetic resonance imaging (MRI) for localization of intraprostatic tumor nodules.

Methods and Materials

Forty-nine prostate cancer patients underwent T2w MRI and ¹¹C-choline PET-CT before radical prostatectomy and extended lymphadenectomy. Tumor regions were outlined on the whole-mount histopathology sections and on the T2w MR images. Tumor localization was recorded in the basal, middle, and apical part of the prostate by means of an octant grid. To analyze ¹¹C-choline PET-CT images, the same grid was used to calculate the standardized uptake values (SUV) per octant, after rigid registration with the T2w MR images for anatomic reference.

Results

In total, 1,176 octants were analyzed. Sensitivity, specificity, and accuracy of T2w MRI were 33.5 % , 94.6 % , and 70.2 % , respectively. For ¹¹C-choline PET-CT, the mean SUV_max of malignant octants was significantly higher than the mean SUV_max of benign octants (3.69 ¡À 1.29 vs. 3.06 ¡À 0.97, p < 0.0001) which was also true for mean SUV_mean values (2.39 ¡À 0.77 vs. 1.94 ¡À 0.61, p < 0.0001). A positive correlation was observed between SUV_mean and absolute tumor volume (Spearman r = 0.3003, p = 0.0362). No correlation was found between SUVs and prostate-specific antigen, T-stage or Gleason score. The highest accuracy (61.1 % ) was obtained with a SUV_max cutoff of 2.70, resulting in a sensitivity of 77.4 % and a specificity of 44.9 % . When both modalities were combined (PET-CT or MRI positive), sensitivity levels increased as a function of SUV_max but at the cost of specificity. When only considering suspect octants on ¹¹C-choline PET-CT (SUV_max ¡Ý 2.70) and T2w MRI, 84.7 % of these segments were in agreement with the gold standard, compared with 80.5 % for T2w MRI alone.

Conclusions

The additional value of ¹¹C-choline PET-CT next to T2w MRI in detecting tumor nodules within the prostate is limited.